As people around the world, desperate for a return to normal, wait to get vaccinated, governments are jockeying to access as many vaccine doses as possible. It’s a familiar and unsurprising story, with rich countries hoarding most of the vaccine for themselves, all the while making it more difficult for less-fortunate countries to access them.
It's a vaccine race that serves no one, experts say, and it could prolong the pandemic for everyone across the globe, while causing countless preventable deaths.
As of Tuesday afternoon, just 10 countries had administered 89 percent of shots given out around the world so far, according to Our World In Data’s vaccine tracker.
“The world is on the brink of a catastrophic moral failure—and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, said in January.
The WHO wants countries to prioritize vaccinations for three main at-risk groups: health care workers, the elderly, and immunocompromised people. Together, they comprise about one-fifth of the world’s population.
If the international vaccine rollout continues down its current path, governments will end up contributing to worldwide inequity, with healthy 20-somethings in rich countries like Canada—where all people who want a vaccine are expected to get one by September—potentially receiving a shot before health care workers and vulnerable people in poorer countries. According to reports, many countries won’t be fully vaccinated until 2023 or 2024.
“People with the highest risk are taking on those risks while they see colleagues around the world getting vaccinated and going back to normal,” said Dr. Zain Chagla, a McMaster University professor and infectious diseases physician. “From a global health standpoint, it’s tragic.”
The very countries vying for their own self-interest are exacerbating inequities at home, too. In the U.S., rich people are getting vaccines that were earmarked for minority groups, while doctors and advocates across North America are trying to figure out how to fight against vaccine hesitancy in racialized communities failed by the health care system in the past.
The bottom line is that skewed global vaccination campaigns—a result of countries and companies putting their own interests first—could make pandemic outcomes worse for everyone.
Take, for example, the variant strains already upon us, including B.1.351, the vaccine-resistant strain that originated in South Africa. The AstraZeneca vaccine doesn’t prevent mild to moderate COVID-19 infections caused by the new variant, and developers of the AstraZeneca vaccine are now tweaking it. The U.K. variant, B.1.1.7, which is more contagious, has spread across the European Union and North America, and now many countries worry it’ll cause COVID-19 cases to spike dramatically. The longer it takes to vaccine the world, the more chances the virus has to mutate into a strain that’s resistant to the vaccines we have available.
Worse still, University of Alberta infectious disease expert Dr. Lynora Saxinger said that a “partially vaccinated world” could be more dangerous than one without vaccines, because the virus will have more opportunities to mutate and become vaccine-resistant. “We might end up creating incubators for variants,” Saxinger said.
Until herd immunity is reached globally, no single country will be safe, said Dr. Katrina Plamondon, a professor with the University of British Columbia Okanagan’s nursing school and global health specialist. Even with travel restrictions, international borders are porous, with people travelling for reasons deemed “essential.” So if a new strain arose, it could, in theory, spread around the world and prolong our return to “normal.”
“We have a global pandemic that is inherently a world health issue and doesn’t care what border lines humans have drawn,” Plamondon said.
According to a study by Northeastern’s MOBS lab that modelled a hypothetical scenario between March and September 2020, if the first 2 billion doses of a vaccine that was at least 80 percent effective against COVID-19 were to be distributed equitably, six out of 10 deaths would be prevented. But if 50 countries monopolized vaccine supplies, only half as many deaths would be avoided.
Quality of health care systems also has to be factored in when the world weighs where to send vaccines. Health care workers in countries with little access to personal protective equipment and infectious disease protocols should be prioritized, Chagla said.
Mysteriously, pandemic deaths have often been worse in rich countries than in poorer ones. According to the New Yorker, Nigeria has recorded a COVID-19 death rate that’s about a hundredth of the death rate in the U.S., for instance. But experts say that’s no reason to avoid vaccination campaigns in sub-Saharan Africa and South Asia, especially since no one knows for sure why COVID-19 outcomes are the way they are.
Underreporting could be one problem: a recent study published in the British Medical Journal found that in Lusaka, Zambia, postmortem tests revealed 20 percent of 364 bodies were infected with COVID-19, and the median age of people who died from the virus was 48; none had been tested for the virus before death.
“There is a bias in reporting when it’s ‘Oh, (lower-income country) COVID cases have been low, not that many deaths, and they’ve gotten away unscathed,’” Chagla said.
This isn’t the first global health crisis marked by an unfair, profit-driven distribution of life-saving medication—the same thing happened during the HIV epidemic. “It would be unforgivable not to heed the clear lessons from the HIV response and for richer nations to race ahead in vaccination while excluding the world's poorest,” an editorial published by the Lancet writes.
“Thousands, maybe even millions of lives were lost (to HIV) because of not opening up access to medications that were essential sooner,” Plamondon said.
‘A lot of capitalism’
There are already campaigns out there pushing for fair vaccine distribution, most notably, COVAX, an international vaccine distribution pool that’s co-led by the WHO and Gavi, a vaccine funder for low-income countries. The goal is to vaccinate 20 percent of people in 190 countries—rich and poor—by the end of the year, with richer countries paying a premium to subsidize vaccine doses for poorer ones. COVAX said it’s on track to hit its targets.
“The fact that the WHO is leading the charge on encouraging vaccine equity...really bodes well because they know the lessons of the past,” Saxinger said. “The equitable global roll out will have to be brokered through these organizations.”
