Fully vaccinating our nation won’t end COVID — fully vaccinating the world will

In most high-income nations, people are focused on their own country’s vaccination rates. This is a reasonable place to start since current outbreaks are driven by the unvaccinated.

Recent data from Los Angeles County showed that unvaccinated persons are five times more likely to become infected when exposed to SARS-CoV-2 than vaccinated persons, and 29 times more likely to be hospitalized with COVID-19. Studies from Scotland and elsewhere show unvaccinated persons also are more likely to spread SARS-CoV-2. 

But vaccinating high numbers of people in high-income countries will not end the global pandemic — not even close. The delta variant, responsible for 99 percent of current U.S. COVID-19 cases, was first detected in India. The Alpha variant, previously responsible for most U.S. cases, was first recognized in the United Kingdom. Beta came from South Africa, and Gamma from Brazil and Japan.  The global tour continues with variants on the horizon that are worrying scientists: Eta (U.K./Nigeria); Iota (U.S.); Kappa (India); Lambda (Peru); and Mu (Colombia). After these variants, there will be more, including ones that are highly transmissible and vaccine-resistant.

The only way to move past the pandemic is to eliminate the high transmission rates in countries around the world that create fertile soil for new variants. Until we do, the virus’s ongoing adaptation anywhere will put lives at risk everywhere.

Importantly, this cannot be done without vaccinations. Using data from all 54 African countries, together with colleagues from around the world, we recently showed that hundreds of millions of people living in Africa lack the means to isolate if sick, quarantine if exposed, and face high barriers to physically distancing or handwashing to prevent COVID-19 spread.

Across 54 African countries, our study found that 718 million people live in households with six or more people at home and 283 million people live in households where at least three people sleep in a single room, making physical distancing impossible. Eight hundred and ninety million Africans lack running water at home, and 700 million people do not have regular access to soap, limiting regular hand washing to prevent COVID-19 spread. In both Nigeria, Africa’s most populous country, and the Democratic Republic of the Congo, one of the largest, fewer than one in 100 persons are vaccinated. 

Living conditions that heighten the urgency of vaccine access are likewise found in other low- and middle-income countries with little access to vaccines. For example, in India, a country home to over 1.3 billion people where multigenerational households are common, just 11 percent of the population is fully vaccinated. Similarly, just 12 percent are fully vaccinated in the Philippines, home to the three most densely populated cities in the world. The only route to COVID-19 prevention for these and far more individuals and families in low- and middle-income countries around the world is universal access to vaccines.

The bottom line is that each of us must also care about all the people globally who will become infected without vaccines — and the new deadly, highly infectious variants that will inevitably emerge and spread around our exceedingly interconnected world as a result.

So what will it take to get vaccines to everyone worldwide? Everyone needs to pitch in. Countries that have surplus vaccines need to share them — and not stockpile extra for their own population while low vaccination rates persist in most countries worldwide. Currently, not only is there a vaccine shortage in many lower-income countries but in some cases, their limited supply is getting diverted to high-income countries with a surplus of doses. It endangers everyone when millions of Johnson & Johnson vaccine doses are sent from South Africa, where 10 percent of the population is vaccinated, to countries such as Spain and Germany, with vaccination rates of 72 percent and 62 percent, respectively.

Companies and countries that have patents and intellectual property rights need to stop blocking others from reproducing vaccines, share the IP and accelerate the production of vaccines around the world.  Preventing low- and middle-income countries from producing their own vaccines needlessly limits supply in areas with shortages, creating grave risks in those countries while jeopardizing health everywhere. Although the U.S. has come out in favor of waiving patent protections on COVID-19 vaccines, other vaccine-producing countries remain opposed.

Government and donor funds are needed to support ramping up production of vaccines to ensure that vaccines are free, so cost is not a barrier to anyone, and to build the public health systems that are needed to support vaccine delivery and reduce spread in this pandemic and the next. Employers and countries have a key role to play in ensuring workers can take leave to get vaccinated, reduce spread and care for their own and family health when sick. Finally, where vaccines are available, everyone needs to step up and get immunized — everyone’s actions affect not only their health but that of their family, their community, and communities that touch them. 

There is no closing borders to viruses when economies are dependent on trade and exchange to survive. Failing to recognize and respond to the global nature of COVID-19 prolongs the pandemic for everyone. Getting the world fully vaccinated is within our reach — but it’s up to every country, company, and individual to do their part.

Jody Heymann, M.D., Ph.D., is a distinguished professor of public health, public policy, and medicine; founding director of the WORLD Policy Analysis Center, and served as dean of public health at UCLA from 2013-2018.

Timothy Brewer, M.D., MPH, is a professor of medicine and epidemiology at UCLA, and served as program director for the International Society for Infectious Diseases, as well as in an advisory capacity to the World Health Organization.