Medicine and health development is incentivized by economics. The narrative of the Ebola vaccine is a testament to this reality. While I have serious ethical and moral qualms with these drivers, I understand that economic incentives sometimes need to be leveraged to meet the needs of millions. This was how the Ebola vaccination was leveraged and how new technology used to develop the COVID-19 vaccinations were leveraged as well. However, despite relative success in vaccination campaigns against these two diseases, prioritization and rapid distribution of COVID-19 vaccination to the most at risk is lacking

Evident in the skepticism of the World Health Organization, businesses and governments alike, promising technologies and interventions are overlooked when the impacted population is small. Funding for such vaccinations against the most lethal viruses are lacking. Prior to the West Africa Ebola outbreak and subsequent infections of Americans, interest in Ebola was nominal at best. This was the case with SARS vaccinations as well — they both implemented VSV technology which proved very effective in animal trials but was rejected funding and opportunity for human trials. I suspect that neglect was due to a lack of prioritization. The global north was not affected by these diseases; therefore, research on them was not important. However, when the masses became at risk in 2014, specifically the wealthy, the technology was seen in a new light and vaccination was invested in. 

I find this increasingly frustrating from a global health and humanitarian approach. Humanitarian work stems off a deontological perspective. The concept of doing the most good for the most amount of people; all are looked at as equal with no life being valued more or less than another. This is obviously not the case as we observe the history of vaccination which has been known to be one of the greatest and most effective public health achievements of all time. Even now, vaccination for COVID-19 is more prevalent among the educated and wealthy. This is perhaps the most rapid and efficient vaccination process of all time. Yet we see a lack of vaccination in the global south. Why? 

If we are honest with ourselves, the answer is a lack of ethical conduct and an interplay of human selfishness. The countries that paid for the development of the vaccines, such as the United States, the United Kingdom and Germany, profit from their investment through deals made with manufacturers while some countries rely on COVAX/GAVI to distribute vaccines. As India and South America suffer from catastrophic COVID-19 surges, an ethical dilemma arises: is it just to have patents on life-saving vaccines during a worldwide pandemic? 

The question of ethics is not far removed from other vaccinations like polio that has been administered in the U.S. for upwards of 30 years but has yet to be standardized in Pakistan. The problem with vaccination is not its efficacy but a lack of priority. That is to say, there is a lack of priority to vaccinate marginalized and most at-risk populations. The emphasis is not placed on those that need it most, and unless there is a shift, humanitarian crises will continue to wax and wane as new pathogens emerge and are neglected. This pattern will continue until COVID-20 strikes or a new flavivirus targets the top 1 percent. Prioritization of vaccinating the most at risk for lethal diseases no matter the geographic location or demographic must occur. Else we will soon experience a pandemic more virulent and lethal than COVID-19.

Joseph Williams is a first-year MPH candidate in the Yale School of Public Health. His column 'Contemplating health' runs on alternate Thursdays.