A planet to vaccinate: the challenge of our lives
EcoCare Showcase is a series of articles, written by EcoCare executive, which explore issues and solutions relating to the global vaccination challenge. The first edition is entitled: "A planet to vaccinate: the challenge of our lives", co-authored by Dr Stephanie Goldhammer, EcoCare Chief Medical Officer, and Kaan Savul, EcoCare Head of International Cooperation and Global Affairs.
Mathematician Edward Lorenz once argued that the flap of a butterfly’s wings can alter the path of a tornado in a distant country weeks later.
We all – nearly eight billion of us – occupy a single planet and our fates are tightly interconnected. However much governments might close borders and impose lockdowns, viruses such as Covid-19 will find a way to circulate. It is short sighted, and ultimately futile, to seek to eradicate the virus in developing countries alone. The magnitude of the threat demands that humanity comes together with a coordinated response, undertaking possibly the most important global endeavour in modern times. Vaccinating the planet is truly the challenge of our lives.
It is to the credit of those at the forefront of the fight against Covid that, within a year of the virus’ appearance, multiple vaccines were receiving emergency use authorisation. Today, according to the World Health Organisation, almost 300 vaccines are at different stages of pre-clinical or clinical development. Yet it is to our shame that the geography of vaccine deployment has, to date, been so woefully unbalanced.
In August 2021, eight months after we saw those inspiring photographs of the first jabs into the first arms, 30 per cent of the world’s population has received at least one dose. But in most low income countries, this falls to around one per cent.
On a human level, this is a tragedy – as Bill Gates has said, “All lives have equal value.” It also fails the test for reasons of self interest. The developed world cannot isolate itself from the threat of a resurgence, especially from dangerous new variants, whilst the virus rages in other parts of our planet. None of us is protected until all of us are protected.
Analysis conducted by EcoCare has confirmed the scale of the challenge. Our estimates suggest there are 40 countries in which more than 25 million people are yet to receive a single vaccine dose, with the greatest concentration being in Africa (15 countries) and Asia (13 countries). As a result, the virus’ ongoing impact remains not far below its early 2021 peak. As recently as 6 August, new daily cases globally reached 698,000 (peak: 901,000), with daily deaths reported at 10,200 (peak: 17,400).
Not before time, political leaders seem to be waking up to the urgency of the situation. In June, the G7 leaders committed to delivering 870 million doses in pursuit of equitable access, with half provided by the end of 2021. Since that date, richer countries have been lining up to announce individual donations – for example, in July, the United States declared a gift of 25 million vaccines to countries throughout Africa in partnership with the African Union and Covax, with the first shipments destined for Burkina Faso, Djibouti, and Ethiopia. Similar initiatives have included the donation of a combined 3.5 million doses to Indonesia and Bangladesh from Japan, 415,000 to the Philippines from the UK, 500,000 to Ukraine from Denmark, and others too numerous to list.
Even the G7 commitment may not be enough – Tedros Adhanom Ghebreyesus, director general of the World Health Organisation, commented, “We need more, and we need them faster. Right now, the virus is moving faster than the global distribution of vaccines”. Non-government organisations are doing their best to fill the most serious gaps – the Bill and Melinda Gates Foundation has committed more than $1.8 billion, with $750 million earmarked to slow transmission and support responses in sub-Saharan Africa and South Asia.
Of course, scaling up the supply of vaccines is just one piece of a multidimensional jigsaw. Achieving so-called herd immunity through inoculating the population can’t happen if cool boxes are piled high in warehouses. Health ministers and international agencies must oversee fully integrated strategies, encompassing such priorities as:
Vaccine hesitancy remains a persistent obstacle¹, especially amongst populations that are instinctively mistrustful of government. A recent survey in Ghana suggested that hesitancy has risen from 17.2% to 28.5% over the past quarter. Recognising this issue, a number of governments have stepped up their communication efforts. The Philippines has declared that August is “Adolescent immunisation month” and the Kenyan government is using posters and videos to amplify the message. Elsewhere, measures have been enacted to reward those who have been jabbed with tangible incentives – for example, Asad Umar, who heads Pakistan’s National Command and Operations Centre, has announced that vaccination certificates will be required for those employed in a wide range of sectors, including air travel, schools, malls, restaurants, public transport and public sector offices.
Operational mobilisation and delivery
The risks involved in delivering a mass vaccination programme at scale are formidable. The vaccine product must be safeguarded to prevent theft, misuse or degradation – those which rely on ultra cold storage are especially vulnerable. Complex infrastructure must be established including testing centres, laboratory services, IT, data processing, and both stationary and mobile vaccination centres. Competent and experienced medical professionals must be recruited and mobilised quickly. Robust process flows must be designed and implemented, from appointment scheduling and confirmation, to the application of exclusion criteria, inquiries into symptoms, and documentation checks. Most significantly, all these factors must be operationalised at scale. Policymakers cannot be satisfied with rollouts that deploy a handful of small centres over a matter of months; in the world’s most populous countries, a leisurely pace would mean it takes years, not months, to reach critical mass. A ‘war footing’ mentality is essential to the task.
Leaving a legacy
Benjamin Franklin once said that, “Out of adversity comes opportunity”, and this holds true even with a global pandemic that has wrought untold damage to lives and livelihoods.
I believe that effective vaccination programmes, especially in low income countries, will not achieve their potential if they merely inoculate people against the immediate threat of Covid. We have the chance to raise our sights. Firstly, we must ensure that programmes don’t hit their targets by focusing exclusively on the major urban conurbations; distant rural communities and townships must also enjoy the benefits. Everyone involved should be encouraged to celebrate success, generating momentum, and taking pride in their accomplishments as societies. Most importantly, a positive public health legacy built upon an enhanced healthcare infrastructure must be secured, so that individuals, families and communities are more resilient in their daily wellbeing, not just to viruses and their variants but all forms of disease.
Sometimes, it’s tough to remain optimistic when you read about vaccination rates of under 2 per cent in many parts of the world. However, at EcoCare, we are seeing many positive developments.
Our footprint in 40 countries across all continents, and our recent participation in many vaccination programmes, means we have been involved in numerous conversations about the response to the coronavirus pandemic, and we’ve been struck by the passion and determination of many organisations – governments, charities, private sector, NGOs – to make a difference.
The key will be collaboration. None of us has a monopoly of wisdom or the resources to vaccinate the world on our own. At EcoCare, our strapline is “Fast and reliable”, and never has this been more applicable than as a driving principle for our collective vaccination mission.
1 Udani Samarasekera, Feelings towards COVID-19 vaccination in Africa, The Lancet, March 2021.