by Ellen Isaacs
March 25, 2022
From the point of view of public health, there are two overwhelming reasons to promote global vaccination against Covid-19. One is that since early in 2020, there have existed vaccines which are highly effective at preventing death and serious illness. Thus it is incumbent on all of us concerned with prioritizing human health to demand that all the people of the world have an understanding of and access to these vaccines. Second, if we allow large population groups to remain unprotected, the virus will have ongoing opportunity to mutate, creating variants which may be more lethal or vaccine-resistant and thereby endanger the health of the whole world, including those already vaccinated. Achieving global vaccination is no less important than practicing sound public health with masking and social distancing.
The reason that much of the world remains unprotected stems from commercial profiteering and the prioritizing of intellectual property rights over human lives. The World Health Organization (WHO), the World Trade Organization (WTO), the governments of the US and other wealthy nations, as well as the pharmaceutical industry are all guilty of creating this situation, which is tolerated because of the racist and exploitative relationship of the high income Western world to the low income nations of the global south. So dismissive are the wealthy nations, home to most of the world’s white population, of the non-white populations within their own borders and of the low and middle income world, that they risk their own pandemic recovery. So fixated on short range profits are the world’s corporate capitalists that, as with climate change, they cannot even act in their own best interests. Thus it is up to us to be part of an international movement that demands that the health of all come before the economic greed of a few.
THE STATUS OF THE DISEASE and VACCINATIONS
By early March, 2022, WHO reported 446 million cases of COVID-19 that had resulted in six million deaths globally, but a worldwide estimate based on excess mortality puts the likely figure at 18.2 million.1 WHO reported an overall 19% decrease in cases in February, 2022, except in the Western Pacific, Eastern Europe and Russia,2 but the new BA.2 Omicron variant is now increasing cases in Europe and the US. This variant is more transmissible than BA.1 Omicron, although its degree of vaccine resistance and severity remains uncertain.3 However, a high number of cases can lead to an increase in hospitalizations and deaths among the vulnerable, even if a variant does not cause severe illness in the general population.
According to the New York Times World Vaccination Tracker as of March 18, 2022, 65.5% of the world population has received at least one dose of vaccine, but only 14.1% of people in low income countries have had at least one dose. In Burundi the total percentage of fully vaccinated (one or two doses without booster) people is 0.1, in Congo 0.5, Chad 0.9, and Haiti 1.0. Altogether, 15 African countries have a vaccination rate under 10%. A few countries, such as the UAE, Portugal, Brunei, Chile, Malta, and Cuba are at 94% or above; China is 91% and the US 65% fully vaccinated.4
Since about 57% of the world is fully vaccinated, which has required approximately 10,935,000,000 doses of various vaccines,5 it would require about 8.25 billion doses to fully vaccinate the world and then another 7 billion or so doses to boost everyone, depending on the eligibility of children. WHO estimates that the pandemic would end this year if 70% vaccination were achieved, which is very unlikely to occur, and vaccine resistant variants could also alter this calculation.
According to an analysis published in STAT news, the G7 and EU nations will have 1.39 billion excess mRNA doses by the end of March, 2022, assuming that 80% of all adults are vaccinated and boosted, but there is a plan to give away only 500 million .6 The US had donated 480 million doses worldwide by March 3 and has promised 1.2 billion more.7 It is estimated that it would cost $12.5 billion to produce the required doses. According to Garrett Wilkinson of Partners in Health, only 7 billion mRNA doses are planned to be produced in 2022.
THE DANGER OF LOW VACCINATION RATES
That so many millions remain unvaccinated virtually assures that new viral variants will emerge. As the virus, a bundle of RNA, enters host cells, it is copied and reproduced and travels into new cells. There are frequent copying mistakes in this process resulting in an altered virus. Most of these changes are of little consequence as they make the virus less potent or do not change the ability of the immune system to react. But some changes will make the virus more dangerous – more infectious, causing worse disease, or less recognizable by antibodies. Variants are more likely to arise the more bodies the virus has to infect and the longer it lives in each one, both of which are determined by immunization status and underlying health. Thus as long as nearly half the world remains unprotected it is inevitable that new variants will keep coming and some may be very bad for us. This is what happened when the original strain mutated into the later Delta and Omicron variants.
The increased likelihood of new variants emerging in populations with low vaccination rates has also led to policies which only worsen rates of international disease and cooperation. In the US, racist anti-immigrant policies, like Title 42 of the 1944 Public Health Services Law, have enabled the expulsion of asylum seekers to Mexico without offering any testing or treatment. (On March 28, The US announced it will end this practice and vaccinate immigrants at the southern border and deport those who refuse.) Travel bans have been enacted after the discovery of new variants, such as against South Africa with Omicron, even though the virus had already spread. Such policies discourage the sharing of information without protecting public health.
BUT WHERE ARE THE VACCINES?
Currently the vaccines that are being used around the world include three made in China, two in India and Russia, Astra-Zeneca in UK, and Johnson & Johnson (paused) and Novavax (pending US approval) in the US in addition to the two mRNA vaccines. According to a recent review in the International Journal of Infectious Disease,8 all the vaccines had effectiveness in stage 3 trials ranging from 59%-98%. Of course, the passage of time and emergence of new variants will greatly affect these results. MRNA vaccines have been the most effective, retaining 50% effectiveness at six months after two doses, and resulting in a 20 fold decrease in death after boosting.
MRNA vaccines are also the most efficient to manufacture because they do not require biologic cells to produce and are the simplest to reprogram for new variants. The process of producing a modified vaccine can take seven days, as opposed to a few months for those that require cellular growth, and could potentially be made by over 100 manufacturers in Africa and several in Asia and South America.
