Nancy Solomon: This is The Takeaway. I'm Nancy Solomon, a reporter in the WNYC newsroom in for Tanzina Vega all week. We're very excited today to welcome our new listeners at WAMU in Washington DC who have joined The Takeaway family of listeners. Good to have you with us.

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Biden: Now, because of all the work we've done, we'll have enough vaccine supply for all adults in America by the end of May. That's months ahead of schedule.

Nancy Solomon: We begin this hour with a look at global vaccine distribution. More than 61 million people in the US have been fully vaccinated. That's nearly 19% of the total population according to new data from the CDC. President Joe Biden said the US is ahead of many countries in terms of their vaccination rate.

Biden: Because we're actually on track to reach this goal of 100 million shots in arms on my 60th day in office. No other country in the world has done this. None.

Nancy Solomon: The outlook is far less rosy globally. High-income countries like the US have purchased over half of the world's supply of vaccines. Even though they make up less than a fifth of the global population. Only 84 countries currently have COVID-19 vaccines, although the WHO estimates that that'll rise to 100 in the next couple of weeks. That's led to deep disparities in vaccine distribution worldwide. Which not only poses an ethical conundrum but also creates a public health challenge. That's because if the virus is left unchecked by vaccines, high levels of spread in any country provides fertile ground for the development of new and possibly vaccine-resistant variants. Which could dismantle the global progress in the fight against COVID-19.

For more on this, I'm joined by Yasmeen Serhan, a staff writer at The Atlantic. Yasmeen, welcome back to the show.

Yasmeen Serhan: Thanks for having me.

Nancy Solomon: Also with us is Dr. Jen Kates, the Senior Vice President and Director of Global Health and HIV Policy at the Kaiser Family Foundation. Dr. Kates, glad to have you with us.

Dr. Jen Kates: Thanks. It's good to be here.

Nancy Solomon: What is the Kaiser Family Foundation seeing in terms of vaccine access in high and low-income countries?

Dr. Jen Kates: Good question. We've been looking at this for quite a while and put out a report recently to highlight the fact that there is a very big disparity, as noted in the intro. That high-income countries, including the US, EU have purchased most of the doses and very few doses available, are going to low and middle-income countries. That presents a real barrier. Right now, only about 4% of the global population has been vaccinated. That's very far away from where we need to go. It's hard to see how we're going to get there.

Nancy Solomon: Is the disparity found across the board in terms of, from vaccine supply, to vaccine access, to rates of vaccinations. Are the disparities there are in each category?

Dr. Jen Kates: They really are. It starts with who's been able to purchase doses, as well as who's been able to manufacture them and access them. Let's say there was enough vaccines to vaccinate everybody, and it was already delivered to countries. There's a whole range of other challenges around infrastructure to deliver those vaccines, as we've seen in the United States, it's not as simple as sending vaccines to a state. There has to be a delivery system. That's another challenge that many low and middle-income countries are going to face.

Nancy Solomon: What countries or regions, are you seeing those supply, especially inadequate right now?

Dr. Jen Kates: I think the big challenges are primarily in Africa, where very little vaccine has been delivered now. We know that some of those countries have done quite amazing efforts in terms of their response to other epidemics like HIV, and actually even with COVID. Still, the infrastructure there in terms of health care workers, and facilities to manage and store vaccines are really needing a lot of attention. In addition to having very few vaccines delivered to many countries in Africa, there's going to be an uphill battle to getting that scaled up.

Nancy Solomon: I believe NPR reported that Africa has 17% of the world population, but only 2% of the vaccine supply. Yasmeen, let's bring you into this conversation. How does this compare to the rates of vaccination or even the supply here in the United States and other Western countries?

Yasmeen Serhan: The US is in a very good position, as I'm sure many of your listeners are probably aware. Duke University has a great vaccine procurement tracker. They found that the US has reserved, I think around 1.2 billion doses so far, which is far more than it will need to inoculate its entire population. Meanwhile, Britain is doing quite well. Britain is where I'm based currently, it's vaccinated about half of its population, it's on track to vaccinate, I think offer the first dose to every adult by summer.

The Biden administration obviously has a similar goal. Israel, I believe, is leading the world in vaccinations per capita. The wealthy countries are doing just fine. As you mentioned, they have the lion's share of the available vaccines, and most of them have reserved more doses than they'll need.

Nancy Solomon: I have to say you who are harshing my buzz, the two of you because I was feeling pretty good about getting my first shot. This is obviously a moral issue, but it's also a public health issue. Yasmeen, you wrote about that, for The Atlantic, tell us about what the public health implications are of these disparities?

