By Noah Louis-Ferdinand, Voices for Vaccines Communications Coordinator
In the wake of a global pandemic, quickly transitioning into another outbreak, many of us are understandably wondering when the cycle of disease will end. Even highly vaccinated countries are struggling to combat infectious disease threats. But the current struggles of public health aren’t surprising. Pandemic prevention—instead of perpetual mitigation—is bound up with global health.
To help navigate the issue, I interviewed experts from The Task Force for Global Health about how to maintain investment in vaccine equity beyond today’s crises.
Global vaccination programs center around key organizations that direct the acquisition of vaccines and assist with their roll-out. Two main players are the World Health Organization’s (WHO) Expanded Program on Immunization (EPI) launched in 1974, and the more recent Gavi, The Vaccine Alliance (2000). Both rely on partnerships with a large number of organizations.
Experts I spoke with made clear the need for more advocacy. Dr. John Ward, who leads The Task Force’s Coalition for Global Hepatitis Elimination, points out that the cancer-preventing hepatitis B vaccine has been around for 40 years and costs only cents per dose (the WHO recommends that babies receive it at birth). Yet many people still lack access. Africa is the clearest example with only 10% infants vaccinated.
I also spoke with Dr. Victor Eboh who is a Task Force epidemiologist combating polio. We have a cheap, safe vaccine and yet, he said, “polio has been a public health emergency of international concern like COVID-19 or monkeypox.”
In this context, it’s not surprising that the pandemic brought new inequities. Eboh told me that his program spent decades training people to go door-to-door to deliver vaccines in parts of Africa where access to clinics is insufficient.
When the pandemic hit, limited healthcare capacity for this type of work was redirected to containing and treating COVID-19. Two years later the WHO reports that 25 million children did not receive their routine (non-COVID) vaccines.
Dr. Fabien Diomande, who directs polio eradication at The Task Force, told the New York Times that these crises play into each other and have changed the public health landscape: “It’s like we’re in a new world – [these] emergencies are not going to disappear.”
Equitable distribution of COVID-19 vaccines could have lessened disruptions. This was the intended role of the COVID-19 Vaccines Global Access (COVAX) program, said Dr. Alan Hinman, a vaccine expert who has served on the board of Gavi and advises The Task Force’s vaccine equity work.
“It was a good faith effort, but the wealthiest countries bought up pretty much all the vaccines,” he said.
He argues that there needs to be a decentralization of the manufacturing process with more production facilities in Africa and Asia. Global health advocate Chelsea Clinton put it succinctly: “we cannot donate our way out of this.” Decentralized manufacturing wouldn’t solve the whole problem but it’s clearly possible. For instance, most of the world’s measles vaccines are already made in India.
Adult vaccination programs are excellent models either for epidemic or pandemic vaccine delivery. Let’s say Ebola, dengue, pandemic flu. Suddenly a country has to deliver a lot of vaccines in a short amount of time…All these processes you build up to deliver the annual flu vaccine are not just similar, they’re the exact same capacities you need to deliver vaccines during a pandemic.”
If we’re going to improve local capacity, we have to act now. The Task Force’s Head of Respiratory Virus Prevention programs Dr. Joe Bresee, who oversaw a massive expansion of flu vaccination programs in the U.S. in the early 2000s, said global progress was episodic. Political leaders whose terms last only a few years rarely think about a problem 10 years down the line, halfway across the world. But we have the perfect opportunity.
“For the first time in history, every country in the world has adult vaccination programs at the national level,” said Bresee. “You have to make sure those programs don’t vanish once COVID goes off the front page.”
Having also helped lead the U.S. CDC’s response to the 2014 Ebola outbreak in Sierra Leone, Bresee sees a link between vaccine equity and epidemic control.
“Adult vaccination programs are excellent models either for epidemic or pandemic vaccine delivery,” said Bresee. “Let’s say Ebola, dengue, pandemic flu. Suddenly a country has to deliver a lot of vaccines in a short amount of time…All these processes you build up to deliver the annual flu vaccine are not just similar, they’re the exact same capacities you need to deliver vaccines during a pandemic.”
Conversely, letting individual countries struggle to effectively vaccinate their citizens makes global crises more likely. Eboh gave the example of antimicrobial resistance (AMR) as a looming threat for which there is not a simple answer. Routine immunization plays a role in combating AMR both directly (preventing pneumonia) and indirectly (reducing prescriptions and superinfections). But much of the world lacks access to vaccines, contributing to the problem.
Strong vaccination programs throughout the world would also help with already endemic diseases that easily cross borders. For example, in the U.S., up to 1.9 million people have a hepatitis B infection. This contributes to massive disability and medical costs but national vaccination isn’t enough. Because, like COVID-19, Hepatitis B and other forms of hepatitis are highly transmissible and incredibly common around the globe.
“Hepatitis B is an excellent example of how improving health globally improves the health of the United States,” said Ward.
That means we should all be thinking about advocacy. August is National Immunization Awareness Month in the U.S., a time when The Task Force’s Voices for Vaccines (VFV) program leverages social media to share accessible information. As the Communications Coordinator for VFV, I encourage every expert I meet to leverage social media’s high potential for equitable education. We make in-depth explainers, interviews and other materials available to anyone.
I very much agree with Courtenay Dusenbury, The Task Force’s Global Affairs Director, who told me she defines health equity in terms of access not only to vaccines but also information, listing public health education as an essential service. Likewise, Ward describes his own work as “putting the best evidence on the table and bringing the public along.”
Public awareness is, of course, the cornerstone of policy change. Hinman noted that the public’s tax dollars go toward all sorts of things that make up the U.S.’s ‘felt presence.’ As citizens we have a say in what gets prioritized and global health equity should be part of our standing concerns.
“People should advocate to their representatives to ensure equitable access to new public health measures,” he said.
Amid two global outbreaks, now is the time for everyone to do their part in shifting public attention and awareness towards the need for vaccine equity.
