• PublicHealthRising

Vaccine nationalism will prolong the pandemic

Failing to support global protection can accelerate emergence of new strains, disrupt supply chains, and perpetuate the inequities that threaten all -- home and abroad.

Worldwide, over 125 million COVID vaccinations have been administered. For a population of 7.8 billion people, which means less than 2% coverage. Six countries have received about 77% of total vaccinations so far in this pandemic (the US, the UK, China, India, Israel and the UAE). In case you are wondering, we have 195 countries globally. Here is the visual representation of what this data describes:

That’s hard to write. It’s even harder to grasp. It sure does feel like a whole lot of vaccine nationalism going on! But the WHO does have aplan, and they report, along with the World Bank, intensifying their focus, financing, and manufacturing of COVID-19 vaccines for global use in recent months. Multilateral efforts such as the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance, are supporting fair allocation and access across countries. In June 2020, the WHO, CEPI, and Gavi launched COVAX, a global initiative aiming to distribute two billion vaccine doses by the end of 2021. AstraZeneca has partnered with the Serum Institute of India, the world's largest vaccine manufacturer, to start manufacturing supply of the vaccine to the Indian Government and also to a large number of low and middle-income countries. This could change the course of vaccine supply for a large proportion of the world. Even with this news, the WHO forecast and aim is to protect only about 20% of each participating population by the end of the year (though they are hoping for more).

In contrast, the US is working to get to community immunity of at least 70% of its population in 2021. The US has yet to put any significant resources towards COVAX, after belatedly signaling support in January 2021. In Europe, there has been a significant clash between the EU and the UK over vaccine distribution, including accusations that AstraZeneca unfairly favored its home market in the UK. The EU has now managed to negotiate vaccine contracts as a bloc to get fairer and reduced prices but they are definitely lagging behind the UK and the US, which should have been avoidable. The EU had really wanted to show off their vaccine distribution and administration campaign as a beacon of European solidarity and strength. The beginning of the COVID-19 pandemic had found each country looking out for itself (closed borders, fighting for PPE stocks etc). The EU had hoped to counter this image as well as contrast the US message of vaccine nationalism (“America First”) with their vaccine procurement scheme. They were unsuccessful. EU countries are now forging their own paths, with Hungary purchasing Russia's Sputnik V vaccine, Portugal (currently the hardest hit country in the EU) warning it could take up to two months longer than initially planned to complete just the first phase of its vaccinations, and Spain stopping all vaccinations for 10 days in January because of lack of vaccines. In the absence of US and EU leadership in global vaccine access, China and Russia are stepping forward although not necessarily with products that have been vetted and approved.

While the EU faces its struggles, the AU (African Union) has similar challenges – but in the context of global inequity, without the same resources available. Africa CDC has been reporting on the devastating second wave hitting at least 40 countries on the continent, with the B.1.351 variant wreaking havoc. It’s hard to quantify a lot of this because data gathering and reporting is often poor and there is not adequate testing occurring in many countries. We have seen asurge in deaths in many nations, especially South Africa which has a much more robust public health and health care infrastructure than many of its neighbors. There is very little to say about vaccine distribution across the nations of Africa (and thinking about Africa in terms of sovereign nations is important to avoid the problematic and reductive use of “Africa”). These nations are part of the COVAX plan so should be seeing more vaccinations this year and hopefully will at least get to the 20% target. In breaking news as we write this, however, South Africa is parking 1 million doses of AstraZeneca vaccine in warehouses, rather than trying to get these shots into arms – due to emerging information about the ineffectiveness of this particular vaccine against B.1.351. Other vaccines, such as the J&J shot (as well as the vaccines we’re currently using in the US), are expected to provide at least some protection. But with few vaccinations in the near future, we are looking at a significant crisis on the entire continent.

The most critical point we want to make with this post is reflected in this quote from Dr. Tedros Adhanom Ghebreyesus, the Director-General of the WHO: “The urgent and equitable rollout of vaccines is not just a moral imperative, it’s also a health security, strategic and economic imperative.” As we’vewritten previously, when we fail to care for everyone we may fail to care for anyone. Achieving COVID control globally, through vaccination, would have a direct impact on the risk of emerging variants that threaten efficacy of existing vaccines and therapeutics: like any virus, the COVID virus has an opportunity to mutate when it replicates. Curbing infection means curbing opportunity to replicate, and the risk of new mutations. Likewise, disruption of global supply chains and setbacks in addressing global poverty and regional destabilization come along with failure to meet our imperative to act with fairness and equity. This is one of those areas where we can do well by doing good. How will the “re-United” States rise to this occasion?

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