Yasmeen Serhan: Yes, you touched on it a bit in the beginning. First and foremost, I think the biggest concern that we have, and we're already seeing the repercussions of it are these new variants that are emerging. Those tend to be emerging in places where the disease, I should say, has been left just running rampant. There was the South Africa variant, there was the Brazilian variant, there was the variant from here in the UK. The biggest concern, I think, among public health experts, is that these variants will effectively be able to escape the vaccine. That if we see a rise in variants, that that could eventually make everyone vulnerable again. This idea that we'd have a scenario of a never-ending pandemic.

It really is in the world's interest to make sure that the countries around the world are able to vaccinate at roughly the same pace, or at least to ensure that there aren't major outbreaks anywhere. Because, as you rightly noted at the beginning, if there are major outbreaks anywhere in the world, we're all vulnerable.

Nancy Solomon: I heard you correctly, that you're talking indefinitely, we could be living with COVID indefinitely if we do not get the whole world vaccinated.

Yasmeen Serhan: Yes, at this point, I think the estimates I've seen is that it won't be till 2023 at the earliest before we have enough vaccines to cover the global population. Which means that we really need to be working together to ensure that the most vulnerable around the world are covered, that frontline workers around the world are covered. At the moment, I don't want to hush your excitement too much, I'm really excited to see my family and friends getting vaccinated too. I'm very much looking forward to my first jab.

There are people around the world highly vulnerable, who need that job more than I do. I think we need to start having a global conversation of, how are we going to prioritize this? What is in the best interest of anyone to ensure that this pandemic is going to last a long while, we know that coming out of this crisis is going to take some time. How do we ensure that we come out of it faster than just, letting it exist anywhere and potentially threatening us all? Preventing the economy from opening back up again. There are public health and economic concerns here.

Nancy Solomon: It's upsetting, but it's not that surprising that we're seeing the same health inequities that have long existed between rich and poor countries. Jen, what's been the history of pandemic response and vaccine roll-outs? Has it ever been done well?

Dr. Jen Kates: Yes, and no. I think the biggest analogy that I like to make where we've learned so much is what's happened with the history of the HIV epidemic. The one distinction I want to say is we don't have any vaccines for HIV. What we do have in the HIV context, are tremendously effective antiretroviral medicines. When those first became available in the mid-1990s, very quickly, it was clear that the high-income countries the US, Europe, Australia, Canada, all had access, and death rates plummeted.

Most of the rest of the world did not and particularly stark was in Sub-Saharan Africa, virtually nobody was able to access antiretrovirals. A movement began to change that and by early 2000s, the United States and actually under President George W. Bush launched PEPFAR, the President's Emergency Plan for AIDS Relief. Which has resulted in providing antiretroviral therapies to millions and millions of people around the world who otherwise would not have them. To me, that's a very close precedent of something that did occur. It required a lot of effort and focus and attention, but it demonstrated that it can be done. A lot of people today are calling attention back to that saying we did it then.

Now I think it's even more pressing because as Yasmeen was saying the implications of this virus are different than the implications of HIV. We're all living with this virus at a different way and so it's in everybody's interest to find a solution.

Nancy Solomon: Staying with that reference to HIV and AIDS, how did that work exactly. Is it merely an infusion of US funds that creates the ability to get people treatment or is it a different mechanism?

Dr. Jen Kates: Yes. There were several elements that went into that that I think are applicable today. There was a strong community advocacy movement to push governments, the US and others to do more, to start to provide antiretroviral therapy. Prior to the US creating PEPFAR, there was the creation of the global fund to fight AIDS, TB, and malaria. International efforts began and those included infusion of funding as you mentioned, which is incredibly important, but also attention to the infrastructure and the healthcare workforce needs as well as the supply chains.

In fact, much of that work could be built on right now for delivery of COVID vaccines and that is what people are looking at. The precedent is there and I think building blocks are there as well. The other thing that's required is bringing along other global partners over time to participate. It's not just the US alone although the US continues to be the main donor to this effort.

Nancy Solomon: Jen, what do you see in terms of what kind of rule President Biden or the US could be playing at this point?

Dr. Jen Kates: I think we see a very different role being played right now by the Biden Administration and the Trump Administration in part because of where we are in the roll-out. The Biden Administration has said it will be active in the multilateral context. It has said it's going to help find solutions. I think the next few months will be pretty critical and the Biden Administration has to balance the needs at home with this global concern. I think it's going to be really hard to talk to the American people about that and explain why both are important and both need to happen at the same time.

Nancy Solomon: Let's talk about COVAX. Yasmeen do you want to start us off with that and explain that program and what it is?

