Two problems have stymied efforts to get more people vaccinated against Covid-19 worldwide: Vaccine skepticism and vaccine scarcity. A coalition of 42 Catholic domestic and international health care providers and development and relief agencies was launched this month to address both of those challenges. The coalition will confront misinformation here in the United States and supply worries overseas, where poor nations so far have only been allocated a fraction of the doses they need to turn back the pandemic.
Sean Callahan, the president and C.E.O. of Catholic Relief Services, a coalition member, made a strong pitch for the practical and moral call to rapidly and equitably share vaccine reserves in an interview with America. “We will never get [the pandemic] under control here in the United States until we get it under control everywhere,” he said, noting persistent spikes in Covid-19 cases around the United States and around the world because of the emergence of Covid variants.
The worst-case scenario, he said, would be for a variant to surface that is unaffected by the current roster of vaccines. The faster Covid-19 can be tamped down everywhere, he said, the better off everyone will be, in poor and wealthy nations alike.
Vaccine rush
More than a year into the crisis and months after a number of vaccines became more widely available, wealthy nations have not exactly set a good example about just or even efficient distribution of vaccines. In the great vaccine rush of 2021, the world’s greatest economic powers hedged their bets and made advance purchases of the lion’s share of the vaccines in production, blocking even middle-income states from the vaccine queue and leaving low-income states far behind. Supplies have followed ability to pay, not need, setting back what had been a global ambition to distribute vaccine supplies where they could have the greatest effect on suppressing the spread of Covid-19.
Sean Callahan, C.R.S.: “We will never get [the pandemic] under control here in the United States until we get it under control everywhere.”
According to an analysis by the Duke Global Health Institute, a handful of countries representing just 16 percent of the world’s population—they include the United States, Canada, E.U. member states and the United Kingdom—have secured more than half of the world’s total Covid-19 vaccine doses. By mid-February, 10 countries accounted for 75 percent of the nearly 200 million Covid-19 shots administered. By July the United States alone will have reserved some 300 million more vaccine doses than it needs.
“If the rich world continues to hoard vaccines, the pandemic will drag on for perhaps as long as seven more years,” warned Dr. Gavin Yamey, a global health professor and the director of the Center for Policy Impact in Global Health at Duke University.
That hoarding represents more than an ethical lapse in its own right. Mr. Callahan noted the adjacent humanitarian costs of the pandemic in the developing world. “A shadow pandemic” now tracks alongside Covid-19, he said, not only threatening a higher direct Covid death toll in low-income states but also imperiling decades of progress on poverty and disease suppression as resources are diverted to confront Covid-19, elective treatments are postponed and other immunization programs suspended.
“We’re seeing a lot fewer children getting vaccines for measles and polio and things like that. Some of these other diseases could reappear on the international agenda,” Mr. Callahan said, “and then, you know, it’s only one flight away from the United States.”
The lack of access to vaccines represents the greatest threats to sub-Saharan Africa and Latin America, reports Chloe Noël, the Faith-Economy-Ecology Project Coordinator for the Maryknoll Office for Global Concerns.
“The South African variant carries a mutation that appears to make it more contagious,” she said in an email to America. “Currently the Brazil variant is overtaking South America and pushing health systems to a breaking point—even in Chile, which [had] been a vaccination success story.”
“A shadow pandemic” tracks alongside Covid-19, not only threatening a higher direct Covid death toll in low-income states but also imperiling decades of progress on poverty and disease suppression.
Most countries in the developing world rely on the Covid-19 Vaccines Global Access coalition (COVAX) to secure vaccine supplies. That program, sponsored by the World Health Organization, UNICEF, the Global Alliance for Vaccines and Immunisation and the Coalition for Epidemic Preparedness Innovations, was meant to be a global equalizer on vaccine access, but it has been underfunded and outbid by wealthy states. It has so far secured about 25 percent of the vaccine doses that have become available. Critics charge that this hat-in-hand approach to acquiring vaccines from for-profit manufacturers and donations from wealthy states will never be adequate to the job of distributing enough vaccines to suppress Covid-19 in the developing world.
