Pandemic priority: Merging the lanes of the ‘vaccine rich’ world and ‘vaccine poor’ world

The idea was to tackle a problem that had been worrying public health experts for months: the widening gulf between vaccinations in the rich world and poor world, which had turned the covid-19 scourge into a two-lane pandemic. In one — call it the fast lane — the fully vaccinated and boosted; in the other, moving at a snail’s pace, those with no shots at all. The central concern: that large unvaccinated populations would give the virus space to spread and then mutate into new and dangerous strains.

For nearly a year, global organizations have tried to merge the two lanes. A World Trade Organization (WTO) meeting in November was meant to help by addressing a critical question: whether to waive patent rules that have kept production of vaccines in the hands of established manufacturers.

It made the omicron variant’s discovery not just a “we told you so” moment, but also a moment of high irony. The latest effort to fix the problem, undone by the problem itself.

The vaccine rich-poor story involves global politics, corporate decision-making and critical gaps in infrastructure. Public health experts say changes must come in all these areas, not only because it is the right thing to do — but because it is the smart thing to do to help end the pandemic.

By the numbers

From the beginning, the world has seemed one step behind.

But across the world’s lower-income countries, a mere 8.5 percent of people had secured even a single shot. Nigeria? Just over 2 percent fully vaccinated. The Democratic Republic of the Congo? Around 0.1 percent. More than 3 billion people — among them front-line healthcare workers who continue to face a high risk of exposure to the virus — had no vaccine protection at all.

It wasn’t supposed to be this way.

Well before the first covid-19 vaccines were approved in 2020, an international mechanism was put in place to secure doses for the world’s poorest countries.

Backed by the World Health Organization and called Covax, the plan envisioned a three-step process to ensure global vaccine equity: First, strike deals with vaccine manufacturers even before the shots were cleared by regulators; second, once the new shots were authorized, secure as many doses of working vaccines as possible; and third, and most important, distribute them equitably around the world.

To do so, Covax needed something that’s been in short supply since the pandemic’s early days: international cooperation. “Every country was thinking about itself,” the WHO’s Chief Scientist Soumya Swaminathan told Grid.

“High-income countries, particularly, who had a lot of money that they could put into [vaccine] contracts did so at an early stage and booked a lot of the doses from multiple companies,” Swaminathan explained.

In other words, fewer than 1 in 10 shots went to the world’s poorer nations. That, experts say, needs to change — and fast. “Unchecked spread in any one part of the world is a threat to other parts of the world,” Priya Sampathkumar, the chair of infection prevention and control at the Mayo Clinic, told Grid.

Getting “from tarmac to arm”

“Reach” here is about more than just global supply. Getting doses into the arms of those who need them requires an array of medical expertise and infrastructure — freezers to store the vaccines, syringes used to administer them and experienced healthcare workers to manage the process.

The U.S. and global health organizations have been aware of this “tarmac to arm” imperative — the need to help poorer nations store, transport and administer vaccines — since the early days of the pandemic. But on this front as well, global efforts have fallen short.

“When you think about the magnitude of the number of injections being given to respond to the pandemic, this is not a place where we can afford shortcuts,” said Lisa Hedman, a senior WHO official who tracks such infrastructure concerns, addressing the syringe gap.

Generous? Perhaps. Sufficient? Probably not. And — with omicron already raging in several of these countries — too late for many.

The patent question

That now-postponed WTO meeting was meant to untangle another critical knot on the path to vaccine equity: the refusal of private manufacturers to share their vaccine recipes with poor-world counterparts. Sharing the intellectual property would not only lead to a significant boost in supply, it would also allow millions of new doses to be made closer to the people in need.

Why so long? Because of Moderna’s refusal to share its know-how.

It wasn’t an abstract moral issue, they said. In their view, opposition to the patent waivers amounted to a human rights violation.

Merging the lanes

Meanwhile, those “tarmac to arm” issues persist, as do the intellectual property claims made by the major pharmaceutical companies. To many critics, the fate of that WTO meeting on patents and intellectual property was telling. It was canceled because of omicron’s arrival, and when a lower-level group met virtually to review the issue, it failed to resolve the deadlock.

One thing global health experts agree on: Generosity and greater global cooperation will be essential to turn the tide. In his year-end address, Tedros said that “as we approach a new year, we must all learn the painful lessons this year taught us. 2022 must be the end of the covid-19 pandemic. But it must also be the start of something else — a new era of solidarity.”