The Additional Lessons Should Be Taken In The COVID-19 Pandemic, except for Bill Gates’s Suggestions – (4)

This is Part 4 of this article. Read the last part here: Part 3

4. Vaccine Shortage in low-income and middle-income countries

Unlike rich countries such as the U.S or the U.K, many poor countries didn’t have enough vaccines. Distributing vaccines globally has been a problem since the vaccines were rolled out.

In an article named Why The Pandemic Isn’t Over Yet, Associate Professor Karen Levey emphasizes the importance of distributing vaccines globally. She explains that the virus needs a susceptible host and a way to travel to the next host. With each person who gets exposed or vaccinated, the number of susceptible hosts dwindles. She wrote, “We watch in horror as the virus ravages India, and to some, it may seem like a distant threat. But every new case offers another opportunity for a new variant to emerge and spread worldwide…..That is why global access to vaccines is not only a moral imperative but also the only way to outsmart the virus.” ^[1]https://theconversation.com/think-like-a-virus-to-understand-why-the-pandemic-isnt-over-yet-and-what-the-us-needs-to-do-to-help-other-countries-161400  One article in Scientific American which I quoted earlier and talk about the same topic also conveys the same perspective: Distributing vaccine globally is the way to outsmart the virus. It wrote, “The question of how the pandemic plays out is at least 50 percent social and political. The other 50 percent will probably come from science…Unless a vaccine is administered to all of the world’s eight billion inhabitants who are not currently sick or recovered, COVID-19 is likely to become endemic.”^[2]https://www.scientificamerican.com/article/how-the-covid-19-pandemic-could-end1/ 

Although Scientific American further provides good suggestions in the article by noting “It is not clear whether a vaccine will confer long-term immunity as with measles or short-term immunity as with flu shots…The end game will most likely involve a mix of everything: Continued social-control measures to buy time, new antiviral medications to ease symptoms, and a vaccine. The exact formula—how long control measures such as social distancing must stay in place, for instance—depends in large part on how strictly people obey restrictions and how effectively governments respond. For example, containment measures that worked for COVID-19 in places such as Hong Kong and South Korea came far too late in Europe and the U.S”, the article in Scientific American also stated, “The combination of vaccination and natural immunity will protect many of us. The coronavirus, like most viruses, will live on—but not as a planetary plague“^[3]https://www.scientificamerican.com/article/how-the-covid-19-pandemic-could-end1/ . This is an argument I don’t agree with. Like other flu, this pandemic could become seasonal flu, but it could also become a planetary plague. The possibility of becoming a planetary plague is not zero. Why? Because of possible mutations.

In Bill Gates’s book, he states, “Early in the pandemic, there was a broad belief in the scientific community that, although there would be some mutations of COVID, they wouldn’t cause a big problem…..Some scientists hoped that the world had already seen the worst mutations that the virus was capable of. But the Delta variant proved otherwise—its genome had evolved to make it far more transmissible.” He notes that “Every time a virus jumps from one person to another is an opportunity for it to mutate.” So there are possibilities that the virus mutates, and more importantly, the coronavirus already mutates multiple times during this pandemic. To understand deeper, you may read what History Of Vaccines writes. It states that DNA viruses do not change or mutate, much. However, RNA virus mutations are frequent and can have important consequences for their hosts. ^[4]https://historyofvaccines.org/vaccines-101/what-do-vaccines-do/viruses-and-evolution .

Is coronavirus a DNA or RNA virus? It’s a RNA virus. Swine flu(H1N1), SARS COV, and current COVID 19 (SARS COV2) are all RNA viruses ^[5]https://en.wikipedia.org/wiki/Coronavirus  ^[6]https://www.ias.edu/ideas/understanding-genetic-evolution-pandemic-h1n1-virus-0  ^[7]https://rcevi.cgu.edu.tw/p/406-1030-72565,r34.php?Lang=zh-tw . Therefore, a mutation of coronavirus is common.