The New York Times reports that by March 30, Covax had shipped about 33 million doses to 70 countries and regions, most acquired through donations—“just 6 percent of the 564 million doses that have been administered worldwide.” (The program’s fortunes could be changing. It received a significant lifeline in February from the Biden administration, which committed $4 billion to support the coalition, reversing the Trump administration’s refusal to participate in COVAX.)
Even if COVAX works as intended, Ms. Noël pointed out, it will only deliver enough vaccines to reach about 20 percent of the population in participating states, too little to achieve the herd immunity of 60 to 70 percent that virologists agree could stop the pandemic. Worse, she said, some countries in Africa are currently not expected to get vaccines until 2023 or 2024. “Price, production, distribution and patents are four of the main barriers to global access,” Ms. Noël said.
African states have endured stark setbacks in economic and human development because of Covid-19, but they have so far not experienced the level of mortality experienced in Europe, the United States, Brazil, Mexico and now India, global leaders in Covid-19 suffering. But that could change in a matter of weeks as new mutations emerge.
That raises the stakes and the concern of health care service providers in Africa. According to Mary Beth Powers, the president and C.E.O. of the Catholic Medical Mission Board, some 20 nations in Africa alone “have not yet received any vaccines whatsoever.”
And those that have received vaccines, she pointed out in an email, are just beginning to reach their health care workers and the elderly but “have nowhere near the numbers of doses needed to protect their populations.”
According to Ms. Powers, South Africa has reached the highest level of vaccination coverage on the continent, but its figures are paltry compared to what has been accomplished in more affluent states. Out of a nation of 60 million, just 292,000 people received a vaccination, she reports—.51 percent of the population. By comparison, on April 15 alone the United States inoculated more than 4 million people, and more than 38 percent of its population has had at least one dose of a Covid-19 vaccine; 24 percent are now fully inoculated.
“Price, production, distribution and patents are four of the main barriers to global vaccine access.”
Developing nations wait in hope for COVAXto come through, but acquiring doses is just the first step toward herd immunity. “The costs of delivering the vaccine once they are in country can be more than five times the cost of the vaccine,” Ms. Powers said, explaining that outreach, storage and in-country mobilization and distribution costs have to be factored in for vaccine campaigns to succeed.
Overcoming ‘vaccine nationalism’
To more effectively address the crisis, advocates have been pressing for a suspension of patents for vaccines and for vaccine manufacturing processes; this would allow low-cost regional production of Covid-19 vaccines, improving simultaneously both vaccine reserves and lines of distribution. That position is supported by the Vatican and endorsed by Pope Francis. In his “Urbi et orbi” Christmas address last year, he criticized “vaccine nationalism” and said: “We can’t put ourselves before others, putting market forces and patent laws before the laws of love and the health of humanity.”
In a statement released jointly by Caritas Internationalis and the Dicastery for the Promotion of Integral Human Development in February, Vatican officials complained that while “the rich nations of the Global North” wait “for a return on their investment…. the Global South, where the majority of the poor live, is left out.” They urged that patent and technical issues be resolved and that local production sites be established in Asia, Africa and Latin America to accelerate vaccine production.
“Since every life is inviolable, nobody must be left out,” Vatican officials said. “The poor, minorities, refugees, the marginalized are the most exposed to the virus…. Our collective well-being depends on how we care for the least.”
That message apparently fell on deaf ears at a World Trade Organization meeting in March, where European and U.S. negotiators tabled an appeal from South Africa and India—joined by scores of low-income states—to temporarily suspend patents related to Covid-19 vaccines. WTO officials promise to revisit the issue at its next TRIPS (Trade-Related Aspects of Intellectual Property Rights) meeting later this month. The Biden administration has come under increasing pressure to support short-term patent waivers as the spread of Covid-19 intensifies and death tolls rise in Mexico, India, Brazil and other less affluent states.
