Global Vaccine Inequities Are Dangerous for Everyone

Photo: Mufid Majnun/Unsplash

I’ve personally received more doses of a Covid-19 vaccine than 130 countries. While most of the world is still waiting for its first vaccine shipment, the United States currently administers 1.7 million doses per day, a substantial increase from the first weeks of our vaccine rollout when only health care workers like myself were vaccinated. But despite this improvement in speed, the rollout has been plagued by inequities, with populations most impacted by Covid facing the greatest hurdles. The inequities are even more staggering on the global stage.

The stark imbalance between the rapidly expanding rollouts in wealthy countries and the vaccine deserts in low- and middle-income countries is ethically problematic. It also increases the risk of a longer, more painful pandemic in the U.S., regardless of how fast we can vaccinate our population. Just as the U.S. needs to focus on an equitable and robust vaccine rollout domestically, we must help increase production and support the vaccine rollout worldwide.

To be fair, the U.S. isn’t completely absent in the global effort, even as it’s mostly focused on getting vaccines into the arms of Americans. One of the Biden administration’s first actions was to reaffirm U.S. membership in the World Health Organization, which leads the global vaccine push. The U.S. also committed to joining the Covid-19 Vaccines Global Access (COVAX) Facility, a global procurement and distribution platform for Covid vaccines. But for humanitarian, public health, and financial reasons, we need to do much more to ensure vaccines are equitably distributed and accessible around the world.

With its financial prowess and ample contracts, the U.S. has gobbled up much of the initial vaccine supply, reducing availability and driving up the price worldwide. A recent White House announcement projects that we will have enough vaccines for 300 million Americans by the end of July. That’s great news if you live in the U.S. The reality for much of the world isn’t so great. In places like sub-Saharan Africa — where essential items like masks and other personal protective equipment are already in short supply because of price gouging and export restrictions in wealthier countries — widespread vaccination won’t happen until 2023.

The greatest threat to vaccination success

After years of abdicating our traditional leadership role in global health under the Trump administration, we have a moral and humanitarian obligation to assist other nations at this critical point in the pandemic. Getting the rest of the world vaccinated is also the wisest strategy from a public health perspective.

The greatest threat to long-term vaccination success in the U.S. isn’t the slow rollout or vaccine hesitancy. It’s the emergence of virus variants that can undermine the efficacy of our existing vaccines. Expanding vaccine access to the most vulnerable around the world would help slow the emergence of such variants and ultimately make us all safer.

It’s a central tenet of basic virology: viruses mutate when they replicate. Since the beginning of the pandemic, over 109 million people have been infected with Covid-19 as of February 17. Unsurprisingly, with so many opportunities to replicate and mutate, multiple coronavirus variants have recently emerged. One known as the B.1.351 variant was first identified in South Africa and is now present in 24 countries and 10 states in the U.S. In the past few weeks, studies have revealed how this variant led to significant reductions in the effectiveness of numerous vaccines. There is also growing concern it may be more capable of reinfecting those who have already had Covid.

Recently South Africa suspended its planned rollout of the Oxford/Astra-Zeneca vaccine because a small study showed it offered little protection against the variant circulating widely there, despite showing promise elsewhere. The B.1.351 variant has also reduced the effectiveness of vaccines by Johnson and Johnson/Jansaan and Novavax (although both still prevented severe disease and death).

The concern is that as the virus continues its uncontrolled global spread, variants could emerge that undermine the protective effect of our vaccines. This would make us all more vulnerable, regardless of whether we were lucky enough to be vaccinated.

An equitable distribution globally is important for the U.S. economy

There’s also an economic imperative for expanding vaccine access worldwide. That’s according to multiple studies looking at the economic devastation that would follow an unequal vaccine rollout.

The pandemic has already had a profound impact on the global economy, and the U.S. has been no exception. We’ve committed $3.4 trillion to relief domestically, with another $1.9 trillion working its way through Congress. Some believe that as soon as we have enough Americans vaccinated, we will finally get the economy back on track.

As a wealthy nation devastated by this pandemic, it’s not surprising that the U.S. is pushing to get priority access to vaccines and ensuring its population is vaccinated first. But this approach — commonly referred to as “vaccine nationalism” — may backfire and enact an even greater toll in the long run.

Research by the International Chamber of Commerce estimates that vaccine nationalism could cost the global economy $9.2 trillion in 2021 alone, with half of that concentrated in advanced economies even if they achieve universal vaccination in their own countries. For the U.S., the cost could total up to $1.4 trillion.

As the Secretary-General of the International Chamber of Commerce John Denton said: “Purchasing vaccines for the developing world isn’t an act of generosity by the world’s richest nations. It’s an essential investment for governments to make if they want to revive their domestic economies.”

The takeaway is that for all countries — and especially those depending heavily on trade — equitable distribution of vaccines globally would be the most beneficial for everyone, from both the public health and economic perspectives.

This is exactly why advanced economies must immediately fill the $27.2 billion funding gap for the ACT Accelerator, the WHO framework comprising the COVAX Facility and the global vaccine rollout. Not only would that speed the supply of vaccines across the world, but it would also generate returns up to 166x the investment.

But this alone isn’t enough. COVAX only plans to vaccinate 20% of the population in participating countries this year, even if fully funded. We need to do more.

A final thought

No one is naive enough to expect wealthy countries will share vaccine doses before their own populations are vaccinated. But there are many things they can do to get the world vaccinated sooner, and the U.S. must be as proactive and committed to getting the rest of the world vaccinated as it has been for Americans.

The U.S. and other wealthy nations must commit to sharing surplus doses as soon as they become available so the most vulnerable groups around the world can be vaccinated as soon as possible. The U.S. must also commit to increasing production capacity, even after the majority of Americans have access to a vaccine, with the stated goal of distributing globally. Further, having financed much of the vaccine development with taxpayer funds, the U.S. must insist that pharmaceutical companies remove patents and share the “recipe” for the vaccines. This technological know-how must be accompanied by sufficient political and financial support to immediately scale-up vaccine production around the world.

This moment represents an opportunity for the new administration to reassert the role of the U.S. in humanitarian assistance and global health solidarity while reaping the public health protections and financial benefits of getting the world vaccinated.

In the past year of this pandemic, Covid-19 has illuminated the undeniable fact that we are all more interconnected than we like to believe. Boundaries on a map mean nothing to the coronavirus or the other pathogens that will undoubtedly emerge in the coming years. While we race against time and try to get as many people vaccinated globally as possible before this virus mutates beyond our capacity to control it, we need to take this lesson with the utmost gravity. If we don’t it will come back to teach us again, and louder than before.

NYC ER doctor | Ebola Survivor | Director of Global Health in Emergency Medicine at Columbia University | Public Health Professor | Doctors Without Borders BoD

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store