Bill and Melinda Gates: The world needs an inclusive vaccination response to end Covid-19 pandemic
The Bill and Melinda Gates Foundation warns the pandemic and vaccine rollout will perpetuate inequalities between rich and poor countries, severely affecting ‘essential workers, communities of colour, people experiencing poverty, and women’.
Warning of the perpetuation of another injustice – immunity inequality – the Bill and Melinda Gates Foundation has made a strong call in its annual letter for an inclusive rollout of the Covid-19 vaccine globally.
“Just as World War 2 was the defining event for our parents’ generation, the coronavirus pandemic… will define ours. And just as World War 2 led to greater cooperation between countries to protect the peace and prioritise the common good, we think the world has an important opportunity to turn the hard-won lessons of this pandemic into a healthier, more equal future for all,” Melinda wrote.
Bill believed that with large-scale vaccinations the world could return largely back to normal by “sometime next year”.
“Covid-19 has cost lives, sickened millions and thrust the global economy into a devastating recession,” they wrote. “Although we have a long recovery in front of us, the world has achieved some significant victories against the virus in the form of new tests, treatments and vaccines. We believe these new tools will soon begin bending the curve in a big way.”
While the cost of stopping the pandemic was high – probably in the tens of billions of dollars per year – the devastation it had wrought had cost the world an estimated $28-trillion.
“I hope people will read the facts about vaccines, and how they’ve worked against other diseases, and see that now we have millions and millions of people who’ve taken this vaccine and we’re tracking that experience to make sure we were right about the overall safety. It is going to be a tragedy if a country continues to have an epidemic because of these false vaccine rumours,” Bill said during a discussion on the annual letter on Tuesday night.
He said GAVI, the vaccine alliance created in 2000 to finance access to donor-funded vaccines in 92 middle- and low-income countries, is awaiting World Health Organisation (WHO) prequalification for the Oxford/AstraZeneca vaccine and others and will then start funding the rollout.
“That vaccine is being made in India today and so, as soon as we get the WHO prequalification for that, which we don’t have yet, but we’re hopeful on, then it will become available through GAVI. That is a very scalable, thermally stable vaccine, just like Johnson & Johnson and Novak’s that we hope also gets approved.”
Melinda wrote: “From the beginning of the pandemic we have urged wealthy nations to remember that Covid-19 anywhere is a threat everywhere. Until vaccines reach everyone new clusters of disease will keep popping up. The cycle of inequality will continue. Everything depends on whether the world comes together to ensure that the lifesaving science developed in 2020 saves as many lives as possible in 2021.”
She added that while the rich countries had prepared for months to get everyone vaccinated the foundation estimates that middle- and low-income countries will only be able to vaccinate one in five of their people.
Bill also said it is time to start thinking about the next pandemic.
“Back in 2015, in my TED talk, I talked about the risk of a pandemic and how we weren’t prepared. At that time not much was done. The foundation, the Wellcome Trust, the UK, Japan and Norway did create a group called CEPI [Coalition for Epidemic Preparedness Innovations] which has helped a lot with a number of these vaccines.
“The world now understands how seriously we should take pandemics,” Bill wrote. “We’re already seeing new pandemic preparedness strategies emerge and I expect to see more in the months and years to come. The world wasn’t ready for the Covid-19 pandemic. I think next time will be different.
“The costs of the pandemic, not only the lives but the economic impact, the educational impact, the mental health impacts, are very hard to measure but they’re gigantic. Fortunately, there is an end in sight. Through great scientific work many vaccines are becoming available and so that means that over the course of this year the numbers will start to go down. Certainly by sometime next year I believe we’ll be able to say that we’re largely back to normal.
“There are some huge challenges in getting the tools out to the entire world. There is some inequality in the distribution, and that’s where the foundation has put a lot of its resources in trying to get vaccine manufacturers, all throughout the globe, to be able to make these vaccines, and make sure that, particularly for those being made in Asia, that they’re available broadly to all countries. There’s a lot to be done in terms of still getting these vaccines out.
“Africa learnt a lot in its fight against Ebola and polio. A lot of resources and infrastructure that was developed for those have been helpful in Covid-19. And it just points out that we need to invest in more of those, even for the times when there’s not a pandemic. The topic of how to drive the investments and make sure we don’t get a loss like this [again]; we need to make sure those are done while this is fresh in everyone’s memory.
“There are many heroes in this process. As we go back and look over what was done wrong, we’ll also see some amazing work that has been done, and our commitment to these health issues is stronger than ever, and we’re proud the foundation has been able to play a role.
