The Peril of Not Vaccinating the World
When Gregg Gonsalves was a young aids activist and researcher, in the nineteen-nineties, he was struck by a pattern that kept showing up in the data: the distribution of antiviral medications fell neatly along socioeconomic and racial lines: wealthy people got them, and poor people, many of them Black or Hispanic, did not. Later, as an associate professor at the Yale School of Public Health, Gonsalves illustrated the persistence of these kinds of health disparities to his students by overlaying a map of pre-Civil War slave-holdings on a contemporary map of life expectancies, which, not surprisingly, showed that life expectancy was lowest in those regions. “It’s not rocket science that we’re seeing covid-vaccine distribution following those same demographic patterns,” he told me. “We’re just remaining true to form.” According to a recent analysis of C.D.C. data by Kaiser Health News, only twenty-two per cent of Black Americans have been vaccinated, and Black vaccination rates are significantly lower than those of whites in almost every state. Much of what has been called vaccine hesitancy is actually a problem of vaccine access.
As it turns out, vaccine distribution follows a similar socioeconomic pattern all over the world, with most covid vaccines going to what are called high- and middle-income countries. According to Nature, as of mid-March, those countries had secured more than six billion out of 8.6 billion doses. Less than a week later, the Times reported that “86 percent of shots” that went into arms across the globe were “administered in high- and upper-middle-income countries.” By early May, when less than eight per cent of the world’s population had received one dose, the Open Society Foundation estimated that the world’s poorest countries may not be able to vaccinate their populations until 2023. This disparity—what Gonsalves and others are calling vaccine apartheid—is a problem that will not be borne solely by the people living in those locales. It has the potential to undermine the gains made on the virus in places where vaccine adoption is high and a post-pandemic future is starting to feel possible.
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There are two reasons that a person in London or Los Angeles should care about vaccination rates in Lagos or São Paulo: simple humanity and simple biology. If left unchecked, the loss of human life for families and societies worldwide will be staggering. Viruses are international travellers, and over time they mutate. Wherever vaccine coverage is patchy, there is selective pressure for the virus to evolve resistance. We’ve already seen robust virus variants from South Africa, Brazil, the U.K., and India spread around the world. So far, the first generation of covid vaccines is holding the line against them, but that protection is not guaranteed. It’s possible that the virus, which has already infected vast numbers of people, won’t evolve in a way that fatally undermines our vaccines. On the other hand, some epidemiologists think that we have a year or less before the virus breaks through and renders them less effective. Pharmaceutical companies are working on shots that are as effective against the variants as they are against the original virus, but their efficacy hasn’t yet been proved. And, as the Oxford evolutionary virologist Aris Katzourakis told me, even if they do prove effective, “the idea that we could revaccinate the whole country or the whole world annually is not an easy challenge. That’s one of the reasons why many people, myself included, think that we should be exploiting the fact that we have vaccines that are incredibly effective right now.”