After reading this, some of you will ask, isn’t SARS COV also an RNA virus? And it became the seasonal flu, not a planetary plague. True, SARS did become the seasonal flu instead of a planetary plague, and the SARS example is why many scientists thought the current COVID-19 could become seasonal flu just as SARS did. Science American’s reasoning is also based on the same point: Past endemics such as Swine flu and SARS COV all have become seasonal flu despite they are easily-mutated RNA viruses. Nevertheless, I want to point out that the result of past events doesn’t mean that the current COVID-19 will 100% become seasonal flu. There is still a possibility that there is a mutation that causes severe symptoms and is able of escaping the current vaccines’ attack.

Does natural immunity from your immune system help? According to Scientific American, “in most cases, antibodies developed by the immune system to fight off the invader linger in enough of the affected population to confer longer-term immunity and limit person-to-person viral transmission. But that can take several years, and before it happens, havoc reigns ^[8]https://www.scientificamerican.com/article/how-the-covid-19-pandemic-could-end1/ . ” This means more people will die before the majority of people develop natural antibodies inside their bodies. Vaccines are still necessary.

Although in Bill Gates’s book, he wrote, “Countries that do the best job of suppressing the virus early on will often be susceptible to later surges, because their suppression measures kept people from getting sick and developing natural immunity”, Bill Gates also said,” The aim is to use suppression to delay widespread infection until there are vaccines to protect people. But if an especially transmissible variant shows up before vaccines are widely distributed, and if suppression measures are ended, then a big wave is almost inevitable.” India is a good example. Before vaccines became available in India, many people didn’t wear masks and do actions that prevent the infection (the responsibility that people didn’t do that should go to the Indian government), then the Delta variant emerged in India. After then, people around the world become in need of a booster shot to prevent Delta. In my view, Delta is a good example of the possibility that there will be more variants that cause severe symptoms and the current vaccines won’t help as the new variant outsmarts the vaccines. So distributing vaccines globally to every country on the planet, just as some scientists said, is very important.

Let’s talk about another example, the Omicron variant. In November 2021, Omicron occurred in South Africa. This is potentially a good case of both the breakthrough case and the vaccines-aren’t-distributed-globally case. Omicron variant was first reported “This family of omicron subvariants transmits more effectively than any other variant we’ve seen so far. They evade a large portion of the vaccine-induced immunity; you’re protected from the severe disease, but can get infected” ^[9]https://publichealth.jhu.edu/2022/an-omicron-vaccine-may-help-curb-the-spread-of-this-game-changing-variant . You just saw how a virus can mutate if it mutates. As for the reason why Omicron occurs? According to Scientific American, the vaccinated population is low in Africa. Michael Head, a scientist, also wrote in Scientific American, “this new variant is a consequence of vaccine inequality in parts of Africa.^[10]https://www.scientificamerican.com/article/omicron-is-here-a-lack-of-covid-vaccines-is-partly-why1/  “

Bill Gates also wrote in his book, “Relatively few people in Vietnam were vaccinated for COVID—partly because of the limited supply of vaccines, and partly because vaccines didn’t seem as urgent when the country had done such a good job controlling the virus…The Vietnamese government saw no need to stockpile vaccines early because of the recent low infection rates. Instead, the government invested in homemade vaccines.” Though Vietnam’s government did make some mistakes, according to Bill Gates, he also points out a limited supply of vaccines is also part of Vietnam’s slow vaccination problem. In another article that discusses the same problem, the author wrote, “But the blame does not lie with Vietnam alone. Rich countries can pay higher prices for vaccines and are accused of “hoarding” vaccines, leaving poorer countries facing a dire shortage. Canada, for example, had bought enough vaccines to vaccinate its entire population five times. Although this appears to have changed in recent months (e.g. the USA announced in June its intention to “share” vaccines), this has led to a structural backlog of vaccines for poorer countries.” ^[11]https://e-visa.co.uk/vietnam/news/slow-vaccinations . Bill Gates also wrote, “Young, healthy people in rich countries who aren’t likely to get sick or die from COVID were getting vaccines before older people and frontline workers in poorer countries, who were at much higher risk”. Vaccine inequality is definitely a problem.

