Compass World: W.H.O. To Trust?

The Pfizer-BioNTech COVID-19 vaccine is used in Israel requires two doses and has a 95% efficacy rate. (Source: Wikimedia)

Countries around the world are lauding Israel’s progress in vaccinating its people, with some calling it the model for how governments should administer the COVID-19 vaccines. Recent studies indicate the Pfizer vaccine has greatly curbed infection rates in Israel and will be effective against variant B117, the virus strain originally found in the UK. 

However, many issues have complicated the rollout of vaccines globally, leading to vast inequities. Many policymakers, health officials, and business executives have spoken out against rich countries hoarding the vaccine. WHO Director-General Dr. Tedros Adhanom Ghebreyesus has warned that doing so leads to “three major problems. One, it will be a catastrophic moral failure. Two, it keeps the pandemic burning, and three, very slow global economy recovery.” Vaccine rollout has also been hindered by intellectual property rights disputes and by systemic racism.

Disease One: Scarcity

On the international scale, there is disagreement on the role intellectual property rights should play in a pandemic. Proponents of intellectual property protections argue that patents are important to incentivize small companies to research and develop vaccines. But when there are already effective vaccines available, are patents still necessary? 

India and South Africa say no. They have proposed a waiver on certain sections of the World Trade Organization’s (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement), arguing that the waiver would scale up global production, import, and export of pharmaceutical products.

Unfortunately, the WTO failed to reach an outcome on the proposal during its meeting on February 4. Fourteen European parliamentarians have backed the proposal. Meanwhile, leaders from the United States, UK, and European Union strongly opposed it, citing the mutating virus as a reason innovation remains crucial. The WTO will continue its consideration of the proposal on February 23.

Because of Pfizer and Moderna vaccine shortages, many low and middle income countries have ordered vaccines from Chinese companies. However, concern is rising that they are not as reliable. China’s Sinovac vaccine has conflicting efficacy rates, ranging from just over 50 percent to 91 percent. 

The most promising initiative to mitigate vaccine inequality is COVAX, led by the Gavi vaccine alliance, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization. Currently, the initiative plans to roll out 337.2 million doses of the AstraZeneca-Oxford and Pfizer vaccines in the first half of 2021— many to lower income countries.

The pandemic has demonstrated that the laws of supply and demand are as strong as ever, even when confronted with health and moral concerns. But when millions of lives are at risk, scarcity is another disease worth fighting. 

Disease Two: Racism

The racial disparity in vaccine distribution is evident in the United States. Although Black Americans are 2.1 times more likely to have died from COVID-19 than white Americans, data from 23 states shows that white people are being vaccinated at more than double the rate of Black people. 

The higher death rate for Black Americans can be traced to a combination of structural and medical racism. As Harvard Professor of Health and Sociology David Williams explains, housing segregation exposes Black Americans to environmental stressors, such as air pollution, which is linked to increased COVID-19 rates. Moreover, Black Americans have more limited access to COVID-19 testing. They experience longer wait times and understaffed COVID-19 testing centers, and some are even denied testing altogether.

Hesitancy toward the new vaccine may also play a role. According to the KFF COVID-19 Vaccine Monitor, Black adults are 65% more likely than White adults to “wait and see” before getting vaccinated. Vaccine hesitancy is tied to Black Americans’ history with systemic racism in the American healthcare system. In an interview with The Undefeated, Cara James, the CEO of Grantmakers in Health, cited the 1932-1972 Tuskegee experiment, in which white doctors withheld syphilis treatment to hundreds of low-income Black men, and Serena Williams’ near-death experience during childbirth as infamous examples of how the healthcare system has mistreated Black people. With the ubiquity of medical abuse against Black Americans, mistrust of a new vaccine developed in a record short timeframe is warranted.

Vaccine rollout is also alarmingly slow among some Native American tribes, which as a collective demographic have the highest COVID-19 death rate in the U.S. The Cheyenne tribe receives only 100 doses per week; at this rate, it would take almost a year to vaccinate everyone. 

Like Black Americans, Native Americans have also suffered a history of oppression that has led to distrust for the U.S. government and healthcare system, from the Indian Health Service’s mishandling of sexual abuse allegations against the organization’s doctors, to the forced sterilization of thousands of Native American women throughout the 1960s and 1970s. 

To increase their community’s trust in the COVID-19 vaccine, the Cherokee Nation has emphasized the mission to preserve their language. Vaccinating fluent speakers, most of whom are elders, has “helped people's anxiety subside. And I think people felt sort of a renewed obligation to try and protect the culture by getting vaccinated,” said Principal Chief Chuck Hoskin Jr. 

A study conducted by the Urban Indian Health Institute has found the Cherokee Nation’s strategy successful. 75% of the 1,435 Native American participants were willing to receive the COVID-19 vaccine, compared to the 64% national statistic. While many participants sympathized with others’ vaccine hesitancy, they felt responsibility to preserve their culture and protect the health of elders, youth, and future generations.

Grassroots efforts by Black leaders are also underway to combat vaccine hesitancy. The National Medical Association, an organization representing African American doctors and patients, has vetted and endorsed the Moderna and Pfizer vaccines. They have also engaged in the more difficult process of building patients’ trust through town halls and community meetings. Other Black physicians have used social media as a platform to explain the virus and dispel vaccine myths.

But doctors alone are not enough. Only 5 percent of active physicians identify as Black or African American, making widespread outreach difficult. Thus, the Health Advocates In-Reach and Research (HAIR) campaign has been implementing vaccine education through more accessible, daily interactions at barbershops and beauty salons. Barbers and stylists have been trained by Dr. Stephen Thomas, the Health Policy and Management Director at the University of Maryland, to answer clients’ questions about the COVID-19 vaccine.

Although Black and Indigenous community efforts have stepped in, it is important not to lose sight of who should be responsible for spreading vaccine trust: government and health officials. The American healthcare system has failed Black and Indigenous people, and restoring community trust is no easy task.