Vaccine apartheid is literally going to kill us

By S. Mitra Kalita

Vaccine apartheid is indeed upon us. 

Consider a March 22 email to Epicenter from a 69-year-old man in Germany who was ready to fly to New York City: “As you probably know, the rollout of the Covid-19 vaccine here in Germany has been incredibly slow and we have not yet received an appointment for our first doses.”

A few weeks later, on April 6, a direct message on Twitter from an immigrant wanting a vaccine for her mother back in Jamaica. No vaccines there either. What to do? 

And just this past weekend, came a plea from the U.S.-based daughter of a Toronto retiree. The mother’s second dose of Moderna isn’t until July and she wants to cross the border to get it earlier. 

Epicenter-NYC, a Queens-based community journalism initiative to help New Yorkers get through the pandemic, has increasingly been hearing from people all over the world in search of a Covid vaccine. The requests come as scary new variants of the virus surge in India, Brazil and other countries. India saw a record 350,000 new cases Sunday (with questions over the accuracy of that count) and Brazil has the second highest-global death toll at 380,000 (second only to the U.S.). Meanwhile, some countries, such as Haiti and Cuba, have no vaccines, and the U.S. has millions of doses it’s not using.  

To serve and cover Queens is to serve and cover the world. That feels especially true now so I sought answers to two basic questions: How did this happen? And what can we do to achieve greater vaccine equity and ubiquity? 

Signs of vaccine apartheid, even within the U.S.’s own rollout, have been around for months. We at Epicenter regularly chronicle the challenges of getting vaccines (see reporting from February, March and April) and how people of color and the elderly disproportionately face obstacles. Admittedly, my interest widened in recent days as the situation worsened in India, my parents’ and in-laws’ homeland. About a half-dozen members of our families had or have the virus; one, my aunt Rini, died. We’ve seen repeatedly that elements of taking the pandemic seriously — symptoms of  Covid, distancing measures, the vaccines themselves — feel theoretical until they become personal. In some ways, this too is at the heart of the problem and contributes to a disjointed response. 

On Sunday, April 26, the Biden administration vowed to help India secure raw materials for the manufacturing of vaccines, along with tests, oxygen, personal protective equipment and medical experts to be deployed. This came after days of Indians and their millions-strong diaspora around the world sounded alarm bells on social media and calls to lawmakers over a humanitarian crisis. 

This crisis continues to threaten the rest of the world, and thus all of us… 

How we got here

“It’s a brutal moment in history,” World Health Organization adviser John Butler told me. 

He goes on to recount the history that got us here: A system of many different vaccines and policies criss-crossing borders, even as the virus does not discriminate. 

Certain countries invest in different technologies, Butler says, and mRNA, the technology used in the Pfizer and Moderna vaccines, is new. Both mRNA vaccines are built on decades of federally funded research, and a half-dozen or so others (including Moderna) also received funding from what the Trump administration called Operation Warp Speed. 

How those vaccines were developed and why some countries got vaccines and others did not are best summarized in the following articles: 

Vanity Fair’s April 6 piece headlined, “‘We Are Hoarding’: Why the U.S. Still Can’t Donate COVID-19 Vaccines to Countries in Need”

Key excerpt: 

The contracts the Trump administration signed with the vaccine manufacturers prohibit the U.S. from sharing its surplus doses with the rest of the world. According to contract language Vanity Fair has obtained, the agreements with Pfizer, Moderna, AstraZeneca, and Janssen state: “The Government may not use, or authorize the use of, any products or materials provided under this Project Agreement, unless such use occurs in the United States” or U.S. territories.

And this earlier March 10 piece from the Washington Post Opinion section: “Poor countries may not be vaccinated till 2024. Here’s how to prevent that.”

