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The coronavirus might not be the worst of it
The Washington PostDemocracy Dies in Darkness

Vaccines have never been distributed equally. A coronavirus vaccine would be no different, history suggests.


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In April 1955, an announcement echoed around the globe: American virologist Jonas Salk had developed a safe and effective polio vaccine. President Dwight D. Eisenhower, with tears in his eyes, thanked the researcher for work that would save the lives of countless children.

“The political leadership in the country did not consider this to be an American vaccine,” said David M. Oshinsky, a professor at NYU Grossman School of Medicine and the author of “Polio: An American Story.”

“They considered this to be a vaccine made by American know-how and American brilliance that was a gift to the world.”

That optimistic vision never quite came to fruition: Polio was eradicated in much of the world decades ago, but wild polio transmission still occurs in a few countries. And nearly 50 years down the line, the tone has shifted.

Amid the coronavirus pandemic, which has left more than a million people dead, the race for a vaccine gains new urgency every day. But some people can hope for a dose much sooner than others, depending in part on where they live, as countries turn to “vaccine nationalism.”

Many public health experts warn that vaccines are best distributed according to need, not nationality. “It is in our interest for our health security to try and help other countries to get rid of their covid-19 outbreak,” said Walter A. Orenstein, associate director of the Emory University Vaccine Center. But the world appears to be heading in a different direction.

Creating a new vaccine can involve thousands of people over several years. Here's what it takes to produce a new FDA-approved vaccine. (Video: The Washington Post)

On Monday, a glimmer of hope for an eventual return to normalcy emerged: U.S. pharmaceutical company Pfizer announced that its coronavirus vaccine, developed with German biotechnology firm BioNTech, was more than 90 percent effective in initial trials.

Wealthy countries including the United States and Britain have poured millions of dollars into various vaccine trials. China and Russia have already started to administer their own vaccines — the efficacy and safety of which health experts say remain dubious.

The United States under President Trump has indicated that sharing is not a priority. The Trump administration refused to join Covax, a global effort to develop, manufacture and equitably distribute billions of doses of a vaccine by pooling money to invest in a slate of vaccine candidates.

More than 150 countries including China have joined Covax, but many are pursuing their own plans in parallel. So far there is no mechanism in place for rich countries to distribute their surplus vaccine doses. President-elect Joe Biden, set to assume office in January, has not said whether he would join the effort.

Wealthy countries have bought up a major share of the available supply, my colleagues Emily Rauhala and Joanna Slater report.

“The United States, the United Kingdom, Japan and Canada have struck deals large enough to vaccinate their entire populations. By contrast, a pooled global effort to distribute vaccines equitably to more than 150 countries — including dozens of low-income nations — has secured only 700 million doses,” Slater writes.

“From a historical point of view, what you’re seeing is actually not an anomaly,” said David P. Fidler, an adjunct senior fellow for cybersecurity and global health at the Council on Foreign Relations. “I can’t think of a single time where there has been a mechanism that has globally distributed vaccines or drugs on an equitable and accessible sharing basis.”

In 2009, when H1N1, known as swine flu, was sweeping across the globe, the United Nations urged wealthy countries to make more vaccine doses available to needier countries. Nations including the United States, Brazil and France had pledged to contribute 10 percent of their national stockpiles to U.N. vaccination efforts. But in October of that year, U.N. officials said that was not enough.

“The challenge … is to build up the solidarity between wealthy nations and poor nations to ensure that adequate vaccine is made available,” said David Nabarro, the U.N. coordinator for fighting new emerging flu varieties, at the time.

Weeks later, the United States, facing unexpected shortages, backtracked on its promise. “I can tell you at this point the priority is getting the vaccine to citizens in this country, and that’s what we’re working on 24/7,” Kathleen Sebelius, then U.S. secretary of health and human services, was quoted as saying.

Another recent example tells a similar story: Inequality poses obstacles for vaccine-related cooperation. When the world was scrambling to develop a vaccine for H5N1, or avian flu, which began spreading significantly among humans in 2003, countries including Indonesia, which reported the highest number of cases in the world in 2006, shared some of their viral samples with WHO-affiliated laboratories. But in 2007, Indonesia declared “viral sovereignty,” announcing it would stop sharing specimens after discovering some samples had been shared with a non-WHO-affiliated Australian lab without its consent.

Indonesia argued that samples it and other hard-hit poorer countries were giving to labs for free were being exploited by labs in richer countries to develop vaccines that Indonesia would ultimately struggle to afford.

“We cannot share [virus] samples for free,” Lily Sulistyowati, a health ministry spokesperson, told Reuters that year.

In the cases of both H1N1 and H5N1, outbreaks petered out before a vaccine became essential, and no equitable sharing system was put in place. The crises laid bare a legacy of inequity that the world has not moved to correct through durable processes or institutions.

“Public health tends to be a victim of its own success,” Fidler said. “The H1N1 crisis did signal the need for building some type of permanent mechanism, so that when the next pandemic came around we didn’t have to create some ad hoc thing. But that’s what Covax is — it’s an ad hoc effort.”

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