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What Universal Vaccination Could Mean for the Global Poor

Universal VaccinationPandemics can happen at any time — a fact that the world has become painfully aware of in the last few years. COVID-19 taught modern people the devastating effects of emerging infectious diseases or EIDs, and as a result, more discussions about vaccination have opened up. Vaccines can save lives, but for the global poor, access to this resource is less than ideal. Universal vaccination would transform the health and livelihoods of impoverished people around the world, allowing them to live healthily in the face of many devastating diseases. 

Sickness and Poverty

Around the world, illness wreaks havoc on impoverished people. Poor health is rooted in political, social and economic injustices — making poverty both a cause and effect of poor health. The poorer one is, the more likely they are to fall ill. If someone is ill, the more likely they are to deal with unrealistic financial burdens, trapping them in poverty. 

There are a few diseases in particular that disproportionately affect low-income populations, called poverty-related diseases, or PRDs. Two out of three deaths among children in Africa and Southeast Asia are due to just six diseases: tuberculosis, malaria, HIV/AIDS, measles, pneumonia and diarrheal disease. Combined with childbirth complications, these diseases kill 14 million people annually. The three largest PRDs, AIDS, malaria and tuberculosis, make up 18% of all diseases in poor countries. Yet, approximately 30% of the global population, and 50% of the poorest parts of Africa and Asia, do not have regular access to necessary medicine. This statistic staggers even higher for marginalized groups and vulnerable individuals, who are often deprived of information, money or access to health care that would help them treat each disease. Essentially, although the poorest parts of the world are most impacted by illness, they have the least access to necessary care. 

Vaccine Access for the Global Poor

Vaccines are a treatment for many PRDs, though they too are difficult for the global poor to access. Taking the COVID-19 vaccines as an example, as of October 2022, only 25% of the population living in low-income countries have received at least one dose of a vaccine. Meanwhile, high-income countries enjoy a rate of 72%.

Similarly, cholera vaccines are internationally available but seldom used in public health settings in developing countries where they are vitally needed. The HPV vaccine shares similar statistics, as it has been introduced in only 41% of low-income countries but 83% of high-income countries. According to the World Health Organization (WHO), vaccines for diseases associated with “markets that are deemed to have little commercial value remain neglected.” According to the WHO’s director general, Tedros Adhanom Ghebreyesus, “The right to health includes the right to vaccines, and yet this new report shows that free market dynamics are depriving some of the world’s poorest and most vulnerable people of that right.”

There have been efforts to share vaccines with the global poor that show just how beneficial access can be. Since 2019, Malawi, Ghana and Kenya have participated in the Malaria Vaccine Implementation Programme (MVIP), coordinated by the WHO and funded by Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria and Unitaid to deliver the malaria vaccine in their respective countries. The vaccine has been administered to more than 1.7 million children, leading to a substantial reduction in severe malaria and a decrease in child deaths. 

Universal Vaccination

Universal vaccination would change the world — access to preventative care against PRDs would allow low-income communities to transform their livelihoods, no longer nearly as consistently devastated by death and disease. Vaccinating the world helps prevent new emerging variants, support health systems and save countries from lasting economic damage. In fact, if low-income countries had the same vaccination rate against COVID-19 as high-income countries in September last year (around 54%) they would have increased their GDP by $16.27 billion. Again, COVID-19 acts as an example of what universal vaccination against all PRDs and EIDs could do. Beyond good health, fair access to vaccines allows a chance for development in many areas.

– Char Nieberding
Photo: Unsplash

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New COVID-19 Antiviral Pill Brings Hope to the Developing World

COVID-19 Antiviral Pill
The developing world is fighting for greater access to lifesaving COVID-19 vaccines and therapeutics. If regulatory bodies approve it, a new COVID-19 antiviral pill called molnupiravir could bring relief in the next year because it would be affordable, easy to distribute and easy to administer. Approval is all but guaranteed, however, several NGOs and manufacturers are jumping into high gear to help ensure equitable access to the drug throughout the world.

The Current Situation

No nation, no matter how wealthy, is exempt from the heartache and struggle that COVID-19 brought. According to the World Health Organization (WHO), COVID-19 has led to the deaths of more than five million people worldwide. In addition to the many lives lost, the disease caused by the novel coronavirus, SARS-CoV-2, has also left many survivors with long-lasting negative health effects. Then, there is the economic toll — experts consider the global economic contraction that the pandemic caused to be the most severe since the aftermath of World War II.

