Friday, January 14, 2022

"Until Everyone Is Safe": Reimagining Social and Community Well-Being through the Lens of Vaccine Equity

“650 Million Doses Short”

Like many people whose community work involved being in close contact with vulnerable populations, I can’t adequately describe the relief, gratitude, and hope I felt when I received my first injection of a covid-19 vaccine in February 2021. In fact, not a day goes by that I don’t feel grateful, and with good reason. Natalie Musumeci reported this week on a recent research letter in JAMA Network Open that revealed, from December 2020 through June 2021, these vaccinations “prevented more than 14 million” covid cases and saved approximately 241,000 lives in the USA alone, cutting hospitalizations and deaths “by nearly half”.  ( ) The vaccines have been both life-saving and life-changing. As a fully vaccinated and boosted person, I don’t have to live with the stress of life before the vaccines and I can’t imagine facing the Omicron variant without it. Tragically, I am one of the lucky ones with this option. While the main obstacles to an adequate vaccination rate we face in the Ozarks have been related to vaccine hesitancy and conspiracy theories, many places in the world have not had that luxury. 

Early in the vaccines’ availability, in February 2021, distribution under the COVAX initiative began, as Joseph Stepansky reported, “to coordinate simultaneous distribution to both wealthy and poor countries”. After all, it was understood that “an equitable vaccine rollout … was essential to preventing mutations of dangerous variants that would prolong the pandemic, and potentially evade vaccines.” But what began as a grave acknowledgement and compassionate aspiration has not turned out as we had hoped. For example, the World Health Organization (WHO) had a goal that all nations would reach a 40% vaccination rate by the end of 2021. In Africa, where vaccine inequity has been severely pronounced, only five nations were on track to reach that milestone, with most failing to even reach 20%. ( )

“An Indictment on Humanity”

Compare this to high-income countries, most of whom have surpassed a 50% vaccination rate and are now focusing on administering boosters. Yet these nations are also the ones that continue to stockpile doses. Just before we began learning about the Omicron variant last November, the COVID GAP report documented that, while the world was approximately “650 million doses short of reaching the 40 percent goal by the end of” 2021, the world’s wealthy nations had stockpiled more than 834 million vaccine doses. (ibid) Al Jazeera has also documented that “Only 5% of people in low-income countries are fully vaccinated against COVID.” ( course, vaccine equity isn’t as simple as one statistic. But this one statistic is a powerful symbol and reminder of our world’s failure to address the pandemic in just, equitable, compassionate, and wise ways. 

Even as high-income nations have hoarded vaccine doses, the powerful have hoarded vaccine profits. For example, “at least nine new billionaires” were created by May 2021 on the strength of covid vaccine sales, including the CEOs of Moderna and BioNTech. ( ) And by last November and as documented by Oxfam, we knew that Pfizer, BioNTech, and Moderna were “making combined profits of $65,000 every minute.” And they’ve done this despite receiving over $8 billion in public funding. As Maaza Seyoum of the African Alliance and People’s Vaccine Alliance Africa pointed out – 

“It is obscene that just a few companies are making millions of dollars in profit every single hour, while just two percent [at that time] of people in low-income countries have been fully vaccinated against coronavirus. / Pfizer, BioNTech and Moderna have used their monopolies to prioritise the most profitable contracts with the richest governments, leaving low income countries out in the cold.” ( )

     I’m trying to walk a tightrope here, emphasizing both gratitude for the amazing work that made the creation and distribution of covid-19 vaccines possible and the conviction that a public health crisis should not be made into an opportunity for profit. Hoarding billions of dollars at any time, but especially while hundreds of thousands of people die due to lack of vaccines and health care, is immoral. But if you prefer the voice of someone who believes “It is misguided to lament that private companies are profiting in the current crisis,” I can also offer the words of Brink Lindsey, who wrote last June about the “fundamental mismatch between the policy design of intellectual property protection and the policy requirements of effective pandemic response” and concluded that:  

“What matters isn’t the existence or size of the profits, but how they are earned. We have good reason to want drug makers to profit from vaccinating the world: the comparative price is minuscule, and the incentive effects are a vital safeguard of public health in the event of future crises. What we want to avoid at all costs is putting drug makers in the position where drug companies can profit from standing in the way of rapid global vaccination. That is why intellectual property rights need to be taken out of the equation.” ( )

     Importantly, these are not unusual convictions, and leaders from around the world have been pointing it out for months. In September 2021, for example, South Africa’s President Cyril Ramaphosa extolled covid-19 vaccines as “the greatest defence that humanity has against the ravages of this pandemic” while condemning the global community for its collective failure to sustain - 

“the principles of solidarity and cooperation in securing equitable access to COVID-19 vaccines. ... It is an indictment on humanity that more than 82 percent of the world’s vaccine doses have been acquired by wealthy countries, while less than 1 percent has gone to low-income countries.”

