We are in a race against time. The development of safe and effective COVID-19 vaccines in record time is a remarkable testament to modern scientific capabilities. Whether it will bring an end to this terrible pandemic is a test of the world’s political will and moral commitment.
Despite the growing number of vaccine options, current manufacturing capacity meets only a fraction of global need. Vaccines are the best chance of bringing this pandemic under control—unless leaders succumb to vaccine nationalism.
International collaboration among scientists was critical to vaccine development, but now weak cooperation between nations is a major barrier to achieving worldwide vaccination at the scale needed to end the pandemic. Vaccine equity isn’t just a slogan; it protects people everywhere, protects the existing shots from new vaccine-resistant variants, and strengthens the international community’s ability to stop COVID-19.
At present, rich countries with just 16 percent of the world’s population have bought up 60 percent of the world’s vaccine supply. Many of these countries aim to vaccinate 70 percent of their adult population by midyear in pursuit of herd immunity. But COVAX—the multilateral mechanism created by the World Health Organization together with the Coalition for Epidemic Preparedness Innovations and Gavi, the vaccine alliance, to ensure that vaccines reach all people everywhere—is struggling to purchase enough doses to cover just 20 percent of the population of lower-income countries by the end of 2021.
Vaccine allocation must not become a zero-sum game. Vaccine nationalism is not just morally indefensible. It is epidemiologically self-defeating and clinically counterproductive. Market-driven mechanisms alone are insufficient to achieve the goal of stopping the pandemic by achieving herd immunity with vaccines. Limited supplies and overwhelming demand create winners and losers. Neither is morally or medically acceptable during a pandemic.
Allowing the majority of the world’s population to go unvaccinated will not only perpetuate needless illness and deaths and the pain of ongoing lockdowns, but also spawn new virus mutations as COVID-19 continues to spread among unprotected populations. Unchecked spread can result in the emergence of more contagious variants, leading to a steep rise in cases. It is a vicious cycle. Faster spread means more people are being infected and more people are dying as health care systems become overwhelmed.
A hermetic seal between the world’s haves and have nots is neither desirable nor possible. This coronavirus spreads quickly and often silently, before symptoms develop, or with mild ones common to multiple diseases. These clinical characteristics combined with uncontrolled spread and the global flow of people means that there is a risk that new variants will continue to emerge and spread between countries.
Most troublingly, new mutations could lead to vaccine resistance. There is already evidence that some vaccines are less effective against the variants first identified in Brazil and South Africa. Vaccines were based on version 1.0 of the virus—but new viruses, like software, are constantly evolving. The new variants may infect people who have already survived an earlier version of the virus. It is also possible that the virus could become more deadly. A small increase in lethality would have a catastrophic effect.
Growing vaccine nationalism is also socially and economically counterproductive. Unprotected populations and communities everywhere will continue to suffer the enormous secondary effects of the pandemic. Continued lockdowns mean economic devastation, with more people plunged into poverty and more lives cut short. A study by the International Chamber of Commerce shows that fully vaccinating the population of rich countries while neglecting poor ones could cost rich countries as much as $4.5 trillion in lost economic activity.
Children are suffering the worst collateral damage. Lost schooling means more child brides and child laborers, greater hunger, and increased gender inequality. The effect of lost education is permanent, leading to shorter, less fulfilling lives.
At the moment, there are not enough vaccine doses in any country, but the shortfall in poor countries is particularly dire. As long as world leaders are calculating whose lives and livelihoods to prioritize, as long as everyone is scrambling to secure enough doses, we are all losing the fight. The main vaccine producers are working to increase production, but they are nowhere near meeting demand.
Governments and companies must come together to overcome this artificial scarcity. There are many steps that can be taken to ramp up vaccine production and broaden distribution. These include openly sharing vaccine manufacturing technology, intellectual property, and know-how through the COVID-19 Technology Access Pool, temporarily waiving intellectual property barriers, and expanding voluntary contracting between manufacturers.
Open-sourcing will enable immediate use of untapped production capacity, through such initiatives as the Developing Countries Vaccine Manufacturers Network, and help build additional manufacturing bases—especially in Africa, Asia, and Latin America—which will be essential to meeting ongoing demand for COVID-19 booster shots and future vaccines. Expanding production globally would make poor countries less dependent on donations from rich ones. This is essential to achieve true health equality and global health security.
The international community cannot allow a handful of actors to dictate the terms or the timeframe for ending the pandemic. The coronavirus is not only indifferent to profits and politics; it is still evolving. The longer we allow billions of people to go unvaccinated, the greater the possibility that new variants will develop vaccine resistance. Vaccine nationalism combined with a restrictive approach to vaccine production is in fact more likely to prolong the pandemic—which would be tantamount to medical malpractice on a global scale.
Despite massive investment, the therapeutic options are limited, and there is no reliable cure. Since vaccines are critical to preventing death, it is vital to maintain their effectiveness. So far, vaccination efforts have rightfully prioritized those at greatest risk of dying: the elderly.
Governments are also urgently moving to protect health care workers, the first line of defense, who risk their lives to save others on a daily basis. The WHO estimates at least 30,000 health care workers have already died from COVID-19—and it could be more than twice that figure—exacerbating a preexisting global shortage of medical professionals.
Beyond each personal tragedy, the multiplier effect of their loss from the work force permanently diminishes the world’s clinical and surveillance capacity, increases COVID-19’s death toll, and lessens the chances of detecting the next pandemic threat before it’s too late. Countries with supplies over and above what they need to vaccinate their health workers, elderly, and people with underlying conditions could urgently donate excess doses through COVAX to help meet this crucial need.
But these urgent needs are just the beginning. To control the pandemic, the only permanent solution is to vaccinate as many people all over the world as fast as possible. That means radically stepping up production. Every week of delay increases the suffering and the social and economic carnage.
If pandemics are microbial wars, then vaccines are our preferred weapons of mass salvation. But they are not a panacea. Stopping this pandemic also requires effective measures such as improved indoor ventilation in workplaces and schools as well as tools that engage everyone in active combat against the virus, such as rapid home tests, masks, and physical distancing.
More broadly, anyone who needs a vaccination—which is everyone—needs access to a health care worker who can provide it. Those most likely to die from COVID-19 are those without access to health care. Moreover, it is hard to incentivize people to get vaccinated in places where governments have not addressed the quotidian killers alleviated by basic health care. The world won’t achieve vaccine equity unless governments deliver on long-standing promises to secure universal health coverage.
COVID-19 is the world’s wake-up call. Relegating the billions of people in poor countries to the back of the vaccine queue, forcing them to wait until the entire populations of rich countries are vaccinated, is morally wrong. Each of us is a human being who deserves the best available health care—the greatest potential for a fulfilling and productive life—regardless of the strength of our native country’s economy.
In a deadly pandemic, the right to health is the right to life. Every human has the right to be protected. But we need everyone protected as fast as possible—or else we all lose.
The pandemic will not be over anywhere until it is over everywhere. This is the reality of an interconnected world, and that reality can be met only by a reaffirmation of solidarity and an inclusive public-health order that distributes vaccines globally, quickly, and equitably.
To the virus, we are all one herd. To beat it, we must act as one community.
