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Melissa Harris-Perry: Hi, I'm Melissa Harris-Perry. Welcome to The Takeaway. In late 2019, as Americans geared up for the winter holiday season, we began to see news stories about a contagious virus affecting people in China. By early 2020, we were getting regular reports about illness in Italy, Spain, England. Most of us, at that point, were aware something was happening, but it was happening over there.

Nearly two years later, Americans are battling a surge of misinformation that is stoking vaccine hesitancy and making it all too easy to lose sight of the truly global nature of the continuing pandemic. Even a casual glance at the map tracking global vaccinations reveals an obvious pattern. Rich countries are vaccinated, poor nations are not. The UAE is slaying the vaccine game with 92% of residents having at least one dose. The G7 nations Canada, France, Germany, Italy, Japan, and the UK, they're putting up big numbers at 70% to 75% vaccination rates, and even the US with all of our maddening anti-Vax rhetoric is holding strong at more than 60% of Americans having at least one shot.

The story is tragically different in Uzbekistan, 9%, full vaccination, Vietnam, 5% full vaccination, Syria 1%, Uganda, Sudan, Nigeria, Sierra Leone, Ethiopia, less than 1% of the population is fully vaccinated in each of these African nations. Last month, the vast global inequality led the World Health Organization's Director-General to call for a temporary halt on booster shots as he expressed his frustration with the slow pace of vaccine donations from high-income countries.

Tedros Adhanom Ghebreyesus: We had been calling for vaccine equity from the beginning, not after the richest countries have been taken care of. Low and lower-middle-income countries are not the second or third priority. Their health workers, older people, and other at-risk groups have the same right to be protected. I will not stay silent when the companies and countries that control the global supply of vaccines think the world spool should be satisfied with leftovers.

Melissa Harris-Perry: Allow me to translate that into a colloquialism used by generations of frustrated parents. "No, you cannot have a booster shot for dessert when you've only eaten half the vegetables of protective vaccination, and I'm going to take this leftover vaccine and send it to poor nations who will be grateful for it. Now go to bed." With me now is Apoorva Mandavilli who is a science reporter at the New York Times. Glad to have you back on the show Apoorva.

Apoorva Mandavilli: It's nice to be here.

Melissa Harris-Perry: Lawrence Gostin, who is professor of global health law at Georgetown University, director of the World Health Organization center on national and global health law, and author of the forthcoming book, Global Health Security: A Blueprint for the Future. Thanks for joining us, Lawrence.

Lawrence Gostin: Thank you. You've made me smile with my bedtime story and not eating my vegetables.

Melissa Harris-Perry: Actually, let me start there because by the time you're 10 years old, Lawrence, you look back at your mom you like, "You're not sending my leftovers to another country. That's not happening. That's not practical, lady." At what point or should we be thinking that same way about vaccines? Are booster shots actually the nature of the problem relative to this overall global inequity?

Lawrence Gostin: They contribute to the problem, but they're not really the cause of the problem. It sounds like the United States and other countries, the UK just decided to do it yesterday, is just completely tone-deaf to the suffering in the rest of the world, and entirely oblivious to WHO's call for a moratorium on boosters. Doses are not fungible. It's really hard to get them off the shelves on our pharmacies to say Ethiopia. A lot of regulations, expiration, whole range of things. It just sounds immoral and in some ways, it is. Although, I do know from the White House that President Biden's under enormous political pressure to push it forward in the US.

Melissa Harris-Perry: The boosters, you mean?

Lawrence Gostin: The boosters indeed. Yes.

Melissa Harris-Perry: Apoorva, I guess I'm interested in-- Again, just if we're going to build off of Lawrence's point there, that there's pressure for booster shots at a time when we have vaccine hesitancy why we don't have that same massive political pressure to ensure that much of the rest of the world has at least an opportunity to be vaccinated.

Apoorva Mandavilli: Well low-income countries are notoriously bad at exerting political pressure on high-income countries. The WHO has been advocating on behalf of these countries, but the high-income countries have to listen. There are multiple problems why those countries have not had those doses. I want to give you one number in addition to the one that you mentioned. Only 0.4% of the total doses so far have been given to low-income countries of all of the doses in the world. That just tells us how little has made it to those countries.

Part of the reason for that is distribution problems. You've had trouble actually getting the doses from airport tarmacs to shots in arms. There are issues with how to get those doses into the people, but there are also issues with high-income countries like the US and some other countries actually having export bans on the things needed to make vaccines for other places. There are enormous production problems.

J&J was supposed to make a billion doses this year, and they've made about a 10th of that. There are multiple problems causing this very low uptake in low-income countries. Countries like the US and the UK and other rich countries have an obligation to listen and to help because, apart from the moral and ethical reasons, we also have a very good scientific reason to make sure that everyone is vaccinated, which is to prevent the virus from evolving.