Now, nearly a year after the arrival to the market of the first COVID-19 vaccines, the developed world is wondering if the end is near — if the world can get back to a pre-pandemic sense of normal. However, in the developing world, the end does not appear to be near because many developing countries have yet to gain adequate access to vaccines. For instance, in September 2021, WHO Chief Tedros Adhanom Ghebreyesus said that “more than 5.7 billion COVID-19 vaccine doses have been administered globally, but only 2% of them in Africa.” Africa, however, makes up nearly 16% of the global population, making it clear that the push for vaccine equity must continue.

However, the developing world is now finding some hope in a COVID-19 antiviral pill that a partnership between Merck and Ridgeback Biotherapeutics brought to market. Researchers invented the drug, called molnupiravir, at Emory University with research funding from the U.S. government. In the Phase 3 clinical study, the pill proved efficient in reducing risks of hospitalization and death by 50% in at-risk individuals when administered before symptoms increase in severity. Following these promising outcomes, Merck has applied for Emergency Use Authorization from the U.S. Food and Drug Administration (FDA) so that it can bring this promising COVID-19 antiviral pill to the market as soon as possible.

3 Advantages of Molnupiravir for the Developing World

  1. Affordability. Merck and Ridgeback Biotherapeutics have agreed to license the production of their COVID-19 antiviral pill to several generic drug manufacturers in India. In addition, they have signed a royalty-free licensing agreement with the United Nations-backed Medicines Patent Pool (MPP). The agreement remains valid so long as WHO classifies COVID-19 as a global public health emergency. MPP will sublicense production of the molnupiravir to qualifying generic drug manufacturers in the developing world. In turn, those manufacturers will be free to market the drug to a collection of 105 low- to middle-income countries for around $20 per five-day course of treatment. For reference, in its initial purchase agreement for the drug, the U.S. government agreed to pay about 35 times as much per treatment.
  2. Ease of Distribution. Depending on the brand, COVID-19 vaccines require either freezing or refrigeration up until the time of administration. The Pfizer-BioNTech mRNA vaccine even requires sub-zero freezing at -80℃ to -60℃, thus requiring specialized sub-zero freezers. These cold storage requirements for vaccines, while not insurmountable, do provide logistics challenges for the delivery of vaccines in rural areas of low-to-middle-income countries (LMICs). On the other hand, molnupiravir is shelf-stable, meaning its attributes allow for safe storage at room temperature. This element will make distribution much easier in LMICs with limited cold storage facilities.
  3. Ease of Administration. Even in high-income countries, there are many accounts of hospitals stretching themselves dangerously thin on resources because of aggressive surges in infections. The limited clinical capacity of LMICs means that the ideal COVID-19 therapeutic would allow for home-based patient administration instead of clinical administration. Because molnupiravir is an oral medication that is shelf-stable, it would meet this need.

Improving Production Capacity

There is some concern that ongoing COVID-19-induced supply chain disruptions could interfere with the mass global production capacity of molnupiravir should the disruptions result in inadequate supplies of the base ingredients needed for manufacture. For its part, the Bill and Melinda Gates Foundation has pledged $120 million to help ensure equitable distribution of molnupiravir. Part of the initiative is to fund research to look into the most efficient and streamlined manufacturing methods to maximize the production capacity of the drug. These efforts bring hope that production capacity goals will meet their mark. Only time will tell, but for many in the developing world, molnupiravir may bring COVID-19 relief before vaccines do.

– Jeramiah Jordan
Photo: Wikipedia Commons

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WHO Calls for Delay in Administering Booster Shots

Delay in Administering Booster Shots
In early September 2021, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus and other WHO officials called for a delay in administering booster shots until the COVID-19 vaccine becomes more accessible to low-and middle-income countries. While wealthier nations are already offering booster shots to their fully vaccinated citizens to protect against COVID-19, other low-income countries, such as the African nation of Burundi, are just recently rolling out their first round of vaccines. WHO officials argue that these doses of booster shots would be more beneficial in ending the global pandemic if countries allocate them to developing nations instead.

Prioritizing Developing Nations

This is not the first time WHO officials called for a delay in administering booster shots as Ghebreyesus previously recommended the postponement of boosters until at least the end of September 2021. However, with many nations disregarding this request, the WHO is now calling for nations to pause booster shots until the end of 2021.

Burundi, a poverty-stricken country in Africa, has noted more than 12,000 cases of COVID-19 as of September 1, 2021. However, Burundi accepted its first supply of COVID-19 vaccines only in August 2021. Thus, at this point, a significant portion of the nation remains unvaccinated. These circumstances stand in stark contrast to countries such as Israel that are now offering booster shots to all vaccinated individuals ages 12 and older.