“The critical need right now is to get vaccines into as many arms and as quickly as possible, but current supply plans cannot meet the demand necessary to reach herd immunity.”
While negotiations over the suspension of some intellectual property rights continue, Mr. Callahan of C.R.S. urged nations with reserves of vaccines to “make a commitment” to at least share out of their surplus “and then challenge [other states] to do likewise, so that we can start getting some flow going out there.” In what could be a model for that resource sharing, the United States recently “loaned” 4 million AstraZeneca vaccines to Canada and Mexico while that vaccine awaits Food and Drug Administration approval for use in the United States.
Viral misinformation campaigns
The dangers of misinformation about vaccines are already becoming evident in the United States, where according to a recent NPR/Marist poll, one in four Americans say they plan to decline the Covid-19 vaccine. If that level of vaccine resistance holds, it would be enough to frustrate Biden administration ambitions to achieve herd immunity by the summer. Resistance to vaccination efforts has also been on the rise in Brazil and other nations as anxieties about vaccine safety are joined by wild conspiracy theories to discourage vaccine participation even as the Covid-19 cases threaten to overwhelm health care systems.
Catholic advocates and health care providers might be uniquely qualified to get the message out about the critical importance of inoculation programs here and overseas. Susan Gunn, the Director of the Maryknoll Office for Global Concerns, described faith leaders as essential partners in responding to public health crises, “particularly in addressing misinformation and establishing effective partnerships for information flow.”
Maryknoll missioners became trusted sources for people “as far apart as Cambodia, El Salvador and Kenya” in confronting HIV, Ebola and other health crises in recent decades, she said in an email to America.
“It’s only natural to feel some fear and hesitancy about a vaccine that’s new and that addresses an illness as serious as Covid-19,” she said. But skepticism can run particularly deep among communities in developing countries that have in the past been lied to about vaccines by Western governments or where fear-mongering about vaccines has been an effective campaign strategy for local politicians.
Because Covid-19 is perceived as only one among others in a hierarchy of sometimes mortal threats in the developing world, getting vaccinated may not seem a major priority to some, Mr. Callahan noted. Part of C.R.S.’s effort will be directed at outreach and education to highlight the importance of vaccine treatment for Covid.
But, he suspects, most people served by C.R.S. will be willing to follow Vatican instruction on the ethical acceptability of the vaccines themselves and the moral necessity to receive a Covid-19 inoculation to protect neighbors and serve the community. He does not anticipate that vaccines will become the “political” issue they have sometimes in the United States.
Vaccine skepticism might be a welcome hurdle to face among the people served by Jesuit Refugee Service. Joan Rosenhauer, JRS-USA’s executive director, pointed out that 85 percent of the world’s refugees are currently hosted by states in the developing world, most of which are already bereft of vaccine supplies. “The majority of the people we serve do not have access to a vaccine to even express hesitancy,” she said.
According to U.N. tracking, some 20 countries have begun inoculating refugees on an equal footing with their citizens, but that “leaves more than 170 that are not vaccinating refugees,” Ms. Rosenhauer said. And for refugees without legal status, “coming forward to receive a vaccine can represent an unacceptable risk without clear protections against being detained and deported.”
Breaking through the patent blockade remains of the utmost importance, these advocates agree.
“The critical need right now is to get vaccines into as many arms and as quickly as possible,” Ms. Noël said, “But current supply plans cannot meet the demand necessary to reach herd immunity. If countries had access to the patents necessary to produce the vaccines, treatments and other supplies to contain the pandemic, this goal would be in reach,” Ms. Noël added. “It would also produce much-needed jobs to get economies back up and running.”
“The global costs of prolonging a pandemic by having low levels of vaccination in certain disadvantaged settings and communities will be calculated in lives lost and growing economic disparity and poverty,” said Ms. Powers. “As the Holy Father has reminded us, this is no time to think we can go back to doing things the old way.
“This pandemic,” she said, “calls us to acknowledge our common humanity and our shared destiny—no one is truly safe until we are all safe.”
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