Terri Wilder: Dr. Katz, where are we in terms of global COVID-19 vaccination rates?
Ingrid Katz: As of June 15, there has been an additional promise of 1 billion COVID-19 vaccines from the Group of Seven nations. While this is a step in the right direction, the concern remains that this number is not enough to end the pandemic.
We’ve seen rates going through the roof in India, Brazil, and other parts of South America. We’ve seen waves of this virus surge in multiple regions in the world, where we haven’t gotten vaccines to them fast enough. And so, we have these short-term concerns that vaccines really cannot address immediately, [such as] incredibly fragile health care systems, the need for public health infrastructure, and vaccine manufacturing distribution, [which combine] to create a perfect storm in many regions in the world.
And recently, the head of the World Health Organization (WHO) has singled out Africa as an area for deep concern. Though, one update is that [in June], we saw results of the Novavax trial, which were very promising. So that may add another vaccine to our global armamentarium for potentially effective vaccines.
Wilder: In the article that came out in April, you all stated that the global vaccination rates were roughly 6.7 million doses per day, and that in order to achieve herd immunity―where 70% to 85% of the population will have received this two-dose vaccine―it has been estimated that it will take approximately 4.6 years.
Katz: That still remains the concern; getting 70% of the world inoculated to achieve herd immunity globally. The rates are improving from when we last wrote that article. So that’s promising. But in Africa, I believe that the inoculation coverage was at about 2% for the entire continent. [According to the New York Times COVID-19 vaccination tracker, It is currently 4.2%.]
Obviously, there are countries within the continent that vary, and Dr. Bekker can speak more specifically to that, but you have regions in the world that still are sorely under-vaccinated and have a long way to go.
Wilder: Dr. Bekker, can you talk about what is happening in Africa?
Linda-Gail Bekker: I think Ingrid has set the scene very well. The continent of Africa has a heavy reliance on the COVID-19 Vaccine Global Access program (COVAX), which sets its targets dismally low. It may be realistic, but it’s low. So, they’re aiming for probably not more than 20% of country populations receiving vaccinations, which is way below what people are considering for herd immunity. And we know we are woefully behind what they were hoping to be able to get onto the continent.
That’s because we have manufacturing inadequacy around the world, and because of variants, which have called a number of vaccines into question. In South Africa, where I live, we were concerned that the two-part AstraZeneca vaccine might not have the efficacy we require against the Beta variant, which is in circulation here.
In addition, most recently, we know that a large number of doses [60 million] of the Johnson & Johnson Ad26 vaccine have had to be discarded because of a contamination problem. And then on top of all of this, you know that India has gone into an enormous surge, despite being one of the manufacturers of vaccines, and now, perhaps quite understandably, redirecting doses that would have gone into different countries.
There’s no other way to describe it but bad news. We see that the continent of Africa is even less vaccinated than perhaps it would have been. So, when we look at a world map and we look at per capita vaccination rates, then really Africa, in many ways, still has to get started.
Wilder: You use the phrase vaccine nationalism in your article; can you talk about what that is and why it is problematic?
Bekker: Yes. Months before we even knew there was efficacy, countries had bought up doses of vaccines, in some cases three to four times more than what they really required, with no thought of countries that either did not have the purse to be able to pre-order, or the fact that the COVAX concept was still trying to find its feet and get on board.
There really was a very strong approach of charity begins at home, and maybe it does, but, overwhelmingly, countries [have taken] care of their own needs without considering global needs. We see countries vaccinating younger and younger people, and you can’t fault that, except there are swaths of the world where the most vulnerable individuals have not yet been vaccinated. So, again, you have that disconnect that speaks to countries looking inwards and caring only about their own public health needs, and continuing as if this is national rather than global.
Katz: I’ll add that vaccine nationalism perpetuates this long history of colonialism, now neocolonialism, where powerful, wealthy countries are securing their own borders with vaccines and therapeutics, at the expense of other countries―even countries like South Africa and India that have the manufacturing capabilities to make these vaccines.