Key excerpt: 

We are in the middle of another global health emergency. Two-thirds of WTO members back waiving patent rules during the pandemic, but the United States and others argue that patents are critical for innovation and are not slowing the global supply of vaccines. Neither is true. First, patents played little, if any, role in stimulating the “warp speed” development of Covid-19 vaccines. The Moderna vaccine was almost entirely funded by the U.S. government, with an additional $1 million donated by Dolly Parton. It is inappropriate for a private company to monopolize technology funded by taxpayers. Moderna itself recognizes this, having previously announced that it will not seek to enforce its vaccine patents.

I interviewed the op-ed’s co-author Madhavi Sunder, associate dean for international and graduate programs and law professor at Georgetown University Law Center, to find out more. Due to its origins in government funding, she says Moderna is known as “the people’s vaccine” and said U.S. taxpayers have the right to demand it gets shared with the rest of the world. 

The ingredients are less an issue than Twitter might be focusing on—but there is a key area where the U.S. could be helping more. “There are certainly supply chain problems. I don’t think those are insurmountable,” she said. “The harder problem is the issue of patents and tech transfer. In order to get a patent a company details how to make this invention. Unfortunately, drug companies have gotten good at being obscure about that description.”

Indeed, mRNA represents a new frontier of knowledge sharing, thus confounding governments. “With mRNA, it’s not enough to make the patent available,” she said. “It’s critical to share the know-how, the technology about how to make the vaccines safely and effectively.”

Drug companies are licensing to manufacturers where they are ensured there is a population who will eventually pay for those vaccines. But Sunder said, “most of the world cannot afford to pay. Incentives to private companies won’t be enough here—there is no incentive for them to make more vaccines for people who cannot pay. This is why we need the government, here, the Biden Administration, to say, ‘Hey, we paid for these vaccines, and our publicly-funded research is critical to your vaccines. You must share the technology with global manufacturers so we can safely end this pandemic as soon as possible.’”

Favoring those who can pay for the vaccine has a potentially deadly impact on those who can’t. It means those who can’t pay move to the back of the line, which could take years before they access a vaccine. “We are holding the knowledge hostage,” Sunder said. “We’re not supposed to use patents in that way. It violates international law. It violates morality.”

The undercurrent of all this is the “America First” mindset of the last administration—an illogical strategy against a virus that does not discriminate. But this crisis has been decades, even centuries, in the making. 

Policies rarely keep pace with people; their movement from one land to another was the defining characteristic of the 20th century, resulting in families and companies as borderless as the virus. While politicians might talk about taking care of their own populations first, for many of us, our loved ones are here and there (and perhaps a few other places, too). There’s no breathing easy until they can. The nature of a truly global diaspora and workforce does not feel captured in rhetoric around vaccine equity and distribution. If you want to see your grandmother again or grab a bulgogi burger at McDonald’s in Korea, we need to commit to the idea of everyone in the world being worthy of a Covid vaccine.

Indeed, the back-and-forth of immigrant populations also affects vaccine hesitancy. On Friday, April 23, Epicenter hosted a table at Diversity Plaza in Jackson Heights to help book our neighbors for vaccines and answer questions. An Egyptian man stopped by and presented his dilemma: He received his vaccine already and a two-month trip to Egypt to see family is imminent. His son, age 17, had not yet gotten the vaccine and can only get the Pfizer vaccine due to his age. We offered to schedule the teen in New York City, easily. But what about dose 2? When we told the father it didn’t look like Pfizer was available in Egypt and we were really recommending not messing with the timing on that second dose, he walked off. He said his son would just get the vaccine when he returns to the U.S. 

Certainly Russia and China—and their respective vaccines—are engaging in a certain diplomacy via their shots, ubiquitous in much of the developing world. By selling or donating the vaccines, despite initial questions over their efficacy and transparency, the two countries are unmistakably gaining goodwill. A woman in the Middle East recently told me she and her friends prefer to wait to get Pfizer, although it’s more expensive and harder to get. Headlines of the global elite taking “vaccine vacations” to Dubai abound. 

What you can do

• Give money to Covax

Some news we break: The World Health Organization plans to announce a fundraising campaign Wednesday, April 28, to fill “the growing vaccine gap between countries who can afford Covid-19 vaccines and those that can’t, and a desire by people everywhere to know what they can do to help end the pandemic.”