And Zimbabwe’s President Emmerson Mnangagwa emphasized that “Vaccine nationalism is self-defeating and contrary to the mantra that no one is safe until everyone is safe.” ( )

“Solidarity and Cooperation”

These deadly and tragic trends are part of the overall shape of our global response to the pandemic, which we’ve discussed many times and that caused Oxfam to describe covid-19 as the “inequality virus.” In short, “oppressive systems have made the pandemic more catastrophic. Social and economic injustice, and the disparities they create, are deadly. The pandemic has amplified their deadliness.” (

The world as we know it has been shaped by an approach to economic and social development that has fueled terrible inequality, catastrophic climate change, and now, covid vaccine inequity. Our society’s leaders, or at least too many of them, seem comfortable with the idea that it is okay to sacrifice the wellbeing of the poor for the sake of the profits of the rich. But what about those principles of solidarity and cooperation that President Ramaphosa mentioned? What might a society look like that was oriented around those kinds of values?

Thankfully, other approaches have been offered to help us re-think how we relate to ourselves, each other, and the earth. We get glimpses of this other world all the time - if we get in the habit of looking. And one of the more beautiful sights to see right now comes to us from Texas, where the Texas Children’s Hospital and Houston’s Baylor College have developed an open-source, patent-free, low-cost covid-19 vaccine named Corbevax. Initial and limited clinical data about the vaccine has shown it to be “at least 90% effective against the SARS-CoV-2 virus, and 80% or more effective against its Delta variant.” India has authorized it for emergency use and Biological E. Limited, an Indian pharmaceutical company, already has produced 150 million doses for distribution, with a goal of producing a billion doses of the vaccine this year. The Texas team is also consulting with the World Health Organization to explore how the vaccine can be shared around the world. ( )

Despite being told that this kind of result is not possible without an extreme profit motive, the team who developed this vaccine, led by Dr. Maria Elena Bottazzi and Dr. Peter Hotez, are motivated by saving billions of lives. And they have done it without the benefit of the $8 billion in public funding that Pfizer, BioNTech, and Moderna received. In fact, Corbevax’ creation was funded on a relative shoestring, receiving $7 million largely through private investment. This small budget is both a testament to the team’s hard work and an obvious limitation, especially when it comes to having resources for performing clinical trials. So while these initial reports are promising, we do not yet have the open data necessary to truly know how effective Corbevax will be, especially against the Omicron variant. This is both wonderful and heartbreaking news. As Hotez said to the Washington Post, "If we had even a fraction of the support that Moderna had, who knows, maybe the world would be vaccinated by now, …. We wouldn't be having a discussion about Omicron." ( )

“The Health of Entire Communities”

Yet this shadow should not dim our celebration of the hard work and generosity that made Corbevax possible. This is very good news. If it continues to be successful, Corbevax gives us an incredible tool in addressing vaccine inequity. And it also helps us shift the conversation around what kind of society we live in and what kind of society we could live in. Peter Maybarduk, director of Public Citizen, emphasized that the development of Corbevax challenges “the false narrative that vaccine production and medical innovation thrive through secrecy and exclusivity.” (ibid) 

The hope is that initiatives like Corbevax can help us shift that norm, and not just for vaccine production. In order to achieve real justice and equity in the pandemic, we need to insist on things like: better sick leave policies that protect essential workers; access to effective masks and other PPE; improved testing options, from availability to transportation to cost; safe housing for anyone who is unsheltered and for those who share shelters but need to isolate; universal health-care; universal education, especially for current and future health care providers; and massive investment in infrastructure, especially in our health care systems. As Ed Yong wrote, 

“Rather than trying to beat the coronavirus one booster at a time, the country needs to do what it has always needed to do—build systems and enact policies that protect the health of entire communities, especially the most vulnerable ones. Individualism couldn’t beat Delta, it won’t beat Omicron, and it won’t beat the rest of the Greek alphabet to come. Self-interest is self-defeating, and as long as its hosts ignore that lesson, the virus will keep teaching it.” ( )

“Self-interest is self-defeating.” Vaccine inequity is a potent reminder of this, but there is an even more important reminder in the story of Corbevax: inequity is not inevitable. Dr. Bottazzi, Dr. Hotez, and their team remind us that people can make a difference even when we don’t have access to the same power and resources that the current system enjoys. As Dr. Keith Martin, executive director of the Consortium of Universities for Global Health, told NPR: 

"CORBEVAX is a game changer …. It's going to enable countries around the world, particularly low-income countries, to be able to produce these vaccines and distribute them in a way that's going to be affordable, effective and safe." ( )

This may be a turning point in our struggle against vaccine inequity. And hopefully, our combined responses to the pandemic can be part of much, much more. Because a world where everything that every person needs to thrive and enjoy life is “affordable, effective and safe” is within our reach. ( ) Having born witness to the pandemic’s terrible toll on human life and wellbeing, may we all resolve to work together in whatever ways we can, “until everyone is safe.”