Yale experts weigh in on how inequitable vaccine rollout may have allowed for Delta variant and cost human lives
COVID-19 has exacerbated existing inequities in global health, with an especially high toll on developing countries.
Regina Sung, Photo Editor
As health leaders across the world have attempted to respond to the COVID-19 pandemic, major inequities in pandemic response and the global vaccine rollout have emerged, according to Yale public health experts.
Over the course of the pandemic, the virus has exacerbated existing disparities and taken a disproportionate toll on developing countries. Although the development of vaccinations for COVID-19 has been a successful effort, the distribution of vaccines to the global community has become a new source of inequity in the pandemic response. While the United States has begun distributing booster shots to healthy individuals, some nations have yet to immunize large swaths of their populations.
According to Saad Omer, director at the Yale Institute for Global Health, several factors have caused some countries to be disproportionately affected by the pandemic. While some of these factors are somewhat random, such as the emergence of new variants, others are more preventable.
One uncontrollable factor in these discrepancies is the variance of countries’ population structures. Because older populations are more vulnerable to SARS-CoV-2 infection, countries with more elderly populations are at higher risk of more lethal outbreaks. Omer noted that this includes the United States, as the average age of the population is older than much of the developing world.
Another key factor that Omer discussed was a country’s ability to implement and facilitate nonpharmaceutical interventions, such as social distancing. He pointed to New Zealand, Singapore and South Korea as countries that have been successful with implementing aggressive contact tracing and quarantine measures.
Over the past year, Omer said that the most robust indication of inequity worldwide has shone through in the varying success of immunization programs, which is determined by the availability and distribution of vaccines. Among developing countries, the biggest challenge has been a lack of supply.
According to Shan Soe-Lin, a lecturer at the Jackson Institute for Global Affairs, the emergence of the Delta variant may have been preventable if vaccines had been distributed in a targeted manner. She said there is a major difference between the vaccination rates of wealthy and developing countries, and called it an inequity that may have cost human lives.
“If COVID vaccine distribution had been done in a rational way on a global level, and with the ultimate goal of protecting as many human lives as possible, not just American lives, distribution would have been done in a really different way than it currently was,” Soe-Lin said.
Omer noted that addressing supply issues would not eliminate the need to also focus on vaccine distribution and acceptance, which have been major barriers to immunization in the United States.
Soe-Lin agreed that the willingness of a population to comply with pandemic response measures is an important factor in the toll the pandemic takes on any given country. In some countries with limited health care resources, a willingness to comply has helped to overcome existing disparities, she said.
She added that it’s not too late for health leaders to take an equitable approach to vaccination rollout.
“When we’re thinking about the health of our population globally, there is the moral imperative to protect and vaccinate people whether they’re here in the United States or whether they’re abroad,” said Albert Ko, professor of epidemiology at the Yale School of Public Health.
Ko also warned of new variants emerging, and he said that the biggest risk would be the emergence of a variant that can resist the immunity conferred by natural infection or vaccination. According to Ko, new variants are only able to emerge if they are given the chance to transmit and mutate uncontrollably.
Soe-Lin agreed that there is still a possibility of a new variant emerging, but she said that it does not seem very likely given that the Delta variant has been dominant for several months.
In addition to the risk of new variants emerging, Omer pointed out that there are economic consequences to the pandemic. These consequences include supply chain disruptions and the fact that economic disturbances in foreign countries will have an impact on the overall global economy, he said.
According to Omer, the next steps to address these disparities would be a donation program for existing vaccine supplies and increasing the production of vaccines in high income countries.
Soe-Lin also suggested increasing donations, noting that the surplus of vaccine supplies in countries such as the United States has led to vaccines being thrown out.
“The way that things are going, I don’t know if there was another pandemic whether we would do any better the second time,” Soe-Lin said.
One solution that Omer pointed to was the COVAX program implemented by the World Health Organization to promote equitable access to vaccines. This program would allow countries with a surplus of vaccines to share resources with countries that have less access.
According to Ko, China has been willing to share vaccination supplies with developing countries, while the United States and Europe have largely failed to meet the demand.
Omer also said that technology transfer to low- and middle-income manufacturers will be a necessary part of the global vaccination effort.
“People should realize that globally more people have died [since] the vaccines became available than before,” Omer said. “So that’s on us as the global community.”
Although the WHO has made efforts to expand the global supply — they have established an mRNA vaccine technology transfer hub in South Africa, for example — the implementation of these measures depends on the willingness of private entities to share their technology.
According to Omer, the Moderna vaccine would be unlikely to even exist without support from government scientists and a subsidized development process. Despite receiving government support to invest in a vaccine that can benefit the global population, the company has refused to broadly share its technology.
Both Omer and Ko said that Pfizer has also refused to cooperate with technology transfer programs. However, Ko said that Johnson & Johnson has agreed to share its vaccine technology with global manufacturers.
“History will judge us poorly if we don’t deliver on vaccines as a global community,” Omer said.
52.7 percent of the world population has received at least one dose of a COVID-19 vaccine, according to The New York Times.