Economics/Class Relations

‘Vaccine Apartheid’: What happened with the political will to inoculate the world?

The Signal

What happened with the political will to inoculate the world? James Love on the barriers keeping coronavirus shots out of developing countries.
Swarnavo Chakrabarti
Swarnavo Chakrabarti
At a Covid-19 summit hosted by the U.S. President two weeks ago, donors came up far short of the US$15 billion that the World Health Organization says is needed to contain the pandemic globally. A few countries and contributors pledged about $3 billion, and Joe Biden himself could only promise $200 million from the United States, with the U.S. Congress failing to move on his request for $5 billion. There’s meanwhile a stark discrepancy in vaccinations between rich and poor countries: Fewer than 20 percent of Africa’s population has received a single vaccine dose, while vaccination rates top 80 percent in most high-income countries. The Lancet, an influential peer-reviewed British medical journal, has gone so far as to describe the gap in vaccination rates as “vaccine apartheid,” a phrase now adopted by The New York Times. But unvaccinated populations in some parts of the world mean the risk of dangerous new Covid variants that could threaten the world as a whole. Why isn’t global vaccination more of a priority?
James Love is the director of Knowledge Ecology International, a nonprofit research foundation that supports intellectual-property transfers in biotechnology. Love says attitudes toward Covid-19 have changed in the West among the public and political leaders; they simply don’t see vaccination now with the same urgency that they did a year ago. And there are other obstacles. One is a near-total absence of testing data to show which of the many available vaccines are the most cost-effective—an especially important calculation when funding is scarce. Another is that many pharmaceutical companies don’t want to share their vaccine trade secrets with producers in developing countries. But, Love says, the biggest obstacle preventing people in poorer countries from getting inoculated remains a lack of money. As leaders in developing countries face limited budgets and an array of other serious health-care issues, it’s a challenge for them to weigh Covid vaccination against their competing concerns.
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Michael Bluhm: Why couldn’t the recent summit raise more money for global vaccination?
James Love: The initial pitch was to vaccinate the whole world with two doses. Now it’s to vaccinate the whole world with two doses every year. That plays out differently.
First, the world was convinced that no one’s safe until everyone’s safe. I don’t think people believe that anymore. People don’t think you’re going to make everyone safe. They don’t think you’re going to have zero Covid. They’re not idiots. They understand that a lot of people aren’t taking the vaccines. They know that even people who are vaccinated are getting Covid. This is what voters are thinking, and political leaders have to pay attention to that.
There’s donor fatigue, not only related to Covid-19—and not just in America. The U.K. is cutting back on development spending. It’s harder to get replenishments for the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which is an older, highly regarded project. When countries look at what they’re going to spend their money on, Covid isn’t the only thing. They’re thinking about the reconstruction of Ukraine.
Bluhm: And thinking differently about the pandemic?
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Love: Yes. At first, there was a tendency to think that the point of vaccination was to keep you from getting Covid. And if enough people took the vaccines, you could get rid of Covid because you’d have herd immunity. Over time, the stories we were getting about the effectiveness of vaccines in preventing infection changed. Israel began to report that the Pfizer vaccine wasn’t very effective in stopping people from getting the Delta variant. Omicron was effective at evading all the vaccines.
The question began to shift from, Will a vaccine stop you from getting Omicron? to, Will a vaccine stop you from ending up in a hospital, getting really sick, or dying? People now accept the fact that they might get Covid even if they’re vaccinated and boosted. You might get Covid multiple times.
Bluhm: How is this mindset change affecting the political will to vaccinate people in poorer countries?
Love: The mindset at the beginning of the pandemic was that Covid was this extremely scary thing; then a lot of people began to feel safer, even if they were going to get Covid. That explains some of the vaccine hesitancy: People weren’t as afraid of Covid-19 as they were of smallpox or Ebola.
It was significant that there ended up being more vaccine hesitancy than public authorities had anticipated. It wasn’t just in the United States. You had vaccine hesitancy in Europe, in developing countries, and around the world.
That feeds into the commitment to vaccinating the entire world. If you have a significant number of people globally refusing to take the vaccine, or feeling that Covid isn’t as deadly as they felt it was earlier in the pandemic, then you get a significant number of people beginning to feel, We’re past the worst—let’s move on. And this sentiment ends up significantly determining whether governments pay for the vaccines—and for the health services needed to get them out there and administered.
Xiangkun Zhu
Xiangkun Zhu
More from James Love at The Signal:
It seems very cost-effective to evaluate the Cuban vaccine or the Baylor vaccine, which are safe, protein-based technologies. That protein-based platform has been used extensively to vaccinate children—and has advantages in vaccine-skeptical populations, as well, because it’s an older technology. The efficacy may last longer than the messenger-RNA vaccines; they’re way cheaper; and they’re easier to manufacture and scale in developing countries. And yet there’s no investment in testing them. The U.S. National Institutes of Health could be doing head-to-head trials with multiple vaccines. It’d be easy to take people who’ve been vaccinated and run clinical trials on boosters with them.”
Donors aren’t just going to throw money at the whole planet and vaccinate everyone. It’s just not going to happen. So prices become important, as do cheaper vaccines that are easier to manufacture—and that may have greater appeal to people who are hesitant about taking vaccines. But cheaper vaccines just aren’t getting the same kind of investment in public-sector funding for trials—or the same recommendation and promotion. In America, we spent tens of billions of dollars buying vaccines, but we’re spending almost nothing to figure out what vaccines are the most cost-effective.”
Money is the issue now. You can have vaccines if you can pay for them. They’re not giving them away. If you want the messenger-RNA vaccines, it’s going to cost you. So the price makes a difference. If the price comes down, the vaccine becomes more cost-effective. That’s true both for donors and for developing countries.”

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