In the industrialized nations, the vaccination programs against Covid-19 are making progress. But that will be of little use if you don’t think about poorer countries quickly enough.
Isabel Rodriguez-Barraquer currently works from Colombia. From a distance, the epidemiologist observes how her colleagues at the University of California in San Francisco as laboratory workers are gradually receiving vaccines against the coronavirus.
It looks very different at their current location. There is a massive Covid-19 outbreak in Colombia, and the country is still waiting for the first vaccination doses: 50,000 Pfizer and AstraZeneca are expected to arrive in February and a few 100,000 more in March. With direct agreements with manufacturers like Sinovac from China and through international partnerships, Colombia is working to get more. But Rodriguez-Barraquer fears it may be too late.
Coronavirus vaccination programs in rich countries are now in full swing. Almost a quarter of the UK population has now received their first dose. In the United States, things are not progressing as fast, but here too there were more than 35 million people with at least the first vaccination in mid-February .
No global coordination
In poorer countries around the world, however, it could look different for a while. Many of the poorest people in the world are still waiting. The Economist Intelligence Unit estimates that around 85 developing countries could not be vaccinated before 2023 . In January , the World Health Organization (WHO) warned that the West African country of Guinea was the only low-income country on the continent where vaccinations had already started – with 25 people ( all high government officials according to the AP ) out of a total population of almost 13 million.
“One of the big problems is that there is still no global coordination,” says Chris Dickey of New York University’s Global Health School. Rodriguez-Barraquer agrees: “The stresses of disease and death could be with more global coordination the vaccine supply will be prevented, “she says.
The imbalance will not only lead to more deaths. It will also create a wave of economic, social and health effects – not just in the countries directly affected, but around the world.
Inequality in vaccination
The main reason why poor countries are poorly supplied is that most of the vaccines available have been bought or promised by richer countries in North America and Europe. To address this inequality, a coalition of international organizations including WHO and governments founded the Covax initiative in April 2020.
The idea behind this was to achieve a global supply of vaccines for 92 low and middle income countries. In December 2020, Covax announced that it had secured around 2 billion cans for 2021 through donations and commitments from some manufacturers . But how many of them will actually be delivered this year is open. The problem is made even more complicated by the fact that some countries are both working with Covax and trying to reach agreements with manufacturers themselves.
The group aims to vaccinate around 20 percent of the world’s population. The focus should be on hard-to-reach people in Africa, Latin America and Asia. To do this, Covax needs another $ 4.9 billion in addition to the already existing $ 2.1 billion. But that’s not the only problem. The cheaper and easier to transport vaccines like AstraZeneca’s are slower to be approved. Other companies, meanwhile, appear to be less interested in participating: only two percent of Pfizer’s global volume has been allocated to Covax , MSF has noted , and Moderna is still “in discussion” with the organization.
Safe only when everyone is safe
“Covax is a crucial starting point that – without the support of US President Biden – had little chance. It looks better now, but without the money and vaccines, the program could still fail, ”said Barry Bloom, health researcher at Harvard University’s TH Chan School of Public Health. The new US president officially ordered his government to join Covax in late January .
If successful, the international program would have many advantages. It creates a fairness mechanism that is not designed according to the colonial give and take mentality, says Bloom. In addition, it relieves individual rich countries of the task of deciding for themselves which others receive which proportion of vaccines. “That way, you can say someone else is taking care of it, including delivery times,” says Bloom.
The motivation for getting vaccines to poorer countries faster is not altruistic: any delays are penalized by evolution. There are now several worrying mutations of SARS-CoV-2, and more are to come. If countries with large populations are not vaccinated for years, the virus will continue to mutate – possibly to the point that the first available vaccines will lose their effectiveness. That would be bad for everyone. But poor countries, which also have less access to newer vaccinations, would again be hardest hit.
“We’re getting more mutants and they’re getting more deaths”
Judd Walson, a global health researcher at the University of Washington, is more concerned about the indirect effects of the pandemic in developing countries; in many of them it is not even among the top 20 causes of death. Health systems have dedicated a lot of manpower and resources to the pandemic, with quarantine centers, controls and other measures. Also, donors and ministries have been distracted from diarrhea, malaria and other deadly diseases.
As a result, these other programs suffer. The immunization rates against measles, diphtheria, tetanus or whooping cough are falling . Because there is a shortage of vaccines and staff, and many people in the current situation are afraid of going to health centers. “All the other causes of death are neglected,” says Walson. Governments would not provide their populations with a corona vaccine, but neither would they return to their pre-pandemic priorities.
In a highly interconnected world, virus mutants can spread quickly – as can economic instability. This is one of the findings in a recent paper from the non-profit National Bureau of Economic Research in the United States. Together with colleagues, Sebnem Kalemli-Özcan, an economist at the University of Maryland, analyzed the impact that delays in global vaccine distribution have on the population of countries that have already been vaccinated.
Cost of inequality
It showed that if poorer countries had to wait for vaccinations, it would mean an economic loss of around $ 9 trillion this year; Nearly half of that would go to wealthy countries in the form of less trade and broken supply chains (according to a similar study by the Rand Corporation , uneven distribution of Covid-19 vaccines could cost the global economy up to $ 1.2 trillion a year). A fair distribution is therefore in the interests of the industrialized nations themselves, says Kalamli-Özcan.
When the majority of the population in richer countries is vaccinated, restaurants and gyms there may reopen. But there are many sectors of the economy that buy into emerging countries, such as retail, the auto industry, textiles and construction. You would all be in trouble. And developing countries are often customers too. “If the US and Europe are doing better and they want to sell goods, the other countries will not buy them when they are still sick,” says Kalamli-Özcan. “No economy is an island, and none recovers until everyone else does too.”
Globalization may have favored the pandemic, but at the same time it is the only solution to it, argues the researcher. Rich countries could not prevent economic problems by hoarding vaccines. Instead, they would have to invest in initiatives that ensure better supply and distribution. Canada, for example, ordered five times as many doses of vaccine as is needed for its own population. The country is considering donating the rest to Covax , but it is not yet clear how that will be organized.
Vaccination nationalism backfires
The study assumed that wealthy countries will be vaccinated this year and others not until 2022. But if the time gap widened to several years, the economic consequences would be even more serious.
Vaccine hoarding, also known as vaccine nationalism, would likely backfire politically and economically. People around the world are watching closely when vaccinations become available.
And it is of great importance how this affects the perception of the United States in the world, says Walson: “Vaccination nationalism would very clearly reinforce the feeling that we only think of ourselves. And that would only fuel the fire against the West, which is already blazing in some. ”In his view, accepting inequalities would have long-lasting consequences.
Sufficient money for Covax is the most immediate solution. There are also opportunities to license vaccination technologies or relax intellectual property rights. Then developing countries could build up capacities for their own vaccine production or at least take over the final steps, known as “finish and fill”, themselves.
“I don’t see why South Africa and Kenya couldn’t produce vaccines or why Ethiopia and Botswana couldn’t do the bottling themselves,” says Bloom. At the beginning of the pandemic, there were only two countries in Africa that could test for Covid-19 – and after a month it was eleven. African countries even teamed up to create a center for disease control for the entire continent, in which they exchanged information and best practices on Covid-19 in a way that does not even happen among all 50 US Federal states is the case.
But time is of the essence. At the current transmission rate, 50 percent of Colombia should be infected before mass vaccinations begin there. For Rodriguez-Barraquer, worries about the country in which she grew up triggers: “I fear that too little and too late is happening and that the epidemic will simply take its course,” she says.