Each booster a nation dispenses comes with opportunity costs. Researchers argue that every booster shot a nation administers constitutes an inoculation that could go toward vaccinating an individual from an underdeveloped nation. These booster shots in wealthier countries ultimately deprive many at-risk populations within low- and middle-income countries of a chance at surviving COVID-19. Without a majority vaccinated population, these nations struggle to thwart the overall spread of the virus in their countries.

The Need for Booster Shots

While Ghebreyesus accepts that higher-risk portions of the population may benefit from booster shots, he believes boosters are unnecessary for low-risk groups. “We do not want to see widespread use of boosters for healthy people who are fully vaccinated,” he said. Furthermore, WHO officials maintain that there is a lack of evidence to suggest that booster shots are beneficial for protecting against COVID-19. Until this proof is available, vaccine doses will likely be more useful if the world prioritizes redirection and distribution of these shots to developing nations.

Compliance for the Moratorium on Boosters

Despite the initial failure of the first moratorium placed on booster shots, WHO officials believe that this time, nations are taking the moratorium more seriously. WHO official Dr. Bruce Aylward has stated that several countries are taking this plea into consideration, delaying their distributions of booster shots. Additionally, some vaccine manufacturers are pledging to supply lower- and middle-income countries with vaccines rather than wealthier nations that already have an ample supply.

As of September 1, 2021, about 73% of the global population was not vaccinated. Many of these unprotected individuals come from underdeveloped nations with lacking resources. Meanwhile, several wealthy nations are administering booster shots to healthy individuals. As the world continues to fight the COVID-19 pandemic, it is important to prioritize global vaccine equity as even one nation without adequate protection from COVID-19 means the whole world is without protection.

– River Simpson
Photo: Flickr

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Hepatitis B in Children Under 5 Falls Below 1%

Hepatitis BIn a difficult year, 2020 carried some bits of great news for global health and children around the world. The incidence of hepatitis B in children under 5 dropped below 1% in 2019, a huge milestone and a cause for celebration for the public health community around the world. WHO Director-General Tedros Adhanom Ghebreyesus spoke positively about reaching the milestone by looking to the future: “Today’s milestone means that we have dramatically reduced the number of cases of liver damage and liver cancer in future generations.” The milestone marks the attainment of one of the Sustainable Development Goals to reduce viral hepatitis to less than 1% prevalence for children under 5 by 2020.

Hepatitis B

Hepatitis B is a viral infection of the liver which can lead to many health problems, the most serious of which being liver cancer. More than 250 million people worldwide are carrying a chronic hepatitis B infection, with 900,000 deaths from the disease occurring annually.

Mother-to-child infection is the most common, making the disease especially damaging to children. Infants are the most vulnerable to the disease — an overwhelming 90% of infected infants under the age of 1 become chronic carriers of the disease. This makes controlling hepatitis B in children very important to global health.

Methods of Control

The best method of prevention is through the hepatitis B vaccine. The vaccine became available in 1982 and prevents millions of hepatitis B cases a year. The timing of the doses is extremely important and three are required to complete the recommended vaccination course. The first “birth dose” is most effective when administered in the delivery room or less than 24 hours after birth. The second dose should follow 28 days thereafter. The third and final dose follows at least four months after the first dose.

The WHO aims to achieve universal childhood vaccination as the vaccine offers lifetime protection for children who receive it at the recommended times. The vaccine is most effective for infants but the vaccine series is still recommended for children up to 18 years old. In 2017, the FDA approved a two-dose vaccine for adults.

Hepatitis B Vaccinations in Numbers

About 85% of children received the recommended three doses in 2019, a remarkable improvement compared to 30% who received it in 2000. The birth dose must be timely as it the most crucial part of the vaccination. This is why timely access to these vaccines is an urgent concern.

Unfortunately, despite rapid improvement, timely access to the birth dose remains unequal. Currently, 43% of children globally receive a timely birth dose. However, this falls to 34% in the eastern Mediterranean region and even further down to a lowly 6% in Africa. This serves as a reminder that, despite significant progress, efforts must continue to completely eradicate hepatitis B in children.

The Road Ahead

While the vaccine is the predominant form of prevention, recent efforts have focused on expanding ways to prevent mother-to-child transmission. The WHO called on countries to test pregnant women for hepatitis B and provide antiviral therapy before the birth of the child, if necessary. This significantly reduces the likelihood of mother-to-child transmission and is one of the key areas of improvement the WHO stresses, along with greater birth dose coverage. While hepatitis B prevention is not yet complete, reaching the 1% landmark is incredibly important and is the result of decades of hard work and effective policy.

– Clay Hallee
Photo: Flickr