The ability of companies in low and middle income countries to make mRNA vaccines has been limited by intellectual property laws that control who can manufacture a product. Currently, the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) requires signatory countries to allow pharmaceutical companies to have monopoly patent protections for their medical products. It should be noted that the WTO only came into existence in 1994, when for the first time Western nations were able to enforce patents on medicines and other technologies in return for concessions to poorer nations that gave them wider access to rich northern markets. In truth this provision marked the end of a massive 20 year campaign by pharmaceutical companies alarmed at the manufacture of generics by India since the 1970s.9
Although WHO and the US have agreed to waive TRIPS laws, the EU, Switzerland and Germany have not. A new compromise just announced allows self-declared developing countries to produce and export vaccines to other eligible countries and to lump all existing patents together. However, the waiver does not apply to diagnostics or therapeutics.10
Moderna has indicated that it will not enforce patent protections, but they refuse to share the knowledge and technology necessary to actually produce their Covid-19 vaccine. The US government has the authority under the Defense Procurement Act (DPA) to require Moderna to share vaccine technology with the WHO mRNA hubs but has not done so, despite the fact that Moderna received $10 billion from the US government to develop its vaccine. Meanwhile, Pfizer and Moderna have made approximately $54 billion from sales of their mRNA vaccines; Pfizer’s projected profits for November 2021 were $36 billion, and Moderna’s $18 billion.
In the past, many low income countries have shown themselves able to produce vaccines, such as against Ebola in the Democratic Republic of the Congo or against cholera and typhoid in several countries. 11 All of the Covid-19 vaccines have one thing in common: the need for cold-chain storage, ranging from around –70°C (–94°F) during specialized shipping to around 2 to 8°C (36 to 46°F) when administered, but only the mRNA vaccines require super cold storage. However, elaborate analyses have been done as to how the obstacles to transporting, storing, and administering vaccines could be overcome in low income countries with various climate and developmental obstacles to overcome.12 What is lacking is the investment and the will. Even the newly appointed White House Covid Czar, the widely respected public health expert Dr. Ashish Jha, has been an unpaid consultant for Albright Stonebridge. This strategic advisory firm advised Pfizer against suspending intellectual property laws and downplayed the ability of other countries to produce mRNA vaccines.11A
COVAX, a multinational agreement sponsored by multiple international institutions such as WHO and UNICEF, was supposed to facilitate the delivery of vaccines to all nations. However, it has accounted for less than 5% of all vaccinations administered globally. A major factor has been the direct deals between high income countries and pharmaceutical companies. The United States has entered into seven deals with six companies for 800 million doses, which are enough to vaccinate 140% of its population.13 COVAX then allowed self-paying nations to choose what vaccines they would receive for up to 50% of their population. Donations by individual countries are highly inadequate to meet the need, nor have their pledges been fulfilled.
A potential game changer is the development of Corbevax, a vaccine designed by Drs. Maria Elena Bottazzi and Peter Hotez at Baylor College of Medicine, which was designed and is to be produced and distributed without patents or profit, financed only by no-strings-attached private donations. It is a two-dose protein subunit vaccine, similar to that for hepatitis B, that can be stored in a regular refrigerator and will cost less than $2 a dose. It has been found to be safe and effective, but only based on immunologic effect in stage 3 trials, and licensed in India, Bangladesh, South Africa, and Botswana to date, with pending deals in Vietnam and Taiwan.The Indian manufacturer, BioE, plans to produce more than one billion doses for developing countries, so it will reach more people than what’s been shipped by the wealthiest nations.14,15,16
THE IMPLICATIONS OF THE PRESENT SITUATION
Thus Vaccination rates remain highly unequal around the globe. The black population of Africa, with its overall vaccination rate of 11%, is far less protected than any other area, which even outstrips the two to three fold racial inequalities of sickness and death within the wealthy countries. Given the hesitancy of several wealthy countries to waive patent protections, the unwillingness of manufacturers to share technology, and the failure of high income countries to donate adequate vaccine doses, the situation will not improve soon unless Cobrevax proves clinically successful and is able to be produced and administered rapidly. Existing disparities assure that new and possibly more dangerous and/or vaccine resistant Covid-19 strains will emerge, for which the whole world will pay a price. Indeed, the greed of the pharmaceutical industry and the governments which promote them has prevented a path to the resolution of this pandemic in all countries, but the shortsightedness of reckoning quarterly profits is not to be overcome, even as a matter of long range self-interest, even of life and death. Rapid and equitable action against Covid-19 depends on us, on building an international movement of ordinary citizens, scientists and health workers to demand that public health, not wealth, is the priority.
1. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext#seccestitle10
2. https://www.aljazeera.com/news/2022/2/16/covid-new-cases-decline-by-19-worldwide-deaths-stabilise
3. https://www.cnbc.com/2022/03/15/is-omicron-subvariant-bapoint2-to-blame-for-rising-covid-cases.html
4. https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html
5. . https://www.bbc.com/news/world-56237778
7. https://www.state.gov/covid-19-recovery/vaccine-deliveries/
8. https://www.sciencedirect.com/science/article/pii/S1201971221008572
11. Excler JL, Privor-Dumm L, Kim JH. Supply and delivery of vaccines for global health. Curr Opin Immunol. 2021;71:13-20
11A. https://thecolumn.substack.com/p/bidens-new-covid-czar-previously?s=r
13. Excler JL, Privor-Dumm L, Kim JH. Supply and delivery of vaccines for global health. Curr Opin Immunol. 2021;71:13-20
14. texastribune.org/2022/02/10/corbevax-texas-coronavirus-vaccine
16. https://www.precisionvaccinations.com/vaccines/corbevax-covid-19-vaccine
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