Solution Of Vaccine Inequality

(1) Local governments play a part in investing in research on vaccines and medicines

Vaccine inequality isn’t the only problem that low-income countries face in terms of healthcare issues. People in low-income countries have faced the problem that there aren’t companies developing drugs or medicines to cure specific diseases which only emerge in these countries. Bill Gates wrote the major root cause and the solution to this problem in the book, “The profit motive is often the most powerful force in the world for getting new products created quickly. It’s the government’s role to invest in the basic research that leads to major innovations”. ( I only cite a few of his words. The basic research that Bill Gates means is from non-state-owned companies, which pursue profit as their motive; above means, that local governments should invest in research from non-state-owned companies.) Bill Gates wrote, “Simply relying on market forces won’t do the trick. The world needs a plan for getting vaccine factories ready in advance and financing new vaccines. This plan should include money to prepare for vaccine trials and approvals, as the U.S. government did during COVID.” In my view, the solution that local governments should play a part in supporting basic research can apply to not only drugs or medicines for curing specific local diseases but also vaccines. It’s the local governments’ role to invest in the basic research in both medicines and vaccines – that includes local governments should play a role in getting local vaccine factories ready, and countries need to work together for getting vaccine factories ready.

(2) Help middle-Income and low-Income countries manufacture vaccines that rich countries developed

Except for support of developments of vaccines from local governments, Bill Gates also said, “The world’s vaccine plan should establish a way to allocate doses so they provide the greatest benefit for public health and don’t simply go to the highest bidders. COVAX was intended to solve this problem during COVID, but for reasons that were mostly out of its control, it fell short of its goals. The idea was to pool the risk that’s inherent in developing vaccines, with richer countries subsidizing lower-income ones. But rich countries essentially pulled out of that arrangement and instead negotiated their deals with.”

Due to the failure of COVAX to distribute vaccines globally, Bill Gates said in the book, “Sharing doses in itself is not a permanent solution—there’s little reason to think that rich countries will be more willing to do that in the future. How many politicians will tell young voters they can’t be vaccinated because the doses are going to another country, at a time when schools are still closed and people are still dying? That’s why I think that, rather than focusing primarily on reallocation, the more realistic approach is to focus on making more doses.” Explaining the detail of how to make more doses, Bill Gates said, “Except for waving Intellectual Property, methods for making manufacturing vaccine in middle-income and low-income countries more easily is important”. Such methods mean that support for the development of vaccines from local governments of low-income countries is still a suggestion; the world needs a plan for getting vaccine factories ready is also still a suggestion; nevertheless, Bill Gates suggests that helping local companies in middle-income and low-income countries manufacture vaccines that rich countries developed are also necessary.

(3) Manufacture all doses of vaccines and distribute them everywhere in the world

Bill Gates also describes another solution from the White House in his book, “TheWhite House published a smart plan with ambitious goals: Develop, test, manufacture, and distribute a safe, effective vaccine to everyone in the world within six months of recognizing a threat. If it’s a two-dose vaccine, that means producing some 16 billion doses”. This is certainly a good plan – just give vaccines to everyone in the world. However, it definitely failed at the time when the vaccines became available because there had been vaccine shortage problems in many middle-income and low-income countries. Bill Gates explains what to do in the future to manufacture all of the doses the whole world population needs in the book, including how to help other countries manufacture vaccines. Nevertheless, assuming that these measures are implemented, it’s possible that such measures are only implemented in some countries in the future, and the supply of vaccines is still not enough to meet the required volume of the world population. So what to do to avoid vaccine inequality if the supply is still not enough? One of the major ways to distribute vaccines worldwide is through COVAX, a mechanism found by three health organizations including the WHO. Nevertheless, according to The Conversation, “The U.S has already made substantial commitments to COVAX, a global collaboration to accelerate the development and manufacture of COVID-19 vaccines and guarantee equitable distribution. The U.S. could channel additional funds now and pressure other countries to do the same. Funding commitments to COVAX may be hollowwithout a concurrent plan to quickly distribute the vaccine stockpile the U.S. has amassed as we raced to buy up the first available doses.”  ^[12]https://theconversation.com/think-like-a-virus-to-understand-why-the-pandemic-isnt-over-yet-and-what-the-us-needs-to-do-to-help-other-countries-161400 . One article of VOX points out the problem is that even though rich countries joined Covax and pledged funds, most still made individual pre-purchase agreements with companies to secure their doses. Rich countries — with 14 percent of the world’s population — have bought up more than 53 percent of the vaccines. Georgetown global health law professor Lawrence Gostin told Belluz, “They (Rich countries) join Covax so they could proclaim to be good global citizens and at the same time rob Covax of its lifeblood, which is vaccine doses. ^[13]https://www.vox.com/22291086/biden-covax-united-states-covid-19-vaccinations-world-g7 ” Bill Gates wrote in his book, “The Pandemic Has Split in Two” ran a headline in The New York Times. ‘Zero deaths in some cities. Thousands in others. The pandemic’s fault lines continue to widen as vaccines flow toward rich countries ‘ “. Indeed, I agree with Bill Gates that there needs to be a plan in place to distribute the stockpile of vaccines that rich countries have, but I don’t think the need should be “concurrent”.