If you look at the most recent data, it still shows that about 85% of the available vaccines have gone into arms that are in upper-middle-income countries, and only .3% of the doses have been administered in the countries with the lowest resources.
You can see from the data that this is still consistently happening. We need to really address this, not just in this moment, but for all future pandemics going forward, since I fear this will not be the only one we see in 100 years.
Wilder: What do you think are some of the key areas that need to be addressed to make sure that every person around the globe has access to the COVID-19 vaccine?
Katz: Global inequalities fundamentally reflect a flawed view of global public health. Vaccines, essential medicines, and our global well-being are not market commodities. These are what we might call public goods—and what’s good for humanity is good globally. If this moment in time has not taught us that, I’m not sure what will.
This started as a virus in China, and it has spread all over the world. If we don’t do a major course correction, we are going to be in the exact same scenario again when a new virus pops up. [The problem] comes from a flawed view of global and public health that we need to address at the root [by] investing in infrastructure.
Bekker: I would add that, as you say, these kinds of decisions do better if we handle them as inter-pandemic rather than intra-pandemic. It’s often in the heat of trying to deal with a crisis that bad decisions are made, or no decision is made. And then people default to the sort of nationalistic thinking.
[One solution could] be a different dispensation of pandemic vaccines so that there is a fairer way of divvying up scarce resources around the world. The second is increasing manufacturing capability around the world. This might mean that companies and manufacturers who have patents and intellectual property rights need to think about how they can share those ahead of usual timeframes. And this is not unprecedented. We shaped this up during the HIV pandemic.
We do have a thing called the patent pool. We have ways that people can share lifesaving products at an earlier time, in a fairer way, in a more equitable way, so that these kinds of lifesaving commodities can be made available.
There has been a lot of talk in the media around this; we raised it in our article, around TRIPS waivers, issues of patents, and creating opportunities for more people, organizations, and countries to contribute towards manufacturing capabilities for the world.
What worked amazingly well during the global AIDS pandemic was organizations coming together, such as the Global Fund, or PEPFAR, the President’s Emergency [Plan] for AIDS Relief; that was unprecedented and extraordinary, and it saved hundreds of thousands of lives and made a huge difference to the AIDS pandemic, in terms of bringing lifesaving treatment to regions that needed it most.
As we, Wafaa El-Sadr, and others have raised previously, perhaps under the current emergency there are ways of working that could make a big difference. And I’m delighted to see what happened at the G-7 forum [during which Canada, France, Germany, Italy, Japan, the UK, and the U.S. agreed to donate 1 billion COVID-19 vaccine doses over the next year and to work with the G20 and other countries to increase that contribution in the coming months].
Many would argue that it’s insufficient. But at least it’s a start to say what else could the rich countries of the world be doing in order to help less fortunate countries. It’s not just helping those less fortunate countries; it’s something that is good for the globe.
It also needs to be said that where the virus is allowed to replicate unchecked, we will continue to see variants of concern and surge upon surge of the epidemic, and we will not bring this current pandemic under control.
So, it is in everybody’s best interest to think about stopping transmission. And the best-known way we have for stopping transmission is not lockdowns and non-pharmaceutical interventions; vaccines are the best way to bring control for this pandemic.
Wilder: When I lived in Atlanta, Georgia, 20 years ago, I had a conversation about what was happening globally with HIV, where there was inequity with access to antiretroviral medication. And I remember someone said to me, “I have to take care of the people in my backyard. I can’t think about what’s happening in other countries.”
So, how do you make people care about human beings in other parts of the world?
Katz: Dr. Bekker said it perfectly; it is in our own self-interest to eradicate a highly contagious virus from all parts of the world because if we don’t achieve herd immunity in India, South Africa, or any number of regions, the pandemic will persist, and more transmissible and potentially more lethal variants will emerge.
