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Rich countries have acquired most of the world’s vaccines, leaving poorer countries with little.
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Such unequal distribution risks higher death tolls, even in the rich nations, experts say.
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New variants develop faster when infection is widespread – and those which emerge in poor nations are unlikely to stay there.
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Rich countries are hurrying to vaccinate their populations as quickly as possible as they fight to end their coronavirus outbreaks.
But doing that while leaving lower-income countries without vaccines of their could own come back to bite them, as numerous public health experts have pointed out.
Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, noted in February that rich countries with just 16% of the world’s population had purchased 60% of available vaccine supplies.
Tedros previously said the world faces a “catastrophic moral failure” because of this inequality. But there are pragmatic drawbacks as well.
The risk is that, even if a few countries fully vaccinate themselves, the virus can still spread elsewhere.
Allowing it to spread risks it mutating into more dangerous variants that could resist existing vaccines and prolong the pandemic around the world.
Professor Ken Shadlen, professor of Development Studies at the London School of Economics and Political Science described this worry in an interview with Insider.
He pointed to “concern that if we don’t distribute the vaccine in a globally more equal way it’s going to potentially undermine the health benefits of all that we’re doing with lockdowns and vaccines.”
He said that the emergence of a vaccine-conquering variant is by no means guaranteed, but that “it would take a lot of confidence to believe that it’s not going to, if it keeps spreading.”
“We’re gambling and it’s a bit of a race.”
Dr. Michael Osterholm, another expert, agreed with the concerns. He is an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and also advised President Joe Biden on the coronavirus during his transition.
He told Insider that vaccine equality should already be a “top priority” to save lives around the world.
He said that one of the biggest risks to ending the pandemic is “largely uncontrolled transmission in the low-and-middle-income countries,” even if wealthier nations have finished their vaccine drives.
He said: “We have got to have an immediate international plan to vaccinate the world as quickly as possible.”
The WHO is warning the pandemic won’t end until outbreaks end everywhere. Tedros said in February: “This is not a matter of charity. It’s a matter of epidemiology.”
Already fighting mutant strains
Variants of the virus are causing widespread alarm and changing the course of the pandemic.
A more-contagious strain first identified in the UK was blamed for surges across Europe, and in the US the CDC warned that it could become the dominant strain.
Some countries’ responses are already changing.
The UK has one of the most successful vaccination programs in the world – almost a third of the population has received at least one dose. There are ambitious plans to end all restrictions before the end of June.
But officials warn that mutations could harm that progress: politicians say the UK is in a “race against evolution.”
The UK is chasing down cases of variants, closely tracking small outbreaks of strains first found in South Africa and Brazil.
Most countries don’t have the resources to react as fast, and it only takes a few mistakes for a new strain to take hold.
Paul Hunter, professor of medicine at the University of East Anglia’s Norwich School of Medicine, noted that some now argue that lockdowns “should continue for longer than we might think” because of the risk from variants.
He noted that the evidence for that is not yet conclusive.
Existing efforts likely aren’t enough
There is one international effort aimed at reducing this inequality: The WHO’s COVAX scheme, which hopes to distribute 2 billion COVID-19 vaccine doses worldwide by the end of 2021.
Its first shots were delivered to Ghana in late February, with shots since arriving in countries like Senegal, Sudan, and Kenya.
But it has been battling underfunding and the problems of limited supply. Even with money to buy doses, COVAX has to contend with the reality that wealthy countries have already reserved almost all supplies for the near future.
The WHO has accused wealthy countries of hoarding doses and driving up prices, frustrating its progress.
That’s adding to the issues created by the shortage of supply globally, leaving it harder for poorer countries to get vaccines and leaving huge populations with little protection.
There’s another big problem with COVAX: Its aims are the “bare minimum,” as Shadlen put it.
It aims to vaccinate around 20% of the populations of 92 countries by the end of the year, far short of the ambitions of the US and others.
Osterholm described COVAX as “a start.” But, he said, “COVAX has never been designed to deliver a vaccine to the entire world in short order.”
“Now we have new data, new information about this thing called variants, which is a game changer. So I think that we’re in a new place. And COVAX to me, while it’s a very positive development, it’s old thinking.”
Instead he called for a plan that involves “everyone, whether it’s Russia or China, or the United States or Europe. We all have the same interest here.”
Tamaryn Nelson, a health advisor to Amnesty International, put it bluntly to Insider: “No one is safe until everyone is safe.”
A big unknown
The key factor is how much risk larger countries are willing to tolerate. Osterholm, the expert who advised Biden, said that there is no way of knowing ahead of time if a new, scary variant will appear.
Researchers are doing what they can to counter this, working on booster shots to fight specific variants. But the development takes time and money, and is itself not guaranteed to work.
The safer option is to get rid of the virus as widely as possible.
Osterholm said: “I always remind people we are a year into this pandemic, but the variants of concern have only been around for about three months.”
“All this has happened in three months: What’s it going to be like three to six months from now?”
“We’re in a chess match with this virus right now. It’s making moves we’ve never seen before.”
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