No, we can't just 'vaccinate the world'

·7 min read
Earth.
Earth. Illustrated | iStock

When news of the new coronavirus variant, now dubbed Omicron by the World Health Organization, intruded on Thanksgiving weekend like a most unwelcome guest, there were widespread calls to accelerate global vaccination efforts to reach poor and remote populations. And because the variant was identified by the extraordinary scientists of South Africa, where the vaccination rate is under 25 percent, these calls had an I-told-you-so element that, while well-intentioned, is probably counterproductive in the long run.

"The new variant is exactly what the experts I've talked to have warned about over and over and over again," wrote New York Times COVID writer Apoorva Mandavilli, a critic of booster shots in rich countries. She warned that giving third jabs to young people in wealthy nations while "leaving millions of vulnerable people elsewhere without a single dose is dangerous. For everyone." On the one hand, Mandavilli is right that variants are inevitable as long as COVID-19 is circulating freely among the human population of Earth. But expanding the global vaccine push is unlikely to rid us of the threat of new, holiday-wrecking mutations anytime soon.

The United States and its wealthy allies should absolutely invest substantially more resources in getting vaccines to countries that need them in Africa, Latin America, the Middle East, and Asia. But we also shouldn't be operating under any illusions that this effort will end the menace of further variants. For one thing, we don't know, and may never know, where Omicron came from. It could have originated in one of the relatively highly vaccinated countries of Europe before marauding through South Africa and neighboring countries. Or it could have originated in South Africa itself, where hesitancy, rather than supply, is largely (though not exclusively) the issue.

A more important reason to be skeptical of "vaccinate the world to protect ourselves" logic is that hundreds of millions of people around the world are going to choose not to get vaccinated no matter what we do, and nothing short of forced vaccination is really going to get us to the kind of herd immunity that we once dreamed of. The best we can probably hope for is to reduce but not eliminate the likelihood of dangerous new variants emerging, because the cold reality is that we would be years from vaccinating the whole population of Earth even if everyone was on board. And everyone is very much not on board.

Almost 12 months since shots starting going into arms worldwide, there isn't a single country that has even sniffed full vaccination of its population. Those countries closest (the United Arab Emirates and Singapore) are tiny dictatorships that have implemented sweeping restrictions on unvaccinated people that would likely not withstand legal challenges in many democracies, and which would be functionally unenforceable in poorer countries.

In the United States, close to a quarter of the adult population — tens of millions of people — expresses hardened hostility to the jabs and seems unlikely to ever get vaccinated. Domestic anti-vaxxers will provide plenty of bodies to incubate mutations, and they already have — the "Iota" variant was first identified in New York City in November 2020, and countless others have likely come and gone without much notice, either because they were unable to displace dominant strains of the virus, or because the U.S. is not doing enough genomic surveillance in the first place. Either way, even with 59 percent of the population of the United States vaccinated, there is massive community spread almost everywhere. Pointing our fingers at "Africa" is mostly a way of absolving ourselves of responsibility for the pandemic's persistence.

Globally, the story is mostly worse. Just 44 percent of the global population is vaccinated, and while a disproportionate number of the lowest-vaccinated countries are in Africa, there are countries with dreadful numbers elsewhere. Just 1.2 percent of Yemenis, 4.3 percent of Syrians, and 13 percent of Armenians, for example, are fully vaccinated. Many of the worst-off countries also happen to be conflict zones, like South Sudan (1.2 percent), Ethiopia (1.3 percent), and Afghanistan (9.1 percent), where it may be difficult if not impossible for aid workers and health care professionals to do their jobs. Tweeting about the necessity of vaccination campaigns in such countries is not particularly helpful in the absence of an operational plan.

Another uncomfortable truth is that there are nearly as many people who aren't fully vaccinated in India and China as there are adults in Africa. India in particular faces resistance from large segments of its population. After a long pause due to the country's horrific Delta wave, India has once again become a vaccine exporter, meaning that hundreds of millions will likely remain unvaccinated indefinitely no matter what richer countries do. Combating that resistance is likely to be as important in the coming months as anything else.

Of course, that doesn't mean that we shouldn't identify every possible avenue to increasing vaccination rates around the world, focusing in particular on countries that lack the resources to buy or produce their own. Pharmaceutical giants must be compelled to share their intellectual property, and the most useful thing that the U.S. could do might be to finance and construct factories and supply chains so that other countries needn't rely on our fickle generosity in the first place. Doing so would save millions of lives and avoid significant disruption to global commerce for a fraction of what the United States spends on the Air Force in a single year. It would also insulate the needy from the wild swings in American foreign policy that are the new normal for the foreseeable future.

By couching a global vaccination effort in purely self-interested terms, we also risk collapsing support for it should another variant emerge despite our best efforts. If we are only vaccinating people in Africa to save ourselves from the next Omicron, then the whole project is vulnerable to backlash and retrenchment when a variant pops up in India, China, Europe, or the United States. A better strategy would be to treat other people as equal and deserving human beings entitled to relief from the terrifying threat of COVID-19 regardless of whether it helps anyone in the United States or Western Europe. Given the long history of horrific, destructive colonialism and exploitation perpetrated by Western countries, our best bet is to keep ourselves out of the lens as much as is possible.

The bottom line is that we need to prepare for a world of continually evolving variants. While the history of viral epidemics might give us some hope that the now-inevitable endemic version of COVID-19 will be less deadly, we should be ready for all eventualities. The coronavirus has already defied confident predictions and models from the world's finest epidemiologists and virologists. In addition to helping boost vaccine uptake around the world, we must also ready ourselves for a new reality of occasional disruptions, and that means creating the regulatory and manufacturing capacity to rush new vaccines to anyone who wants them in time to avoid prolonged lockdowns and widely loathed interventions like distancing and masks.

The bleak message that Omicron has sent is this: Almost two years into this unceasing nightmare, the coronavirus still has new tricks up its sleeve, and we should all be wise enough not to fall for pat solutions designed to make us sleep better. An end to the most horrific phases of the pandemic is still in sight, at least for wealthier countries.

Ultimately, the most important reason to redouble our efforts to inoculate poorer countries isn't to head off variants, but rather to avoid the sadly predictable long-term outcome of rich people living mostly without fear of COVID while those in the developing world continue to get sick and die from it.

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