Vaccine Inequality Fuels Suspicion and Division
The world can’t repeat the mistakes of polio, tuberculosis, and measles.
Much of the world is pinning its hopes on Pfizer, after the pharmaceutical company announced this week that it could be months, if not weeks, away from having the first safe and effective vaccine for COVID-19.
An implicit assumption behind the warranted excitement is that almost as soon as a vaccine is found, everyone will get access, and the virus will disappear almost as quickly as it spread. If that does happen, it would be a first.
The historical norm is that a vaccine of this sort is quickly given to those privileged to live in the world’s richest nations, while the rest of the world’s population often suffers for several decades before deadly diseases are eradicated—if they ever are.
Take polio, for example. The disease, which leads to symptoms including muscular atrophy and paralysis, was first described in the late 18th century. In the 1950s and ‘60s, vaccines were found, leading to the eradication of the virus in most developed countries within a decade or so. But it took until August of this year for the continent of Africa to be declared free of wild polio. Afghanistan and Pakistan still suffer from the disease. U.N. programs to eradicate the disease there have been stymied by pockets of resistance from groups skeptical of what they deem to be further Western intervention.
Polio is not an aberration. Tuberculosis killed 1.4 million people last year—more than the death toll to date from COVID-19. The bacille Calmette-Guérin vaccine for tuberculosis was developed almost a century ago, but in the time since then, millions and millions of entirely avoidable deaths have occurred. There simply isn’t the funding or political will to avoid those deaths by making the vaccine universal.
It doesn’t stop there. In 2018, measles took some 140,000 lives, mostly of children under the age of five. Although there is a safe measles vaccine, which prevents millions of deaths every year, 1 in 7 children in the world do not receive it before their first birthday, leaving them vulnerable.
In short, millions of people die each year not because there is no way to prevent them from getting sick but because existing vaccines aren’t being manufactured or delivered to all those who need them. Such health inequality mostly holds back those who are already starting from behind, and creates a tragically divided world. The world cannot repeat the same mistakes with COVID-19.
Perhaps the universality of the COVID-19 pandemic, along with the global presence of news cameras in intensive care units, will make this time different. And it really needs to be. This virus is more infectious than comparable diseases, and there is more movement of people around the world now than during every past outbreak. That means that the global human chain of transmission (or lack of transmission) is only as strong as its weakest link. Unless the virus is largely eradicated almost everywhere in the world, there are likely to be repeated surges in infections among unimmunized populations, and even among immunized populations in the case that the vaccine, as Pfizer reported, is only about 90 percent effective.
For their populations’ own health—not to mention the health of their fellow humans around the world—governments of developed countries must work through intergovernmental organizations such as the World Health Organization (WHO) to form a fair global vaccine distribution strategy. There is some hope that this will happen: U.S. President-elect Joe Biden has already announced that the United States will rejoin (and presumably restart funding commitments to) the WHO on his first day in office. Biden has stated that rejoining the organization will “restore our leadership on the world stage,” suggesting that he sees membership as being about more than simply the health of Americans
At the same time, Biden has made clear that he wants a vaccine to be available to all Americans, even the uninsured. But distributors will still need to prioritize, leaving the potential for many communities to remain vulnerable to the virus for many months or even years. To the extent that the next U.S. president is preoccupied with domestic vaccine distribution, there will be less bandwidth for him to support the global strategy.
This is where nongovernmental organizations, which can focus on the humanitarian imperative to preserve life without being distracted by political complexities, should come in. Nonprofit organizations have experience in all the skills required for global vaccine delivery: identifying those most in need, setting up logistics, and delivering what is needed cost-effectively and at scale. The World Bank has announced a $12 billion plan to fund vaccinations for 2 billion people in poor countries. Other early signs of cooperation include British Prime Minister Boris Johnson’s planned meeting with Bill Gates (who has poured over a billion into the search for vaccines) to discuss the potential rollout of the vaccination.
But governments should not simply outsource their vaccine aid policy to philanthropists, however well-meaning they are. It is the responsibility of world leaders, not private citizens, to ensure the world’s most disadvantaged communities receive this vaccine when it is ready. They must avoid exacerbating the health disparities, domestic and global. If health and economic inequalities are further entrenched by vaccination, it could lead to mistrust, further death, and potentially even civil unrest.
While the world is right to celebrate the existence of a vaccine, the true celebration should come when every person has access to it, regardless of their economic status.