Melissa Harris-Perry: Apoorva, just stick with this for one second, because you said something that is a detail I don't know and I want to understand a little more. What do you mean by having export-- We have rules against exports for some of the things necessary to make vaccines. What kinds of items?

Apoorva Mandavilli: That could be lipids, which are the packaging materials for the vaccines. They could be tubes, needles, syringes, and they're made in a few different places, and the US and Japan, and some other countries are restricting how many of those raw materials can be shipped out of their own countries. That automatically puts a limit on how many vaccines you can make worldwide.

Melissa Harris-Perry: Got it. Thank you. Lawrence, can you talk to us about COVAX. I can remember at the G7 meeting, President Biden came out, he talked about COVAX, he was like, "Don't worry, we got this under control." Now all these months later, we're still talking about 0.4% of vaccines going to poor nations. What's going on with COVAX?

Lawrence Gostin: Thanks, Melissa. Can I just add to a couple of the points that Apoorva made? I thought she did it beautifully. We've not strictly export bans, but use of the Defense Production Act that prioritize things here and made it so that we had to keep all of those raw materials here in the United States. The big problem we haven't actually even mentioned was that, while the public was just going about their daily life, and they didn't realize it, very early in the pandemic, even before we had vaccines, rich countries, and indeed rich businesses of Davos had already started to plan and then pre-purchase most of the world's supplies.

Countries in the European Union, the UK, the US, Canada, really pre-purchased most of the supplies even before they were authorized or manufactured. That does two things. One, it leaves us with great global scarcity, and second, it shows that some of the direct responsibility for why we've got these global inequities is because of the decisions that we made to prioritize ourselves. COVAX is--

Melissa Harris-Perry: While Americans in their households were stockpiling paper towels and toilet tissue, the nation was stockpiling these necessary aspects for making and then distributing the vaccines?

Lawrence Gostin: Yes, and actually, the vaccine doses themselves. They were already brought up even before we even thought about authorizing them, even before they finished clinical trials.

Melissa Harris-Perry: Got it. In fact, I can even imagine listeners saying, "Well, yes. That's precisely what we want our government to do is to protect us and to build the hedge here nationally first." Obviously, again, on this scientific point about how something like a contagious respiratory pandemic moves, Apoorva, it's also an insufficient strategy, even for the protection of Americans over time, isn't it?

Apoorva Mandavilli: It is, and this is where the boosters come in too. If we start thinking about just hoarding doses, we're talking now about the next round of doses, and the next round of doses, and where does that leave the rest of the world, and where does that leave the unvaccinated people right here in the United States? That really should be the main focus everywhere. According to every expert I've spoken with, that will give us better benefit than trying to get boosters out to the rest of the country.

From the perspective of the companies, you can see why they would continue to fulfill these orders. The US is paying about $7 per donated dose. That's a third of what we pay when we buy for Americans. If you're Pfizer, you know where you're going to make more money, and so the companies also continue to fulfill those orders over what the low-income countries need, or what COVAX might need.

Melissa Harris-Perry: Now, you've reminded me. Lawrence, let's circle back. I had asked you initially about COVAX. Can you tell us a little bit about where it stands?

Lawrence Gostin: Very early on in the pandemic, Tedros, the head of the World Health Organization, and partners like that like the GAVI Alliance for Vaccinations, CEPI, and others got together and they formed what's called the ACT Accelerator. It was a global initiative to try to do two things to amplify or accelerate the supplies of scarce medical resources, not just vaccines but also other medical resources like therapeutics and diagnostics, and at the same time to find a multilateral mechanism for the equitable global distribution of these.

Unfortunately, COVAX was a great idea, and I couldn't imagine a world without COVAX, but it hasn't even begun to achieve either of its objectives, either to boost supplies of these medical resources that are life-saving or to make sure that low and middle-income countries get the doses that they need. Right now, even health workers who are right on the front lines with bulging hospital admissions around the world are unvaccinated, for the most part. That is a moral stain on the nation. In fact, I think it could be one of the greatest ethical failures of our generation.

Melissa Harris-Perry: Apoorva, maybe you can paint a picture for us about what this lack of vaccination around the rest of the world means, relative to lived experience. I can easily look at the map. I can see where there are, fewer than 1% of individuals being vaccinated. Do we also see higher cases there? What are the mortality rates like? Just talk to me about what it means to not have vaccine.