(4) Additional suggestion

So how? What kind of a plan should be used to distribute the vaccine stockpile rich countries have? Or more importantly, what kind of a plan should be used to make sure there isn’t a vaccine inequality problem when the next pandemic happens? The suggestions of Points (1) and (2) are all good suggestions; COVAX in Point (3) is good, too; however, I suggest some additional changes to ensure the plan of COVAX won’t fail again.

To ensure vaccine equality and the plan of COVAX won’t fail again, I suggest making an investment in research of vaccines and medicines, and vaccine distribution is part of the WHO’s mandatory job, not each government’s business; no country can buy excessive vaccines without the WHO’s consent, and every member of the WHO has to join the job of distributing such vaccines globally. What my suggestion means is not doing the same thing as what was done in the current situation: countries join COVAX and book excessive vaccines at the same time; what my suggestion means is that distributing the supply of such vaccines should be the job of the WHO, not that individual countries determine how much such vaccines they want to buy and just make the purchase with companies on their own.

How does this work out? First, the fund of the WHO should be used more on investing in promising medicines and vaccines, and distributing vaccines to “every” country – not only low-income countries but also rich countries. Second, since every member of the WHO pays its member fee, and part of the fund of the WHO is used on investing in promising medicines and vaccines, the WHO should play the central and the only role in purchasing and distributing vaccines globally and coordinate the demands from each country, including rich countries. What this central and only role means is that the distribution of vaccines against a virus raging globally should be done by only the WHO, not individual buyers. In this way, we can make sure that no country or no one will buy excessive vaccines and occupy other countries’ resources.

In detail, this suggestion means that the WHO uses its funds to invest in medicines and vaccines. If there is a pandemic happens, such an event should be treated as a special high-risk event. Because it’s a special high-risk event, no individual buyer except for the WHO can purchase the vaccines against a virus raging globally, and the WHO distributes “all” of the vaccines from companies around the world to “every” country, including rich countries. The WHO will coordinate each country’s needs and priorities in phases. For example, let’s set the time when a specific vaccine becomes available as Phase 1. In Phase 1, the priority is to get healthcare staff in every country including low-income countries vaccinated, not to get all of the populations in rich countries vaccinated. The WHO should calculate the demand of healthcare professionals in each country and coordinate the vaccine distribution – The WHO’s job is definitely done by the cooperation of all of the member states, and each country should definitely provide the necessary information and work with the WHO.

What about rich countries? With my suggestion that making the WHO the central and the only role to purchase and distribute vaccines globally, rich countries won’t have to spend as much money as they did in this pandemic for vaccines, because the money was already paid to the WHO; the WHO is the only one who can make a purchase of a vaccine that is against a virus raging globally and will distribute such vaccines to rich countries when a special high-risk event such as a global pandemic happens. What about another concern that rich countries will have? The concern is that rich countries always want to let their population get vaccinated first – that’s natural. Bill Gates’s concern – How many politicians will tell young voters they can’t be vaccinated because the doses are going to another country, at a time when schools are still closed and people are still dying – did make sense, too. Nevertheless, Governments of rich countries should educate their people that vaccines will be distributed fairly based on jobs and phases by the WHO, and before the whole world population is vaccinated, the best way to prevent getting infected is to stay home and continue remote learning. In addition to these, people should know that the way of equally distributing vaccines globally can be far better to control the global pandemic than selfishly making the population in your own country vaccinated. Why? As I describe in Point 1 and Point 4 of this article, part of the reason that the pandemic is still going on is that not enough population in the world get vaccinated to reach herd immunity – part of the root cause is certainly vaccine inequality as I explained above. If such education is made, I think fewer people will argue why they can’t be vaccinated.

