The pandemic is splitting in two. In the United States, case numbers have plummeted, thanks to a remarkable vaccine rollout. For the first time since the pandemic began, I didn’t see a single COVID-19 patient during my last shift in the New York City emergency department where I work. As emergency physicians, many of us spent the last year at the epicenter of this pandemic. We never want to be there again.
Explore This IssueACEP Now: Vol 40 – No 06 – June 2021
More than ever, people now recognize emergency physicians for our hard-earned frontline expertise. Colleagues, friends, and relatives are likely to ask you what we can do now to help bring the COVID-19 pandemic to an end worldwide so that the smallest number of people are harmed and we don’t end up facing a new wave of infections that are impervious to our vaccines.
The answer: We must keep advocating for public health, even though the gravest risk to our fellow Americans is, we believe, in the past.
While COVID-19 caseloads have declined in the United States, our colleagues in emergency departments around the world are being tested harder than ever before. In the last few weeks, there were more new COVID-19 cases worldwide than the entire first six months of the pandemic. Tragically, there will be more COVID-19 deaths in 2021 than in 2020.
Despite this, only 0.3 percent of all COVID-19 vaccines are going to low-income countries. The vast majority of doses are going to wealthy countries like the United States. Global vaccine inequity is profound. Approximately 75 percent of all vaccine doses administered have occurred in just 10 countries. Some countries have yet to receive a single dose to date.
Now that we’ve vaccinated a large percentage of the eligible population here, we need to think about how to help vaccinate the world. President Joe Biden has vowed the United States will provide an “arsenal of vaccines” for the world. There are significant humanitarian, public health, and economic reasons for the United States to lead the global effort, even as the pandemic ebbs here at home.
The United States has already made some laudable commitments. Recently, the White House announced it would send 20 million doses of the three Food and Drug Administration–authorized vaccines (Pfizer-BioNTech, Moderna, and Johnson & Johnson) abroad by the end of June. That comes in addition to 60 million doses of AstraZeneca vaccine (which is not currently authorized for use in the United States). Furthermore, the United States has been the largest financial contributor to COVAX, the global vaccine equity effort spearheaded by the World Health Organization.
But we can and must do more.
What We Can Do
The pledge to donate 20 million doses by the end of June seems like a nice gesture, but in reality, it’s inadequate. Twenty million doses barely exceeds what the United States allocates to all of its states and territories in a single week, and it’s only a small fraction of the 1.3 billion doses for which the United States has secured supply contracts, more than any other country in the world.
We don’t need to wait until the end of June to do this. The United States is already sitting on a surplus stockpile, and the vaccine supply chain has been remarkably reliable in recent months. We should deploy these doses now, with a focus on getting our health care worker colleagues around the world vaccinated. Already, 115,000 of our colleagues have died from COVID-19. Any further delay will only add to that grim toll.
You also may have heard of another move toward vaccine equity pertaining to intellectual property. In May, after mounting pressure, the Biden administration announced to the World Trade Organization that it would be enacting a temporary waiver on intellectual property protections—known as Trade-Related Aspects of Intellectual Property Rights (TRIPS) waivers—for coronavirus vaccines. This move fulfilled his campaign promise to not allow patent protections to stand in the way of expanding global vaccine supply and will make it easier for countries to expand their own domestic vaccine-manufacturing capabilities.
A waiver on vaccine intellectual property is important for increasing global vaccine supply, but even that is not sufficient in itself. Since October 2020, South Africa and India have argued that protections on proprietary formulas and technology are also inhibiting access to lifesaving therapeutics and vaccines. More than 100 countries have heeded their call and offered support.
To make an impact in the medium term, the United States must also help facilitate the transfer of technical know-how so that others can produce the vaccines themselves—instead of relying on handouts from wealthy countries. Unsurprisingly, pharmaceutical companies have vigorously resisted this, on worries that these tech transfers would impact financial returns from any future vaccines built on the same technology.
These are legitimate concerns. But seeing as the U.S. government bankrolled vaccine development in one case, and served as a guaranteed buyer in others, and many of our health care colleagues may otherwise not have access to a vaccine until 2022 or even 2023, now is hardly the time to prioritize the bottom line over public health priorities in a pandemic.
With an eye towards the future, the United States should help build manufacturing capacity in other countries where vaccine production capacity is limited or nonexistent. For example, in Africa there are 1.2 billion people but only 10 vaccine manufacturers. Only 1 percent of all vaccines administered on the continent are manufactured there.
The Africa Centres for Disease Control and Prevention (Africa CDC)—itself a product of a partnership of the African Union and the U.S. Centers for Disease Control and Prevention—recently announced plans to establish five new vaccine-manufacturing centers across the continent. At a recent summit hosted by the African Union and Africa CDC, leaders committed to increasing the percentage of vaccines manufactured in Africa from 1 percent to 60 percent by 2040. The United States must be a partner in helping Africa achieve that goal.
As we start seeing friends and family again here in the United States and our emergency departments fill with our regular pre-pandemic patients, it will be all too easy to forget that the COVID-19 pandemic is still raging around the world.
Here in the United States, we like to point out how we’ve donated more money and more vaccine doses than any other country. Even if that’s true, the reality is that just doing more than others isn’t enough.
By donating surplus doses, supporting the transfer of the technical know-how needed to produce vaccines, and helping expand manufacturing capacity around the world, the United States can help end this pandemic and better prepare the world—and ourselves—for a safer future.
Dr. Spencer is director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center and assistant professor of emergency medicine and population and family health at the Columbia University Medical Center in New York City.