The campaign, called Go Give One, allows individuals, companies, charities and others to raise money for the global vaccine fund, known as Covax. While Covax, whose most famous backer is Bill Gates, has come under fire for favoring paying for the vaccines versus giving them (or the knowledge needed to make them) away, it is possible to donate to Covax even as you fight for the right of countries to make or access their own vaccines. 

Here’s a good primer on Covax, from the Associated Press. Key excerpt: 

Covax is only planning to provide enough vaccines to immunize about 20% to 30% of people in poorer countries — a figure that will still leave those nations vulnerable to coronavirus outbreaks. Experts estimate that at least 70% of a population needs to be protected against Covid-19 to prevent future epidemics.

Kate Elder of Doctors Without Borders called Covax’s first vaccine delivery to Ghana “a very small, late start” to global immunization. The charity suggested postponing vaccine shipments to rich countries  “while the world works to catch up on protecting the most at-risk people living in developing countries.”

• Talk to your family about vaccines.

No question, there’s vaccine misinformation spreading, sometimes from world leaders themselves. Immigrant communities, while often guilty (Exhibit A: the family WhatsApp group), also represent an opportunity to leverage networks to spread facts. One of our volunteers at Epicenter says he believes Brazilian immigrants in the U.S. better understood the need to get vaccines when they saw how bad things in their homeland were getting and how lucky they felt to be able to access them. 

As we have seen in the U.S., who chooses what vaccine depends on what they have heard about it and the experience of their friends and family. Serbia, for example, has access to many of the vaccines, and WHO’s Butler says it’s common to go with the familiar: “If lots of people’s friends got a particular vaccine, whether it be Chinese, American, Russian or from elsewhere, that is a major deciding factor on the choices people make.”

The word of mouth among families is strong and trusted. I have been sharing this one-sheeter from Dr. Celine Gounder, an infectious disease specialist in New York, on my own family and friend WhatsApp groups and social media. 

• Vet and give to these India-focused charities. 

Longtime public-relations veteran Lavanya DJ compiled this list of donation options in India, which has been growing every day. I asked her what prompted the list and she said, “I’ve known donating to Indian organizations is hard because of my experience trying to support Indian media outlets. Every time I find a publication that accepts international credit cards I share it on my Instagram. I figured as more people start to learn about the situation in India they will want to help and it’s not going to be easy.”

• Help beyond India. 

India’s own vulnerable population, and indeed, the rest of the world, are relying on Indian vaccine production so the Biden announcement is indeed significant. India has long been known as “pharmacy to the developing world” as one of the most prolific producers of inexpensive medicines for low- and middle-income countries. 

Every day is bringing worrisome news from Brazil, Peru, Bangladesh, Indonesia and others. Still other countries are saying their vaccine shipments are delayed, or nonexistent. We’re a global, interdependent economy and need to act like it. 

Join Epicenter, in partnership with ScrollStack, for a special livestream on Tuesday night at 9 pm EST (6:30 a.m. in India) as we try to get a better pulse on the ground and ways we can help other countries, too. 

• Demand better. 

Georgetown’s Sunder calls donations “a drop in the bucket” and advocated for more sustainable solutions to help countries vaccinate entire populations. “You teach them how to make the vaccines around the world and that helps neighboring populations and is empowering them to care for themselves.”

The inequities are hardly limited to just vaccines. This imbalance in global healthcare, of course, applies to heart disease or cancer, but even simpler diseases to treat or prevent. The World Health Organization is clear on this: “People living in a low-income country are far more likely to die of a communicable disease than a noncommunicable disease.”

Reach out to your elected officials to demand the healthcare system   you want. Says Butler: “I think health was seen as a cost and now it will be much more fundamental and foundational to everything we do.

“We already pay for this out of our taxes. And then we end up paying twice,” Butler said. “People get sucked into thinking, ‘The only way to finance innovation is high prices.’ That is not the case in these vaccines.”