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Experts warn that vaccine nationalism could delay the achievement of global herd immunity.
Photo editing by Stephen Kelly; Martin Barraud/Getty Images
  • Vaccine access and vaccination rates are high in high-to-upper-income countries but remain low to nonexistent among lower-income and lower-resource countries.
  • At current global vaccination rates, it will take 4.6 years to achieve worldwide herd immunity against COVID-19. This lengthy time gap will likely allow variants of the virus to develop and spread, potentially rendering current vaccines ineffective.
  • Treating vaccines as public goods rather than market commodities is the way to improve vaccine equity. This may involve scaling up existing vaccination distribution programs, developing new ones, and temporarily waiving vaccine patent protections.

At least 159 countries have begun their COVID-19 vaccine rollout. Some, like the United Kingdom, are well on their way to vaccinating a majority of the at-risk population.

In the U.K., over 6 million people have received both doses of an authorized COVID-19 vaccine, and some estimates project that the country may achieve herd immunity on April 9, with an estimated 73.4% of the population having formed immunity.

However, vaccines remain scarce in many low-resource nations, and vaccination rates low to nonexistent.

And according to a new Perspective piece in the New England Journal of Medicine, global vaccine inequity will make it very difficult to end the current pandemic and prepare for the next one.

“The early competitive procurement of vaccines by the United States and purchases by other high-resource countries have fed a widespread assumption that each country will be solely responsible for its own population,” write the authors of the new Perspective piece.

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“Such vaccine nationalism perpetuates the long history of powerful countries securing vaccines and therapeutics at the expense of less-wealthy countries; it is short-sighted, ineffective, and deadly,” they add.

Doctors from Brigham and Women’s Hospital, Massachusetts General Hospital Center for Global Health, the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town (UCT), South Africa, and Harvard Medical School, MA, authored the article.

The current pandemic is by no means the first time that vaccination and treatment efforts have been one-sided.

During the height of the HIV pandemic, low-resource countries struggled to access life-saving medications due to their high costs. Agencies, such as the United Nations, also decided it was more important to focus on prevention in these nations rather than treatment.

Priorities have shifted a bit this time around. For example, the United States and the other six of the G7 nations (Canada, France, Germany, Italy, Japan, and the United Kingdom) have committed to help vaccinate 20% of the population of involved low-to-middle income countries by the end of 2021 via the COVID-19 Vaccines Global Access (COVAX) program.

However, according to a December 2020 paper, high-income nations representing 14% of the world’s population now possess up to 53% of the global supply of promising vaccines. That equates to 100% of the Moderna vaccine supply and 96% of the doses of the Pfizer-BioNTech vaccine.

And many high-to-middle income countries have worked to secure a supply of vaccines large enough to vaccinate their entire population several times over.

Canada, for example, has bought enough to vaccinate its entire population five times.

The authors of the Perspective article write that global vaccine inequity is both a moral issue and a national security issue.

That is because inequity reinforces disparities between health and economic well-being. In a recent session of the World Health Organization’s (WHO) Executive Board, the director-general Tedros Adhanom Ghebreyesus said that “[t]he 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.”

And at the current global rate of 6.7 million vaccine doses per day, it will take roughly 4.6 years to gain worldwide herd immunity.

“Herd immunity” refers to a point when a disease-causing pathogen — in this case, a virus — can no longer spread easily in a population. This happens when enough people have received the vaccination or have recovered from an infection that gave them adequate natural immunity.

In the case of COVID-19, the writers indicate that herd immunity occurs when 70-85% of the population has had two doses of the vaccine.

Experts estimate that 80% of people in low-resource countries will not have received the vaccination by the end of 2021. By other estimates, at least 90% of the population in 67 low-income countries are unlikely to have had the vaccination by the end of the year.

The longer it takes to gain global herd immunity, the more time it gives the SARS-CoV-2 virus to mutate, potentially creating a new variant that could render current vaccines useless. As things stand, there are already five variants of concern circulating in the U.S.

And if available vaccines become ineffective, it would undo the hard work that many countries have already done to limit the pandemic and cripple future efforts to boost global vaccination rates.

The authors of this Perspective piece lay out a series of tools that could help lessen the vaccine equity gap.

For starters, it is essential to view vaccine procurement as a global affair, not an every-country-for-itself one. That means high- to upper-income countries will need to agree to limit fierce competition and the resulting high prices to gain vaccine doses.

It is also crucial to treat vaccines and other essential medical products or services as a public good rather than a commodity that denies people or countries that cannot pay.

There is also pressure on the World Trade Organization to consider enforcing a Trade-Related Aspects of Intellectual Property Rights (TRIPS) waiver for Covid-19 vaccines to lower manufacturing costs and ease production.

This idea, proposed by South Africa and India and supported by an additional 90 plus countries, would temporarily prevent pharmaceutical companies from using patent protections on their vaccines.

Currently, most pharmaceutical companies use a system of voluntary licensing where they control who produces their vaccine.

The authors write that people who oppose TRIPS argue that patent protections on intellectual property, such as vaccines, may limit future discovery and innovation.

But while they agree that patents do provide essential incentives for vaccine development, they note that private pharmaceutical companies have already received $18 billion in public funding to develop COVID-19 vaccines.

They add that the current state of the pandemic should also warrant a reconsideration on how companies use and profit from vaccine patents.

Even if vaccines became cheaper and easier to manufacture, the authors claim that the world may not have sufficient manufacturing and distribution capacity and infrastructure to end vaccine inequity.

That is why they advise that global cooperation is needed to ensure the world can tackle the current pandemic and future ones equitably.

The authors also write that the U.S stands in a unique position to help drive programs to rebalance vaccine inequity and improve global diplomatic relationships along the way.

They claim to do so the U.S. government could commit to a so-called President’s Emergency Plan for Vaccine Access and Relief (PEPVAR). This program would help provide funding to improve global vaccine production, distribution, and healthcare infrastructure, and involve working with foreign governments and multinational organizations.

If approved, PEPFAR could build on the success of a program designed to help improve access to antiretroviral therapy in populations lacking it. The program, approved in 2003, is known as President’s Emergency Plan for AIDS Relief (PEPFAR).

Improving vaccine equity will take a lot of complex, persistent work from every country in the world. But the authors conclude their Pespective piece by stating:

“Vaccinating the world is not only a moral obligation to protect our neighbors, it also serves our self-interest by protecting our security, health, and economy. These goals will not be accomplished by making the world wait for wealthy countries to be vaccinated first.

“By investing in multilateral partnerships with a sense of shared commitment and employing a global allocation strategy that increases supply and manufacturing, we can meet the urgent challenge of COVID-19 while creating sustainable infrastructures and health systems for the future. Getting the world vaccinated may well be the critical test of our time.”

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