5. Additional Advice For Creating GERM and the WHO’s Role For Future Outbreaks

Bill Gates also suggests creating an organization called GERM to do some jobs in countering global diseases. He wrote, “Although there are many organizations that work hard to respond to a major outbreak, their efforts largely depend on volunteers…..The only organization that sort of has that mandate, the WHO, has very little funding and almost no personnel dedicated to pandemics, relying instead on the mostly volunteer GOARN (A volunteer organization) “

In addition, Bill Gates also wrote, “WHO declared the disease a ‘Public Health Emergency of International Concern’. That’s an official designation under international law, and when the WHO invokes it, every country in the world is supposed to respond by taking various steps”. In my view, although every country would see the WHO as an authority and follow it, the result of this pandemic isn’t good enough – there are many problems; vaccine inequality is one of the problems.

Creating GERM is a good idea. However, I suggest that the responsibility of GERM, which should be put under the watch of the WHO, includes my idea of letting purchases and distributions of vaccines against a virus raging globally be one of the WHO’s jobs since I said it should be the WHO’s responsibility. Earlier I talked about the strict rule of the WHO as the only party who purchases vaccines against viruses raging globally should only take effect when a special high-risk event occurs. We can use the current terminology, ‘Public Health Emergency of International Concern‘, as the standard for a special high-risk event.

Life-Saving Equipment Distribution

Another problem that Bill Gates points out in his book is the shortage of life-saving equipment, “Get preventive equipment (such as masks), oxygen, and other lifesaving equipment to people who needed it. This wasn’t easy for anyone—even the United States struggled to acquire and deliver these things early on”. The current way is through the raised money from nonprofit organizations in low-income countries, which Bill Gates describes in his book.

Suggestion

Though even the U.S indeed struggled to acquire some equipment, I do have some suggestions. Getting masks and some medical equipment for everyone is much easier than getting vaccines for everyone. Compared to manufacturing vaccines, manufacturing masks and some medical equipment aren’t that complicated. Therefore, for low-income countries such as many countries in Africa, I would suggest the WHO and nonprofit organizations put resources into building factories and hire local people to teach people how to manufacture some medical equipment on their own. This can be done through local investment invitations from the WHO and nonprofit organization’s teachings on how to manufacture this equipment, or the WHO can work with local governments and let local governments build their national factories with a donation of money from the WHO and nonprofit organizations, or even the WHO can build factories on its own in low-income countries. This way will not only increase the volume of medical equipment in the world but also provide local employment opportunities and boost the local economy in low-income countries.

For the entire world, I would suggest the WHO regularly review the manufacturing capacity of masks and some fundamental or important medical equipment to cope with infectious diseases in every country on the planet, including non-WHO countries such as Taiwan. In this way, we can try to make sure every country has enough medical equipment such as masks to prevent transmission, and we can even create a plan and a communication mechanism to check what should every country do when one country run out of specific medical equipment, thus improving our readiness for future outbreaks (Note: Specifically discuss the suggestion of communication mechanism, in current time, the way is simply a country calls for help through media reports and diplomatic methods, then countries who are willing to do it will donate equipment. A communication mechanism is a better way. I will explain the reason in the next paragraph.) Either the WHO or GERM team which should be put under the watch of the WHO can do the above things I suggest.

A side note, in the future, when such a communication mechanism is established in the WHO, the WHO and nonprofit health organizations should work together to collect data from low-income countries. For instance, in Bill Gates’s book, he said right now a nonprofit organization, Gavi, helps countries gather data to measure the effectiveness of their work and make improvements. In the future, the WHO may need to collect data on low-income countries on its own. GAVI or other nonprofit organizations can focus on the remaining areas that the WHO hasn’t been able to reach. Or the WHO may need to request data collected by GAVI to evaluate the current control of an outbreak.

Read Part 5

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Chrissy Slora

The articles published in this website are all written by Chrissy Slora. Chrissy Slora aims to make people learn about how the world can be better and provide her intelligent and wise insight by writing about various topics from technology to issues happening in the world. Follow her on social media: Facebook | Twitter | Linkedin