Evolutionary pressures accompanying the spread of the coronavirus have driven the COVID-19 pandemic into a phase in which new variants are starting to pop up everywhere. In response, governments around the world are racing to vaccinate enough people to achieve herd immunity before the virus acquires a mutation that nullifies existing vaccines’ effectiveness. Sadly, in many emerging and developing economies, this race is being lost, leaving everyone vulnerable to new strains. But it doesn’t have to be this way.
The global deployment of COVID-19 vaccines has so far been an ugly free-for-all, with rich and large countries winning out. At this point, many emerging and developing economies probably will not achieve meaningful levels of vaccination until the end of this year, at the earliest. And many of these countries may never get vaccines that have already been pre-purchased, because manufacturers have massively overpromised what they can deliver. Worse, there is now a distinct possibility that the vaccines, even if they do arrive, will no longer be effective, owing to the proliferation of new variants.
But these delays and global-governance failures could yet be made into an opportunity. Because the situation calls for mass-vaccination drives on a global scale, such efforts could serve as a platform for ambitious international initiatives to improve health-system resilience, prepare for future pandemics, and work toward universal health coverage. The recent start of deliveries under the COVID-19 Vaccine Global Access (COVAX) mechanism for vaccine finance and deployment is very encouraging.
The stars are aligned for precisely such a global strategy. For once, health is atop the global agenda, with world leaders and finance ministers eager to listen. US President Joe Biden’s administration has brought hope of global leadership and proper funding for efforts to reach poorer countries.
Biden’s reversal of Donald Trump’s decision to withdraw the United States from the World Health Organization will provide much-needed authority and resources to that indispensable body. We must not squander this opportunity.
Vaccine deployment, with an emphasis on primary care for delivery, requires mobilizing a broad range of capacities, including transportation, storage, and logistics infrastructure. Moreover, most immunization systems are currently focused on delivering childhood vaccines and will need to be adapted to reach adult populations.
Governments are already drawing up national plans to deal with difficult questions such as which vaccine recipients to prioritize. Health officials are updating information and monitoring systems, identifying vaccination sites, targeting hard-to-reach populations, and preparing communication tools to address vaccine hesitancy and other challenges.
As a first step in establishing a more robust framework, the COVID-19 vaccination infrastructure should be retained to deliver vaccines against other diseases.
Many vaccination programs and health interventions have been postponed or put on hold as a result of the pandemic. We should now be looking for opportunities to reactivate them.
At a minimum, it is critical that health workers around the world be vaccinated against other illnesses such as hepatitis B and influenza.
Administering COVID-19 vaccines calls for upgrades to, or the creation of, delivery infrastructure, particularly for the vaccines that require cold storage chains. But to retain this infrastructure after the pandemic, it will have to be made sustainable. Introducing solar power into vaccine logistics chains and basic health units in remote areas could provide huge long-term benefits in poor countries with unstable power supplies or unreliable electricity grids.
Expanding immunization to adult populations also will require extra training. Here, we should be considering how digital platforms and artificial intelligence might be used to train health workers, volunteers, and non-medical personnel around the world. The same technologies could also be used to disseminate critical public health messaging against non-communicable diseases such as diabetes, or to expand smoking-cessation programs.
In the months ahead, governments and health-care providers will need to collect an extraordinary amount of information about who was vaccinated with what vaccine at what time. Vaccine registries will have to be upgraded or built from scratch, and modern digital infrastructure will need to be developed and expanded widely. Fortunately, these data banks can be enriched or synced with additional health information – possibly using blockchain technology to protect privacy – and then used to improve delivery of care, or to enhance disease surveillance and other preventive measures.
Finally, and perhaps most crucially, the COVID-19 vaccination effort could lead to more pharmaceutical production and even research in the emerging and developing world. India is already an important drug and vaccine producer, but the world will need even more regional production and logistics hubs, particularly if the COVID-19 virus becomes endemic, as many epidemiologists fear. Existing governance structures to prevent counterfeits and black-market activity will need to be reinforced.
Though this implies some up-front costs, it will yield long-term benefits for health infrastructure in these countries.
Making the most of the COVID-19 vaccination effort will require leadership at the highest level.
As the current occupant of the G20’s rotating presidency, Italy – now with Prime Minister Mario Draghi’s experienced hand on the tiller – could work with the United Kingdom, the current G7 chair, and the newly empowered WHO to seize the opportunities on offer. Now is the time to leverage the skills and financing capacities of multilateral development banks, non-governmental organizations, and the private sector.
The unprecedented speed with which COVID-19 vaccines were developed represents a signal achievement for humanity. With just a little foresight, we can leverage that success into equally impressive improvement in global health, longevity, and life satisfaction.