We should be moving beyond a scarcity mentality of just vaccinating the people in our own backyard. Obviously, that [mindset] comes from a time during the prior administration where the United States had the highest rates of COVID in the world. And so, understandably, people feel scared.
In many ways, you could think back to the HIV pandemic in the ’80s when there was this feeling of scarcity before we really had successful antiretroviral therapy available. I think there was this sense that everyone’s going to have to take care of themselves. But in the mid-’90s, when we really started to see protease inhibitors come on the market in the United States, there was still a residual sense of scarcity that people felt and that I see playing out here in the United States again.
We need to recognize that we are not in this alone; that we are interconnected. This is a very transmissible virus that has traveled easily around the world in a very short time. People are still getting on planes and traveling, so it’s not going to be contained if we only try to contain it in our own backyard.
Something that we learned from the HIV pandemic is that community partnerships are critical. PEPFAR and Global Fund were and continue to be game changers, and the top-down approach is not going to get the job done, particularly when you’re dealing with pandemics where there are so many ripple effects—whether it’s stigma or discrimination or even thinking about how people feel about getting vaccinated. And given the amount of misinformation circulating globally, I cannot emphasize enough the key importance of community partnership in addressing structural barriers as well as vaccine hesitancy.
Wilder: Is COVAX [doing] enough?
Bekker: Well, their whole thing is, “We are going to provide equitable access to the countries that have bought into COVAX,” figuratively speaking, and, in some cases, in a monetary way. And that’s why they’re saying at least 20% or 10% of the population will get a vaccine. So that has been an equitable approach to the problems.
Katz: I definitely agree with Dr. Bekker, that using a lens of equity is critical. But, because COVAX’s goals are modest, they have not been able to reach the goals that they have set forth, and it’s not going to be enough if we really want to achieve global herd immunity.
Wilder: So we have PEPFAR. Some folks are calling for a “PEPVAR,” with COVID-19 vaccine [in place of HIV]. How long would it take for something like that to happen for vaccines? And what could be problems that we may face to get something like that to bolster or even do better than COVAX?
Bekker: I think the world needs to get behind institutions like COVAX, but it isn’t something we can be planning for in three to four years’ time, after someone’s written a nice proposal, and everybody’s agreed. This is highly urgent. And we need activism, advocacy, and lots of enthusiastic noise to make it clear that this is an urgent problem.
Katz: I completely agree. Putting all the skillets in the fire is worth doing, and investing in a program like a PEPVAR initiative shouldn’t undermine what’s also happening with COVAX and other efforts that are being made, such as TRIPS waivers and ramping up manufacturing in other countries. I don’t think you have to abandon any of these measures, because, fundamentally, we need everybody on deck to help support this.
Wilder: Who needs to lead these efforts, and how can people get involved if they are concerned about this?
Katz: Countries that still wield a lot of power, like the United States and other nations in the G-7, have to come together to support big efforts like this; and that includes big financial commitments.
So in the United States, every citizen [should] remain active and speak with their congresspeople to let them know. Raise your voice. One of the most important activist movements of our time was ACT UP in the ’80s. That was a very grassroots movement, but they moved the needle in the United States [as well as] globally. They fought tooth and nail for social justice and for equity. It’s an important reminder that we can all be activists wherever we are.
Bekker: Couldn’t have said it better. And I would argue that it doesn’t let low- and middle-income countries off the hook. I think every single country around the globe has to say, “What is our responsibility in this pandemic? What are we doing as our part? What are we doing to contribute wherever we can?” And to use the resources we do have at our disposal wisely.
Certainly, it doesn’t absolve poor countries from doing their part. But patently, these vaccines are not being manufactured in our countries, and they are not all affordable by every country. So, it is going to have to be a global joint effort. And every single human being can get in on the social justice journey to say, “How do we make the world a better place?” and actually use this opportunity to say, “How do we bring a little more equity into the world at large?”