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Covid Vaccine Equity - Developing Countries Need Our Help

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A few months ago India was doing relatively well and the U.S. was getting crushed by a devastating second Covid-19 wave. Now it’s the reverse. Public health measures were implemented too sporadically (U.S.) and reversed too quickly (both), with predictable results.

While the U.S. is beginning to focus attention on the growing catastrophe in India, not enough attention is being given to other areas in the region. Countries like Bangladesh, Nepal, Pakistan, Laos and others in the region may soon be matching the explosive growth of Covid in India.

Nepal is one of the poorest countries. Although it has a population of 30 million people, there are only 1595 ICU beds and 480 ventilators throughout the entire country. (This is not much less than in India, at ~1 ICU bed/19,000, but the US has ~1/3800). There are only 80 physicians per 100,000 people, compared to 93 per 100,000 in India or 259 per 100,000 in the US.

With a 50% positivity rate for Covid testing, how long do you think those few beds and limited healthcare will last before being completely overwhelmed.

Cases in Nepal have increased by 1,645% in the past month. Thailand had a similar rate of increase, with most of their cases being the U.K. variant B.1.1.7, which is known to be more transmissible.

Part of the problem in Nepal is that its Prime Minister, Oli,  like India’s PM Modi, and Donald Trump had allowed religious festivals and large political gatherings to continue as politically expedient, at the expense of public health and safety. Heavily reliant on tourism to support its economy, Mount Everest has been opened to climbers; there have been outbreaks reported from the base camp although the government has denied this. And much as our former president recommended injecting bleach, PM Oli has reportedly suggested gargling with guava leaves, which is at least less immediately hazardous, although still as useless as treatment. This uncontrolled pandemic will endanger us all by increasing the likelihood of further mutations emerging and spreading globally. India has a new “variant of interest,” called B.1.617, which is also spread more rapidly. The South African variant, B.1.351, is also circulating in India, along with the UK’s B.1.1.7. This—and the huge number of cases—are what prompted the US to ban travel from India.

Vaccines

One of the problems in the region is that India’s Serum Institute was to supply much of the area with vaccines. Instead, India is desperate, unable to meet its own country’s needs, and has banned the export of vaccines. Nepal has instead turned to China and Russia, who are engaging in vaccine diplomacy who are donating supplies while the US has been sitting on the sidelines.

Even now, with the U.S. finally agreeing to donate 60,000,000 doses of AstraZeneca vaccine, it feels like too little, too late—obviously too little for a population of more than 1.3 billion.

The real problem is that vax is a good retail (one at a time) solution, whereas in a pandemic you need a wholesale, behavioral semi-solution: masks, ventilation, quarantine.

With its nationalistic approach to global problems the previous administration brokered deals that prohibited donation of supplies, in part due to liability concerns of the manufacturers or shortages of raw materials.

There has been a great deal of debate over whether we should waive intellectual property rights, given the urgency of the Covid pandemic. Some in industry feel it will stifle their innovation. Others reply that public and non-profits have provided over $10 billion towards research and development of vaccines.  Furthermore, the U.S. government holds the patent for a technique for modifying the coronavirus protein used in vaccines produced by the major U.S. manufacturers.

Inequities

Unlike his predecessor, President Biden understands that sharing vaccine with other countries is also in our best interest, and joined the international Covax program. Covax is led by WHO, Gavi (Global vaccine alliance), CEPI (Coalition for Epidemic Preparedness Innovations) and the UN’s Children’s Fund (UNICEF). So far, only 0.3% of the vaccines that have been administered have gone to low-income countries, according to the Director-General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus. Covax’s goal is vaccinating 20% of the population of poorer countries. Covax had hoped to administer 2 billion vaccine doses in 2021 (that’s more than 25% of the world’s whole population); so far, they’ve only reached 29 million doses. We need at least a 70% vaccination rate to develop herd immunity and stop the pandemic.

Another problem is that even if the patent protections are waived, allowing companies to have the “recipe” for producing vaccines, many lack the technical know-how or experience to do so. WHO is proposing a technology transfer hub to assist in this process.

In 2019, the U.S. participated in the most recent of a series of pandemic preparedness exercises. This one, called Event 201, was a collaboration between the Johns Hopkins Center for Health Security, the World Economic Forum, and the Bill and Melinda Gates Foundation. Key recommendations at that time included:

— to avoid lockdowns,

— increase coordination to combat mis- and dis-information during a pandemic,

— and to enhance internationally held stockpiles of MCMs (medical countermeasures) and personal protective equipment that could be equitably distributed.

Obviously, we are nowhere near successful in reaching even those limited goals. There is a growing realization that, even if we don’t do it for the “right” or selfless reasons of equity, it is in our own self-interest to share vaccines and help poorer countries.

An ongoing, uncontrolled pandemic will wreak further economic havoc as billions are unable to work and travel, and risks more virulent mutations emerging.

Tom Bollyky director of the Global Health program at the Council on Foreign Relations, told NPR, “…in the midst of a global crisis where countries are under tremendous pressure to begin the rollout of vaccines, they will remember which countries came to their aid and when. And where Russian and Chinese vaccines are going today their influence may follow, and that puts U.S. interests at risk, too.”

When I expressed pessimism about the outcome of Event 201 as a portent of things to come, Dr. Eric Toner, senior scholar with the Center for Health Security and a Senior Scientist in the Johns Hopkins Bloomberg School of Public Health, cheered me a bit by noting that significant progress had been made over time. He concluded, “We’re trying to aim at making things better than they would be...I don’t think ‘prepared’ is a place…I think we can only be better prepared.”

Somehow, I’m not at all reassured that our efforts will be adequate. We must realize that we are all in this together and work together to assure global equity in access to vaccines and medicines. Viruses do not recognize borders. No one is safe until we all are.

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