Yasmeen Serhan: Sure. Yes, so COVAX is a multilateral initiative that's backed by the World Health Organization and it's basically aimed at solving the problem that we've been talking about of inequitable vaccine distribution. Its goal is to provide enough vaccines to cover at least 20% of participating countries populations. Effectively to provide vaccines to ensure that all the vulnerable people and all the frontline healthcare workers in countries around the world can get the vaccines they need.

This is an initiative that the US has contributed to. This is new under the Biden Administration, under Trump the US did not join COVAX and numerous other countries around the world. The US has contributed billions of dollars to that effort.

Nancy Solomon: What about Russia and China? Are they filling a gap that's been left open by Europe and the United States?

Yasmeen Serhan: They have indeed. I recently wrote a piece looking at this. Whilst COVAX has been doing work to make sure that there is more equitable distribution, it hasn't been able to obviously distribute a lot. It's been affected by supply issues and as we've already established a lot of wealthier nations have really taken a lot of the vaccines for themselves and their own domestic needs. Which has left a gap that Russia and China have proven all too willing to fill. I believe China has produced more than 225 million doses as of the end of last month, nearly half of which they've sent abroad. Russia has also distributed I believe of the 14 million doses it has produced, 31% of which they've exported elsewhere.

They've been targeting countries around the world across Asia, Latin America, Africa. The way a lot of Western leaders see it, they're effectively trying to really bolster their own image using their vaccines are soft power so to speak. Yes, they've been really stepping in. You see it even in wealthy countries like the UAEs. Like Israel, the US has vaccinated large sways of its population and it's largely done so I believe using Chinese vaccines.

Nancy Solomon: There must be just grave geopolitical implications if not hazards ahead given this restricted supply of vaccine. Could this become the new oil? Could we be seeing in worst-case scenario wars break out over vaccine distribution?

Yasmeen Serhan: Gosh, I hope not. I think the way to understand this is that obviously there’re geopolitical concerns and I think we've heard leaders talk about them. When it comes to a public health crisis, it really is in everyone's interests to ensure that vaccines are getting where they need to go. In this respect, I've spoken to people who have really criticized the politicization of these vaccines. We're at a moment where these vaccines are saving lives. If we aim to politicize them, it can cause a lot of problems. I think crucial for a lot of US and European leaders is they've I think leveled plenty of legitimate criticisms against Russia and China's vaccination distribution efforts.

They're aggressive sales tactics, their lack of transparency when it comes to efficacy data, their efforts to undermine trust in other vaccines. Western countries haven't really offered a lot of the receiving countries many of which have scarcely begun their vaccinations roll-outs any alternative. As long as wealthy countries like the US, like Britain are focusing on their own domestic needs, which given how battered both countries have been by the pandemic is understandable to an extent.

They're really not in a position to tell other countries, "Look, you shouldn't take these vaccines because geopolitically it's bad for us." I think it's really complicated but I think vaccines are unlike oil or any other commodity that we would typically fight about. These are products that save lives. If they're safe and effective we should hope that world leaders will work together to ensure that they get where they need to go.

Nancy Solomon: Let's talk about pharmaceutical companies and manufacturers. Jen, what can you tell us about what their role has been and what they've done about vaccine inequity that we're seeing?

Dr. Jen Kates: I think the big picture as we've seen in many other cases. There's a few manufacturers right now that have come out with successful products particularly that are for use in the US and several other countries. China and Russia have also developed their products. In general, there's a good story here and then maybe a more challenging one. The good story is that the pharmaceutical industry really did rally quite quickly. In fact work together in some ways that don't usually happen to massively speed up with help of government regulators and others the process to get effective, safe vaccines into the many countries and into the arms of millions of people now.

That is quite an amazing accomplishment and one, we should look back on and try to understand what was able to be done that we can learn from for future efforts, emergency or otherwise. On the other hand, there is a debate and a challenge going on about what should their role be in terms of easing up on patent protections and other regulatory mechanisms that allow pharmaceutical industries to enjoy protection for their products?

Again, going back to HIV, this was a big battle in the HIV context. There's going to be a tension I think between the pharmaceutical industry coming forward and voluntarily making its technology available and making its products available on the one hand versus being forced a little bit to do so. That's a discussion that's happening at the WTO and the US and some other countries are not supportive of easing up on those patents.

I think the issue of what happens with the pharmaceutical industry and how governments approach this is going to be one to look for the next several months to over the next few years, and it could have some pretty significant implications.

Nancy Solomon: Dr. Jen Kates is the Senior Vice President and Director of Global Health and HIV Policy at the Kaiser Family Foundation. Yasmeen Serhan is a staff writer at the Atlantic. Thank you both so much for joining us.

Dr. Jen Kates: Thanks.

Yasmeen Serhan: Thanks for having me.

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