Apoorva Mandavilli: What it means to not have vaccines is where we were last spring, where every case meant people would end up in the hospital, and the medical system is completely overwhelmed. I think we saw these enormous numbers back in the winter, in December and January here, and a lot of that has gone down really because of vaccination. We're still seeing record cases here in some states and hospitalizations, but this would be so much worse with the Delta variant if we didn't have vaccines. That's what those countries are facing.

Some of these countries like India and African countries and in South America are enjoying a little bit of a reprieve right now. The cases are actually falling after many months of high numbers, but those numbers will come back up. A lot of those countries are facing fourth waves, and the Delta variant is no joke, as we know. It's really terrifying for people in those countries to be waiting, basically, for this variant to take over and send them to the hospital. People are dying, again, in really high numbers, in a lot of these places. As I mentioned before, every single person who is infected anywhere in the world, there's an opportunity for the virus to evolve. This is really in all of our best interest to make sure that people are vaccinated there.

Melissa Harris-Perry: Lawrence, as I listened to Apoorva talk about that human cost, and before the break, you were talking about the moral and ethical stain that this will be, both in this moment, and then how history will remember this. Yet, I wonder, is there anything else, any other set of institutions, practices, people who are able to hold accountable these wealthy nations beyond history and our moral judgments?

Lawrence Gostin: It's a really great question. In international relations and international law, countries really have been very assertive about their autonomy and their sovereignty, and some even boast about it, "My country first," and which often means my country only. As Apoorva said, that's not a very good strategy to get out of this, because if you've got a widely circulating virus, it's very much in our national security interests to do something about it.

We do have international law, the International Health Regulations. The World Health Organization, this November, is going to be holding a special session on a pandemic treaty to try to deal with these questions, with equity being the first one. International law and treaties are our heart, as we know. We've seen it with the Iran nuclear deal, and in climate change, and in so many other areas. It's hard but there are solutions.

AIDS maybe gives us the best model. Apoorva was talking about, "We've got this vaccine. It's helping us. They're dying because they don't have it." That reminds me very much of the beginnings of the AIDS pandemic, where civil society, ACT UP, and others in the United States, the Treatment Action Campaign in South Africa said, "There's this pill that it just saves your life. The rich have it. The poor don't." That had a lot of traction.

I think that might start to have traction now, as has been reported, and I've talked to the White House, I think that invitation to the Global Vaccine Summit that Biden sent out to in advance of the UN General Assembly is going out. I think there's going to be announced over the next coming weeks, some significant plans to try to vaccinate the world. My understanding is something like the goal being 70% of the world being vaccinated by the fall of next year.

Melissa Harris-Perry: Apoorva, can you talk to me a little bit about the infrastructure issues in poor nations. If tomorrow there were this ability and willingness to make more vaccine doses available on large scale, what might be some of the challenges in poor nations, relative to infrastructure, in getting them, again, from tarmac to people's arms? What other kinds of maybe longer-term investments do rich nations need to make in order to make the mass vaccinations possible?

Apoorva Mandavilli: These are very simple problems. In some cases, these countries are actually short of funds just in terms of training people to administer the shots, to persuade people to get them, to do the sort of outreach campaigns that we've had to do, and then simple things like buying fuel to transport the doses to clinics. A lot of this can be alleviated by funding. We know that the US has made some commitments to get hundreds of millions of doses to other countries, but that commitment has come at the cost of diverting funds away from the money that was supposed to go to help these countries get the shots into arms.

We look like we're doing something very good, but we're doing it at the cost of something else that is also required. I think one of the big things that really needs to happen is, as Lawrence was talking about, is for these countries to get together and figure out what is needed and to make a commitment together to get all of the things that these countries need. That's not just vaccines but also testing and oxygen, other supplies that they need, and that will help a lot in containing the epidemic.

COVAX, which we were talking about before, they're about 500 million doses short of where they wanted to be at the end of this year. A lot of that is actually not from a high-income country. That's from India, which was supposed to make about a billion doses for the rest of the world at low cost. Larry was talking about the AIDS drugs, and those drugs were made at low cost by companies in India and South Africa, and other places. India was supposed to do that for this pandemic as well, making doses of AstraZeneca, but they were hit by such a big outbreak in the spring that they stopped exporting them and kept them for themselves. If India starts to export doses, that will also help a lot.

Melissa Harris-Perry: As you tell that story, though, it's pretty clear what that cycle may end up being, relative to the challenge of trying to make the doses to stop it, but also the way that the virus keeps changing and then moving through our global communities. Apoorva Mandavilli, science reporter at the New York Times. Lawrence Gostin, professor of global health law at Georgetown University, and director of the World Health Organization Center on National and Global Health Law. Thank you both for joining us.

Apoorva Mandavilli: Thank you for having me.

Lawrence Gostin: Thank you for having us, Melissa.

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