The first 600,000 doses of the AstraZeneca vaccine from COVAX went out on Wednesday to Ghana, with shipments to other countries ramping up in March. Richer countries that don’t need to solely rely on COVAX have been able to strike deals directly with pharmaceutical companies like Pifzer and Moderna. That has made it more difficult for COVAX to buy vaccine doses, subsequently delaying its initial rollout, Al Jazeera reported. Tedros has repeatedly warned that when wealthy countries buy doses in bulk from corporations directly, it can drive vaccine prices up for everyone.
“There is a lot of capitalism and jockeying with money here, and unfortunately, we’re left with very effective vaccines, but we don't have an exit strategy,” said Chagla.
Patents are a hurdle
One of the problems is that pharmaceutical companies can keep their vaccine “recipes”—technology and materials needed to make COVID-19 vaccines—top secret under patents, Plamondon said.
WHO has asked major players to pool their vaccine-related knowledge, intellectual property, and data, so that production can ramp up around the world. Low and middle-income countries are also asking to temporarily waive the enforcement of patents until the pandemic is over, so that COVID-19 vaccine technology can be shared widely. That would allow for scaled up production of affordable COVID-19 treatments for poorer countries, Plamondon said.
“If approved, the decision could signal a major turning point in countries’ response to the pandemic and truly put people’s needs before pharmaceutical companies’ profits,” Doctors Without Borders said in a statement.
Nearly 100 countries support the move—many of them from the Global South—but predictably, rich governments, including the European Union, the United States, Australia, and Canada—the country that has ordered the most vaccines per capita in the world—have tried to block the waiver, saying they are constrained by international patent agreements. A vote is slated for March, but as Jacobin magazine put it, any delays “will almost certainly bring more deaths.”
Youmy Han, a spokesperson for Canada’s Ministry of Trade, said the country does not oppose the waiver and will continue to engage with “all WTO members to better understand their concerns so that concrete, consensus-based solutions can be found.”
U.S. Department of Health and Human Services did not respond to multiple VICE World News requests for comment.
OXFAM has also started the People’s Vaccine Alliance, a coalition of organizations and leaders advocating for COVID-19 knowledge and technology to be shared widely, and for patents to be waived.
AstraZeneca has already partnered with Serum Institute of India (SII), the world's largest vaccine manufacturer, to produce doses for India and other low and middle-income countries. When asked if they have plans to share their vaccine technology, Pfizer reiterated its commitment to equity and said it will provide up to 40 million vaccine doses to COVAX in 2021, and Moderna did not reply. (Most of Moderna’s doses have been sold off to rich countries and it has not signed onto COVAX.) Meanwhile, China is giving away hundreds of thousands of doses made in house to others and the United Arab Emirates has bought doses in bulk to share with its allies, both likely seeking influence in the countries they help.
Patent laws protect profits for companies, which encourages more drug research and development, the logic goes. But Plamondon pointed out that public dollars helped fund COVID-19 vaccine development in the first place. “Organizations are calling pharmaceuticals to open up and share their recipe because their development relied on public dollars and should be a public good,” she said.
Canada, the U.S., and Israel alone committed billions of tax dollars to pharmaceutical companies back in the summer, before vaccines were ready. “I don’t really feel too sorry for pharma companies right now because they have a long-term mechanism to stay involved (with COVID-19),” Plamondon said. “Should they make excess profits at the cost of holding up the entire global health of humanity?”
It’s not too late to implement meaningful solutions: companies can continue scaling up production and partner with local research institutions that could also develop COVID-19 treatments, and countries that have bought doses directly from pharmaceutical corporations could explicitly include COVAX commitments in their contracts, and deliver a portion to COVAX in real time, Chagla said.
“Competitors around the world have manufacturing facilities in lower-income countries and elsewhere where they could very well retool and develop vaccines in-house,” Chagla said.
Domestic pressure vs. ‘global good’
Saxinger said she isn’t surprised that leaders have prioritized their own people. “The initial flurry of setting aside vaccines for your own population was motivated by the fact that you'd be criticized if you did not do that,” she said. “People have been so fearful for so long and they want out of that fear...But we’ve gotten going and attention needs to be paid elsewhere.”
Plamondon said she has noticed people comparing their country’s own vaccine rates to those elsewhere—people living in Canada, where about 0.8 percent of the population has been fully vaccinated, comparing themselves to the U.S., where more than 6 percent of people have been, for example.
“What is not getting as much attention is what that tension is doing to further divide countries,” Plamondon said. “It’s in everybody's best interest if we treat this global pandemic like a global pandemic and pool our collective resources.”
And while the “public good” is a huge argument for making the vaccine race equitable, Saxinger said there is also a “business case” to be made. For economies to recover, many of which are global and interconnected, everyone needs to make it to the other side. Travel also won’t fully return until then, she said.
“Maybe this will speak louder for some people than humanitarian arguments, as sad as that is: A lot of people are not thinking about the implications of their holiday,” Saxinger added. “What country have you gone to—that you want to go to again—that hasn’t had a good vaccination campaign and is a place with higher transmission and higher risk?”
There is hope, though. The world is about halfway through the WHO’s “100-day challenge,” which encourages people and organizations to commit to vaccine equity. In the first 50 days, France, Germany, the U.K., and the U.S. made new commitments to COVAX.
“This can’t be business as usual and there is an urgent need for countries to share doses and technology, scale up manufacturing, and ensure that there is a sustainable supply of vaccines so that everyone, everywhere can receive a vaccine,” Tedros said.
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