Public Health Students to Fight COVID-19 Worldwide, Not Just at Home

Several high-income developed nations, including the United States, have now begun administering COVID-19 booster shots, whereas only a little more than 2% of people in low-income countries have received at least one vaccine dose.¹ This enormous and grim disparity perfectly illustrates how global health inequity has been further amplified during this pandemic.

It is safe to say that global health equity has not been the primary focus of most leaders of developed nations during this global pandemic. From the moment vaccines became available, wealthy countries have been hoarding vaccines—securing enough supply to vaccinate their populations several times over, even if it meant leaving poorer countries empty-handed.² As of January 2022, more than 4.8 billion of the world’s population has received at least one dose of a COVID-19 vaccine.³ However, only about 11% of the population in low-income countries have received at least one dose of the vaccine, compared to 78% percent of the population in high- and upper-middle-income countries.³ In fact, it is estimated that low-income countries won’t reach widespread vaccination coverage (60%–70% of the population) until 2023.⁴

“WHY SHOULD WE CARE ABOUT OTHER COUNTRIES?”

I am an international student from Estonia, and my family has been lucky enough not to experience these vaccine inequities. However, being a part of a diverse international student community in the United States, I have listened to my friends echo the feeling of living in another world. They are living and studying in a society where people are fighting against a free, lifesaving vaccine, and all the while they have friends and family back home who are literally dying because there are no vaccines to be had.

It is impossible to put ourselves in others’ shoes, but the pain they convey is extremely frustrating. I hear many Americans say a version of “Why should we care about other countries? We are okay as long as we are safe, right?” Wrong.

First, there is the obvious reason—we have a moral obligation to help. Low-income countries have fewer resources and poorer infrastructure with which to tackle the pandemic, which will increase the already deep inequality between developing and developed countries, as well as the inequalities within these countries themselves.⁵ The economic and social conditions in many developing countries is a direct legacy of Western imperialism. Is it fair to have the randomness of being born in a certain country decide whether someone receives a vaccine? I say no; health is a human right.

Second, poor vaccination rates in low-income countries could have a serious economic impact on the United States. It is estimated that this economic cost to the United States of vaccine nationalism is up to 1.38 trillion USD.⁶ Until the virus is under control in all regions of the world, the global supply chains and demand will be impaired, having an impact on the United States as well. The economic cost through fractured supply will be felt in sectors that rely on buying from international markets, such as the retail, textile, and automotive industries, as well as through declining trade and export, all of which in turn have an effect on consumer prices and even our salaries.

Third, we should not overlook the fact that while Western countries have been preoccupied with their domestic needs, China and Russia have been furthering their global influence using vaccine diplomacy—a type of soft power that aims to improve a country’s diplomatic standing through the use or delivery of vaccines. Before studying public health as a PhD student, I studied international relations and worked in embassies and intergovernmental organizations such as the World Health Organization and United Nations Human Rights Council, so I always look at the potential geopolitical ramifications of public health policy. China’s primary target has been Southeast Asia, which has already received nearly 500 million vaccine doses from China.⁷ Both China and Russia had previously been expanding their influence in the Western Balkans through energy, loans, and investments, and now, at considerable concern to the European Union, Serbia is manufacturing Russia’s and China’s vaccines, and expanding its own geopolitical importance in the region.

Last but certainly not least, there is a very real possibility of additional vaccine-resistant variants emerging from poorly vaccinated countries, which could draw the developed world right back into the depths of an uncontrolled pandemic.

MAKING GLOBAL VACCINE EQUITY A REALITY

Now that I have established the need for a global response, I will discuss next steps for the United States.

The Biden administration recently made a pledge to bring 500 million more vaccines to low-income countries. This brings the total US contribution so far to approximately 1.1 billion doses. However, we need far more to be able to vaccinate roughly half of the world’s population that has not yet received even a first dose.

The United States should further support COVAX—the global vaccine alliance that supports vaccine research, development, and manufacturing. Its primary focus is to ensure that low-income countries also get access to COVID-19 vaccines; however, it has been facing both funding and supply challenges and could use more backing from developed nations such as the United States.⁸

In addition, the United States can and should take a more proactive role in ensuring that vaccine development continues and manufacturing capacity is ramped up here. The White House could broker further deals between American vaccine manufacturers to share their technologies and collaborate on production. A successful example was set in March 2021, when the White House stepped in to broker a deal between a pharmaceutical giants Merck and Johnson & Johnson.⁹

But perhaps the most important thing to do right now would be to share the intellectual property used to manufacture the American vaccines with the rest of the world. Donating vaccines is great, but it is clearly not enough. It is crucial that we enable other countries to produce their own supply. Advocacy groups have been urging President Biden to pressure Johnson & Johnson to partner with drug manufacturers in the Global South, because they already have experience with producing the similar Russian Sputnik vaccine. Although the Biden administration supported the waiver on intellectual property earlier in 2021,¹⁰ action has stalled, and the administration has not asserted any serious pressure on US pharmaceutical companies to take substantive actions to increase global production capacity.

We all want to return to a normal life as soon as possible. For this to happen, it is crucial to produce and deliver more vaccines. Otherwise, it is very likely that the majority of low- and middle-income countries will remain unvaccinated longer than necessary, allowing COVID-19 and its negative impacts to lay siege to those countries with effects that will spill back to the developed world. We, as public health students and scholars, can all do our part by (1) creating more awareness of this critical issue by spreading the word about vaccine inequity in our respective communities and social media platforms, (2) writing to policymakers to implore Congress and the President to do more, and (3) initiating and fostering collaboration between public health students and faculty in high-income and low-income countries. Although the keys to solving the problem are in the hands of high-level policymakers, it is important to remember the power that the public holds—particularly in relation to putting pressure on the government. Public health professionals and researchers can and should be at the forefront of this movement.

More than 5.5 million people globally, with more than 800 000 of those in the United States, have died of COVID-19. How many more people need to die for us to stop making vague commitments and develop a real strategy? The pandemic won’t be over for anyone until it is over for everyone.