Three interminably long months in, the U.S. coronavirus vaccine rollout is blessedly and finally going well. But the global one is very much not: For every 100 people on the planet, only five have received a shot. Models predict there won’t be enough doses for the world’s population until 2023 or 2024, and what doses there are have been snatched up by the world’s richest countries, creating what a senior United Nations official has called a “global vaccine apartheid.”
Here’s what the situation looks like from Kenya:
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How can the global vaccine distribution be made more equitable? Here’s what public health experts, journalists, politicians and activists are saying.
The many hazards of vaccine nationalism
The New York Times
According to the Kaiser Family Foundation, enough vaccine has already been purchased to immunize 80 percent of the world’s adult population. But high-income countries, which account for just 20 percent of the world’s adult population, have bought more than half of all doses. As a result, only about one in four people in lower-income countries can expect a shot this year.
The moral argument against this hoarding of lifesaving medicine — what the sociologist Zeynep Tufekci approvingly calls “the hippie dippy wishful thinking” argument — is self-evident. But there is a growing chorus of experts who argue that vaccine nationalism is not only morally unconscionable but also self-defeating.
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The epidemiological argument against vaccine hoarding is that the virus can’t be defeated anywhere until it’s defeated everywhere.
“As long as there are large swaths of people who are unprotected, then we’re going to see variants continue to pop up,” Ruth Faden, a bioethics professor at Johns Hopkins University, tells The Atlantic. “And it’s likely that some of those variants will evolve to escape the power of vaccines.”
Not everyone agrees with this argument’s premise, though: Tufekci finds it quite easy to imagine a world in which high-income countries also hoard variant booster shots, enabling the wealthy to live and travel freely while the rest of the world suffers.
The economic argument against vaccine hoarding is that even the richest nations will not be able to recover if developing countries continue to be shut out. In the worst-case scenario, the inequity might cost the global economy up to $9 trillion, nearly half of which would be borne by wealthy nations like the United States and Canada.
The geopolitical argument against vaccine hoarding is that it’s harmful to the West’s global standing, such as it is. China and Russia have made deals to send at least 1.6 billion doses to more than 50 countries, while the European Union has exported only 40 million since January. The United States just announced its first export of four million doses (to Mexico and Canada), and Britain has apparently yet to export any.
“This petty vaccine nationalism is irreparably damaging the West, betraying their claims to magnanimity, inclusive global leadership and concern for global health,” Fatima Bhutto writes in The Guardian. As The Times editorial board writes, “Poor countries will remember who came to their assistance, and when.”
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The push for a ‘people’s vaccine’
The New York Times
When the polio vaccine was announced safe and effective in the spring of 1955, its inventor, Jonas Salk, was asked on television who owned the patent. “The people, I would say,” he responded. “There is no patent. Could you patent the sun?”
Today, a movement involving 57 countries, hundreds of scientists, the director of the W.H.O. and congressional lawmakers has sprung up to demand coronavirus vaccine makers follow in Salk’s footsteps by temporarily waiving their patent rights so other nations can manufacture their own supply. The Biden administration and the European Union, however, have blocked the waiver requests, which they say could stifle innovation.
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We’ve been here before: As many proponents of the patent waivers are quick to point out, such exceptions were made in the early 2000s, after years of activism, for antiretroviral drugs that transformed H.I.V. from a death sentence into a manageable condition. Taxpayers funded the development of many of those drugs, just as they did the Moderna vaccine’s (with some help from Dolly Parton).
“If more Americans actually knew the substance of the requests being made by other nations, they’d have no reason to worry about losing any of ‘our’ vaccine doses,” Alex Pareene writes in The New Republic. “Instead, they would understand that the only thing at risk — and only temporarily at that — are some potential future profits of Johnson & Johnson, Pfizer, and the like.”
Another view: Vaccines are much more complex products than ordinary drugs, so giving other countries only the legal ability to replicate them without the “proprietary recipe” would be an insufficient remedy, argues Rachel Silverman, a policy fellow at the Center for Global Development. It could even backfire by serving as an excuse for vaccine makers to pull out of their current global commitments. A better option, Silverman says, would be pressuring vaccine makers into licensing agreements that would give other countries both the rights and the knowledge for generic production in exchange for modest royalties.
“Already, voluntary licensing deals from AstraZeneca and Novavax are facilitating large-scale production in India, Japan and South Korea,” she writes in The Washington Post. “The best route to vaccine equity involves creating the conditions for pharmaceutical developers to identify and execute more of these voluntary deals, engaging industry as a partner in the process.”
Three more ideas for fast-tracking global immunity
Take on price gouging: The price of vaccines varies widely across the globe, and many poor nations are paying more than rich ones. The price of an AstraZeneca dose, for example, the most affordable vaccine, is $3.50 for Europeans, $5.25 for South Africans and $8.50 for Ugandans.
“During natural disasters, price gouging for essential supplies is illegal,” writes Paul Kagame, the president of Rwanda, in The Guardian. “It should not be tolerated for vaccines during a pandemic either. If prices are fair, and Africa is allowed to place orders, many countries on the continent would be willing and able to pay for themselves.”
Increase Covax funding: So far, wealthy countries have committed $7.5 billion, including $4 billion from the United States, to the global initiative known as Covax to drive down the cost of vaccines for middle- and low-income countries. But the W.H.O. has said the program is still $23 billion short of what it needs.
“Wealthy countries could simply contribute more funding to Covax, which would give the initiative the buying power it needs to reserve a fair share of doses for the countries relying on it,” Yasmeen Serhan writes in The Atlantic.
Redistribute the doses: No matter how much funding Covax receives, lower- and middle-income countries will not be able to acquire enough doses if rich countries continue to hoard them. Rich countries “want to have it both ways,” Lawrence Gostin, a professor of global health law at Georgetown, told Vox. “They join Covax so they could proclaim to be good global citizens, and at the same time rob Covax of its lifeblood, which is vaccine doses.”
While no country yet has more doses than it needs, it will be only a matter of months before that changes. The United States, for instance, is expected to have enough vaccines for every adult by the end of May and has been sitting on 30 million AstraZeneca doses that are not authorized for domestic use. Four million of those will now be exported, but the White House could put more up for sale, as China and Russia have done, or donate them, as Norway has committed to doing.
“Mr. Biden’s legacy will surely include not just how he oversees the outstanding campaign to vaccinate Americans but also how his administration steps up to help vaccinate the rest of the planet against this scourge,” Tufekci writes in The Times. “Along with doing whatever we can to increase vaccine supply globally, we should let our excess doses go where they’re desperately needed, without waiting another day.”
The New York Times