W.H.O.’s Dr. Tedros – Covid vaccine promises must be kept

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Almost one billion doses of Covid-19 vaccines have been administered around the world, and yet the weekly number of cases hit a record high last week, and deaths are climbing, on pace to eclipse 2020’s grim tally. How can this be? Weren’t vaccines supposed to douse the flames of the pandemic?

Yes, and they are. But here’s the thing about an inferno: If you hose only one part of it, the rest will keep burning.

Many countries all over the world are facing a severe crisis, with high transmission and intensive care units overflowing with patients and running short on essential supplies, like oxygen.

Why is this happening? For several reasons: The rise of more transmissible variants, the inconsistent application and premature easing of public health measures like mask mandates and physical distancing, populations that are understandably weary of adhering to those measures and the inequitable distribution of vaccines.

Scientists developed several vaccines for Covid-19 in record time. Yet of the more than 890 million vaccine doses that have been administered globally, more than 81 percent have been given in high- and upper-middle-income countries. Low-income countries have received just 0.3 percent.

This problem is sadly predictable. When the H.I.V. epidemic erupted in the 1980s, lifesaving antiretrovirals were developed rapidly, and yet a decade passed before they became available in sub-Saharan Africa.

A year ago, the World Health Organization and many global health partners came together in an effort to avoid history repeating. The Access to Covid-19 Tools (ACT) Accelerator, including the vaccine sharing initiative Covax, was begun to ensure the most equitable possible distribution of vaccines, diagnostics and therapeutics for Covid-19.

The concept was crystal clear: At a time when no one knew which vaccines would prove effective in clinical trials, Covax was designed to share the huge inherent risks of vaccine development, and to offer a mechanism for pooled procurement and equitable rollout.

While scientists toiled in laboratories, the W.H.O. and partners set standards, facilitated trials, raised funds, tracked manufacturing progress and worked with countries to prepare for rollout.

Countries at all income levels, manufacturers and others in the private sector committed to participate.

But many of the same wealthy countries that were publicly expressing support for Covax were in parallel preordering the same vaccines on which Covax was relying.

In January, I issued a global challenge to see vaccination underway in all countries within the first 100 days of the year. This was an eminently achievable goal.

By April 10 — the 100th day — we had come close to achieving it: All but 26 countries had started vaccination, and of those, 12 were about to start, leaving 14 countries that had either not requested vaccines through Covax or were not ready to start vaccinating.

But the amount of vaccines delivered has been totally insufficient. As of Thursday, Covax has distributed 43 million doses of vaccine to 119 countries — covering just 0.5 percent of their combined population of more than four billion.

Since the ACT Accelerator’s birth a year ago, many of the world’s biggest economies have given strong support to Covax politically and financially, but they have also undermined it in other ways.

First, vaccine nationalism has weakened Covax, with a handful of rich countries gobbling up the anticipated supply as manufacturers sell to the highest bidder, while the rest of the world scrambles for the scraps. Some countries have placed orders for enough doses to vaccinate their entire population several times over, promising to share only after they have used everything they need, perpetuating the pattern of patronage that keeps the world’s have-nots exactly where they are.

Second, vaccine diplomacy has undermined Covax as countries with vaccines make bilateral donations for reasons that have more to do with geopolitical goals than public health. This inevitably leaves countries with the least political clout as wallflowers at the vaccine ball.

Third, vaccine hesitancy has hampered the rollout of vaccines, through the same combination of myth and misinformation that has enabled measles to resurge around the world. Reports of very rare side effects linked to some vaccines have spurred countries with other options to cast some aside. This includes vaccines that many of the world’s low-income nations were relying on but now question. Let’s be clear: While safety is paramount and we pay careful attention to any signs of adverse events, the shots’ benefits vastly outweigh the risks for all four vaccines with W.H.O. emergency use listing.

And fourth, a new trend — let’s call it vaccine euphoria — is undermining hard-won gains as some countries relax public health measures too quickly and some people assume that vaccines have ended the pandemic, at least where they live.

It doesn’t have to be this way. Scarcity drives inequity and puts the global recovery at risk. The longer this coronavirus circulates anywhere, the longer global trade and travel will be disrupted, and the higher the chances that a variant could emerge that renders vaccines less effective. That’s just what viruses do.

We face the very real possibility of affluent countries administering variant-blocking boosters to already vaccinated people when many countries will still be scrounging for enough vaccines to cover their most-at-risk groups.

This is unacceptable. Analysts predict vaccines will generate huge revenues for manufacturers. Meanwhile, the ACT Accelerator is still $19 billion short of the funds it needs to expand access not just to vaccines but also to diagnostics and treatments like oxygen. But even if we had all the funds we need, money doesn’t help if there are no vaccines to buy.

The solution is threefold: We need the countries and companies that control the global supply to share financially, to share their doses with Covax immediately and to share their know-how to urgently and massively scale up the production and equitable distribution of vaccines.

One way to do this is through voluntary licensing with technology transfer, in which a company that owns the patents on a vaccine licenses another manufacturer to produce its shots, usually for a fee. Some companies have done this on a bilateral basis. But such agreements tend to be exclusive and nontransparent, compromising equitable access.

A more transparent method is for companies to share licenses through the Covid-19 Technology Access Pool, a globally coordinated mechanism proposed by Costa Rica and started by the W.H.O. last year.

Another option, proposed by South Africa and India, is to waive intellectual property rights on Covid-19 products through a World Trade Organization agreement that would level the playing field and give countries more leverage in their discussions with companies. Governments could drive greater sharing of intellectual property by offering incentives to companies to do it.

If this is not a time to take those actions, it’s hard to fathom when that would be.

In combination with proven public health measures, we have all the tools to tame this pandemic everywhere in a matter of months. It comes down to a simple choice: to share or not to share.

Whether or not we do is not a test of science, financial muscle or industrial prowess; it’s a test of character.

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