Ending COVID once and for all has to be a global fight

The United States has now surpassed 700,000 deaths in the COVID-19 pandemic and the vast majority of the more recent fatalities occurred among unvaccinated people. The challenge in the United States is no longer vaccine supply. Americans are now dying from a preventable illness due to a plague of misinformation and mistrust. At the same time many in under-resourced countries around the world are dying because they cannot access vaccines and COVID-19 therapeutics. 

This inequality in access represents a shared global public health threat. If we allow SARS-CoV-2, the virus that causes COVID-19, to replicate globally, not only will countless lives be lost to a preventable illness, but we risk the emergence of a new variant that can circumvent current vaccine and therapeutic tools that offer protection from one of the world’s deadliest outbreaks in modern times.

We have both worked in Africa. One of us managed the development programs of the U.S. Agency for International Development and the other researches and provides medical care for patients infected with severe viral diseases like Ebola, Lassa Fever and COVID-19. 

The World Health Organization reported that as of Sept. 30 only 4 percent of the people of Africa had been vaccinated. Far less have had access to monoclonal antibody treatments. In our view this isn’t just a humanitarian problem that affects Africa, it is also a threat to the well being of all people globally, even those who have been vaccinated. 

In the absence of a concerted global effort to ensure equal access to vaccines and therapeutics, we are enabling the virus to replicate, evolve and evade our current strategies of prevention and treatment. Two clear examples of this risk include the emergence of SARS-CoV-2 variants of concern, including the B.1.351 beta variant, which can evade neutralization by one of the currently available monoclonal antibody treatments, and the B.1.621 mu variant that carries mutations that may help it circumvent vaccine and infection-induced immunity. These variants are warnings of what lies ahead if we perpetuate the inequity in access to prevention and treatment strategies that exist today.

In his speech at the United Nations, President Biden committed the United States to further increase its contribution of vaccines to the international COVAX facility. Of the half billion Pfizer vaccine promised, 160 million doses have already been sent. Biden said he wanted the United States to be seen as an “arsenal of vaccines.” This is an important start as it will leverage contributions from other Western countries, but it is imperative that this access extends to both vaccines and therapeutics. 

At the same time the U.S. Centers for Disease Control and Prevention endorsed a recommendation that Americans over 65 and those with compromised immune systems were eligible for a third booster shot. The Director General of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, reacted strongly against the third dose plan, saying it will “make a mockery of vaccine equity” 

The reality is we don’t have to choose between booster shots here and initial shots there. A global pandemic requires a global solution and creating private-public partnerships between resource rich countries and biopharmaceutical companies can ensure increased vaccine and therapeutic production locally. The success of vaccines and therapeutics can no longer be measured just by safety and efficacy, but must also include access as well.

Despite the research that has been done on the threat posed by new COVID variants, more emphasis remains on national communities in the West. This pandemic can take new forms as variants emerge, and sadly, while diseases don’t respect national borders, access to vaccines and therapeutics too often do. It is time to create a global public health network for a global challenge.

Vaccines are being produced by commercial entities that are making billions of dollars. These companies have strongly opposed waiving the intellectual property restrictions (particularly, the WTO Agreement on Trade-Related Aspects of Intellectual Property Rights, or TRIPS) on sharing their formulas with other countries, even though the Biden administration has recommended they do so. 

COVID-19 is not going away and if history is any indicator of the future, more viruses are likely to emerge and once again threaten global public health. Over the past 20 years, we have witnessed the emergence and re-emergence of viruses with epidemic and pandemic potential including Ebola, Lassa virus, Influenza and three coronaviruses (SARS-CoV, MERS-CoV and SARS-CoV-2).  

If we are to be fully prepared for future outbreaks, we need to recognize that an outbreak anywhere is a threat to lives everywhere. The only effective response will require equal access to vaccines, diagnostics, and therapeutics.

J. Brian Atwood is a visiting scholar at Brown University’s Watson Institute and was the Administrator of USAID in the Clinton administration. Dr. William Fischer is associate professor of Medicine, Pulmonary and Critical Care Medicine and Director of Emerging Pathogens at the Institute for Global Health and Infectious Disease at the University of North Carolina.