Inoculate Low-income Countries, Stop Trying with U.S. Citizens Who Still Don’t Want It
By: Hannah Gardner
Convincing people in the United States who don’t want to get vaccinated is time consuming, complicated, and expensive but vaccinating people in developing countries is only about logistics. We are in a global emergency. A necessary question to consider - how can we make the greatest impact with the resources we have?
Since March, the United States has discarded 15 million expired vaccines[1]. Alabama alone has thrown away over 65,000 vaccines[2].
The consequences of wasted vaccines – the virus spreads in the most vulnerable countries, which could’ve otherwise benefited from vaccine protection. Statistics show that merely 1.9% of residents in low-income countries have received at least one dose of the vaccine[3]. An end to the pandemic is inconceivable without vaccine access in every country.
Vaccine access inequities are exacerbated by booster vaccines, and the United States is not solely to blame. Nationalism is on display, as the North American, European, and other high-income countries are hoarding vaccines. Canada has enough doses to vaccinate its country four times over[4]. The “need” for booster shots is the rationale behind vaccine stockpiling. While booster shots are necessary among certain high-risk professions and the elderly, data on an immediate need for booster shots in the general population is sparse and conflicting. While we continue to research this issue, extra vaccines should be given to low-income countries for their first and second doses.
Do we have a moral obligation to bolster low-income countries? In the words of bioethicist Giovanni Berlinguer, “the idea that the combination of scientific progress and free market would spontaneously extend its benefits worldwide, which was dominant in the past two decades, has failed, and a paradoxical situation about science has arisen[5].” There has never been a more perfect example of this paradoxical situation than the COVID-19 vaccine. Scientific innovation gave us this vaccine in an unparalleled timeline – seemingly a quick solution to this pandemic. However, vested interests in this technology have propagated inequities in access and affordability. Manufacturing companies have patented market-exclusivity. Countries that can afford vaccines receive protection, and countries that cannot suffer. This pandemic will not end until countries that can afford the vaccine spread the wealth.
The U.S. has an abundance of vaccines, but too much of our effort is focused on vaccinating our unvaccinated. We face internal vaccine opposition stemming from the spread of misinformation, mistrust in science, and conspiracy theories. Countless efforts have been made to address this opposition through scientific explanations, marketing strategies, monetary incentives, and even pleas from the President of the United States. Yet, our vaccination rates remain stagnant. Perhaps we are naive to think that we can argue with irrationality and the great misinformation machine that is the internet.
Conversely, willingness to take the vaccine is almost 20% higher in low-income countries than it is in the United States[6]. Surveys indicate that on average, 80% of people in low-income countries would take the vaccine[6] and hesitancy is generally attributed to vaccine induced symptoms. This form of hesitancy is easier to address than what we face in the United States. Overall, the uptake of vaccines would yield positive outcomes in low-income countries.
However, shifting inoculation efforts will have repercussions. Pockets of unvaccinated people in the U.S. leave us susceptible to the virus continuing to spread and perhaps, what is more concerning, mutate. While virus mutations mostly result in innocuous but slightly more infectious strains, scientists are more worried about a mutation that evades our vaccines[7]. This potential reality must be taken seriously as scientists and politicians debate vaccine mandates - a reality that may arrive after it’s too late.
The potential benefits of vaccine advocacy in low-income countries are substantial. Increasing vaccination rates in low-income countries would result in decreasing COVID-19 infections, fewer mortalities, relief in overburdened hospitals and clinics, and economic benefits. Specifically, the economic benefits would manifest by prevented illness costs, a larger productive workforce, and the re-opening of closed businesses[8].
Before we can work towards vaccinating low-income countries, there are critical steps that must be taken.
Our nation must, in collaboration with countries globally, support an effort to produce billions of doses. Advocacy groups have pointed to The Build Back Better Act for supporting this initiative. Specifically, SEC. 31022. of The Build Back Better Act titled, “Funding for Public Health and Preparedness Research, Development, and Countermeasure Capacity,” incorporates $1.3 billion to expand global vaccine production.
Secondly, we need to generate support among political leaders to reallocate excess vaccine supplies to low-income countries. This step requires the support of public health agencies with access to data, such as the CDC. Data will illustrate where vaccines are going to waste. For example, doses are likely being wasted in states with higher concentrations of vaccine hesitancy. Doses in these states can be reallocated to low-income countries.
Lastly, our country’s decision to hastily offer booster shots may be ill-considered. While the WHO has already urged countries to delay booster rollouts, we need to apply greater pressure to examine alternative strategies that are global in scope. We need to engage with stakeholders, public health experts, and politicians to prioritize vaccinating low-income countries first.
The global inequities in this pandemic can be attenuated by distributing resources fairly. It is up to us to prioritize where the vaccines go.
References
1. Murphy, J.E.a.J., 15 million Covid vaccine doses thrown away in the U.S. since March, new data shows. nbcnews, 2021.
2. Goldman, D., Alabama Just Tossed 65,000 Vaccines. Turns Out It’s Not Easy To Donate Unused Doses. npr, 2021.
3. Hannah Ritchie, E.M., Lucas Rodés-Guirao, Cameron Appel, Charlie Giattino, Esteban Ortiz-Ospina, Joe Hasell, Bobbie Macdonald, Diana Beltekian and Max Roser, Coronavirus Pandemic (COVID-19). OurWorldInData.org, 2020.
4. Bolongaro, S.R.a.K., Canada has reserved more vaccine doses per person than anywhere. BNN Bloomberg, 2020.
5. Berlinguer, G., Bioethics, health, and inequality. Lancet, 2004. 364(9439): p. 1086-91.
6. Solís Arce, J.S., et al., COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nature Medicine, 2021. 27(8): p. 1385-1394.
7. The effects of virus variants on COVID-19 vaccines. World Health Organization, 2021.
8. Ozawa, S., et al., Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001-2020. Bull World Health Organ, 2017. 95(9): p. 629-638.