The U.S. Won't be Safe from COVID Until Poor Nations are Vaccinated

Although Americans tend to look inwards when it comes to foreign affairs, the trajectory of the coronavirus pandemic may soon compel a change in outlook.
Statistics explain why. About a third of the people who live in high-income countries like the U.S. are vaccinated, which means their citizens are hoping to soon return to something resembling normal life. On the other hand, only 0.2 percent of people have gotten the shots in low-income countries like India, which is now experiencing a horrific COVID-19 outbreak. This means that that the COVID-19 virus will continue to circulate for months, raising the chances that it will mutate into forms that render vaccines ineffective.

One of the people working to close that gap is Dr. Seth Berkley, CEO of Gavi, an organization that promotes access to vaccines in developing nations. "At the end of the day, we're only safe if we're all safe," says Dr. Berkley, who is a native New Yorker. "Now with the variants and with what's happening in India, all of a sudden people are realizing that that really is true. Instead of thinking just about our country, our community, our family, we need to worry about what's happening in other places."

Dr. Berkley also leads COVAX, the initiative sponsored by the World Health Organization to manufacture and distribute vaccines to developing nations. COVAX's goal is to vaccinate health care workers and vulnerable populations in the poorest nations by year's end. The outbreak in India and a suspension of vaccine exports from that country has disrupted those plans. Although COVAX has fallen behind schedule, Dr. Berkley is hoping to make up for lost ground. Much depends on whether wealthier nations decide to donate their excess supplies of vaccines and help out in other ways.

Dr. Berkley spoke with Newsweek about the challenges the organization is facing and when the global pandemic will be brought to heel.

Dr Seth Berkley
Dr Seth Berkley wants to vaccinate the developing world. GAVI

Newsweek: What is your day like?

Dr. Berkley: We're in intense problem solving mode. We started from no money, no people, and really had to build it all moving along. I was really surprised how few standardized features were in place, despite having had previous pandemics. We just don't have a lot of [vaccine] doses now and that's what we're struggling trying to solve.

Is the Serum Institute in India your main vaccine supplier?

When the problem happened with India, we were counting on them for very large volumes for the poorest countries, because they have very good prices. When that stopped, that really challenged us. Right now we are 140 million doses short and next month it'll be 190 million doses short.

The Biden administration recently threw its support behind suspending vaccine patents during the pandemic. Would that help?

We really welcome the idea that the U.S. is willing to use any and all mechanisms to increase equitable access. But even more important was the announcement that they would work towards increasing raw-material production, which will have an impact on alleviating the current global supply constraints. We have facilities sitting idle because they couldn't get basic equipment.

Intellectual property is not a major factor for vaccines. The really big factor is know-how—you need to transfer intellectual property, but you have to have the know-how to use it.

What kind of know-how are you talking about?

Seventy-percent of vaccine production is quality assurance and quality control. You have to show that every time you do the process [of making a vaccine] that it's exactly the same as the original vaccine that showed the results in the clinical trial. You have to help work through the problems and issues as you try to scale up to thousands of steps that are necessary. The best way to do that is to have companies work together as partners and to be able to share all the information and assets.

The rise of variants has people worried. Has that affected your work?

It should have people worried. The more the virus is circulating unrestrained in large numbers of humans, the more variants we're going to see.
Many of the companies we're working with have started working on new variant vaccines. We're having to pay attention to this and make sure we have agreements with industry to give us access to them.

Have you sent extra vaccines to hotspots like Brazil?

We sent a second round of doses to Brazil this week and we're sending more next week. But to be honest, our goals are to cover the high risk groups everywhere. Our belief is that every healthcare worker in the world ought to be vaccinated.
If you're chasing all of your doses for the places that have the big epidemics, you're not preparing for the next place that is going to get the epidemic. What you really want to do is reach parts of a country that doesn't have the big infections now but may in the future. It's about trying to cover the whole world.

Healthcare workers and high risk people comprise the 20 percent you're aiming for?

That's correct. The 20 percent was never a ceiling, it's really a floor. It seems now that we are likely to get above 20 percent—maybe the 30 percent—by the end of the year, which would be about 50 percent to 60 percent of adults in the low income countries. But that depends partly upon supplies and whether India gets back in the game or not.

Is vaccine hesitancy an issue for your program?

In general, the vaccine hesitancy we have is usually worse in the West and better in developing countries. Prior to COVID, the country that statistically had the highest vaccine hesitancy was France and the one that had the lowest was Rwanda. One reason developing countries want vaccines so badly is because they still see many diseases. In the West, vaccines are so effective that people think these diseases don't exist anymore.

How long is it going to take to get the pandemic under control globally?
The challenge is to get the world to understand that this as a global problem. It's important for places like the U.S. to say this isn't a humanitarian thing or a charity thing, this is global health security. We're only safe in the U.S. if the rest of the world is safe. We can't do travel and tourism if new variants are going to appear. And you can't put a wall up. Variants move around the world in very short periods of time.

The U.S. will pretty soon have enough vaccines. You will have gotten the people who are waiting on lines to [get vaccinated], and you'll have to go into communities and find [people] and convince them. So, the vaccination rate will slow down.

The U.S has built up stockpiles of AstraZeneca and Novavax vaccines. If they can take those vaccines and make them available to the rest of the world, that'll have a dramatic effect on tamping this down.

What lessons should we take away from this pandemic?

It is evolutionarily certain that we will have more outbreaks.
During this pandemic, we have delivered vaccines two and a half times quicker to eight times the number of countries, 20 times the number of doses than during the last pandemic in 2009. But it's not good enough, for all the reasons we just talked about.

We've seen $12 trillion worth of [gross domestic product] lopped off. We've seen more than two and a half million deaths across the world. We've seen the whole world grind to a halt. I hope that when we come out of this, we keep in mind that with global warming, with desertification, with intense urbanization, with population growth, we are going to have more outbreaks. If we know that's true, then let's prepare for it.