“The key for the vaccines is getting more approved and getting more factories into production. A lot of the work that the foundation has done is to back a variety of vaccines.”
Referring to the Moderna and the Pfizer vaccines using new mRNA technology, Bill said they are fairly costly to make and hard to scale up.
“They’re very good vaccines…, but it’s the next three… AstraZeneca, Johnson & Johnson and Novavax, that will give us the highest volumes,” he said, adding that the manufacture of these can more easily be scaled up, while they also have thermal stability.
“We are hopeful that, particularly with some factories in India, that the foundation has helped to finance… within the next few months a large number of doses will come out of there and be [rolled out] almost entirely to the developing world, which is the goal of what we call COVAX. It’s a dynamic situation, I’ve been talking with governments and companies about this going back to last March, and so we have a chance here to get a lot of vaccines.”
Building a new vaccine factory from scratch would take about five years.
“For this epidemic we need to take advantage of the large capacity that people like [the Serum Institute], BioE and many others have, which are the developing-world manufacturers who can, in volume, make four to five times as many vaccines as all the Western companies put together. So, the factories really are there. We can’t get new ones overnight.
“The plan for the next round is to globally have lots of mRNA capacity, and to advance that technology so that it’s more scalable, more thermally stable and cheaper, over the next five years. That should be possible if we get the rich countries to make large investments. I’ll certainly be a huge advocate for that.
“The agreement we have with India is that those factories, at least half the capacity will be dedicated to going to supply, through GAVI, to Africa and other developing countries. Every day, of course, we’re trying to speed this up. The history of vaccines is that until GAVI was created in the year 2000, the really key vaccines for saving literally millions of lives were not cheap enough for the poor countries, and the coverage levels were very low.
“GAVI deserves more visibility for what it did, funded by many governments and our foundation, to get diarrhoea vaccines and pneumonia vaccines into all the children in the world. GAVI buys the vaccines at the very lowest price with… donor money, it has worked very well. That’s why deaths of children under five, since the year 2000, in the world at large has been cut in half. It’s an even higher percentage if you just focus on Africa. So, we have that success story. GAVI had a hard time getting money from the United States, until recently, which was fairly key… We were successful in getting a $4-billion allocation for GAVI. In the meantime, we were giving money to get these factories ready.”
Bill said they were trying to use the GAVI model to roll out Covid-19 vaccines.
“Doing it very very quickly is a challenge because you never want to build a factory that can’t make quality vaccines. You really would prefer to use vaccines that have gone through the toughest regulatory process, like the United States regulator or the United Kingdom regulator, and then receive the WHO blessing. Right now, we’re working on those processes but you don’t want to speed them up where you would compromise safety for those factories or for those trials, so we have to balance those things as we push ahead.”
Asked what his message for those who are hesitant to take the vaccine would be, he said that for people who care about childhood death, vaccines are the best thing yet.
“Smallpox killed over a million people a year, and because of vaccines, now smallpox is gone. The miracle of vaccines is very clear… The more people learn about vaccines, the more amazed they should be about how fantastic they are. As I said, the safety issues are challenging. You do need to go through the trials, you do need to use extremely well-regulated factories. A factory can only be built in a country whose regulator is a gold-standard regulator and can look at every aspect of that factory, making sure that it’s very, very good. There are very few countries that have that safety review capacity that the world trusts.
“We are now getting the experience with these coronavirus vaccines, I had my first dose last week. There are very, very few side effects, and it is protecting people. In fact, almost no one who has been vaccinated has had severe disease, which is really quite miraculous.”
They were expecting data from vaccine trials with the South African virus variant this week.
“It’s one of three countries right now where it’s pretty clear that the variant is slightly more infectious, and may even be slightly more fatal. What we think is that the vaccines will be only slightly less effective, but within two weeks the data will be out. If there is a drop in effectiveness, even by 10%, we’ll still need to use the vaccine because it is still very effective. But then
we’ll look at whether we need to add an additional thing to the vaccine so it covers the variants that have emerged, and we get the efficacy level back up closer to 100%. So we’re investing money in that right now – I’m talking to all of the companies. It’s definitely bad news that these variants showed up, but we do expect that the vaccines will still have a pretty high level of efficacy, even before we make that new addition.”
Bill said he also received his first dose of the vaccine recently.
“I ended up getting the Moderna vaccine, I had no choice, they don’t ask what your preference is. There are only two vaccines approved in the United States right now, Pfizer and Moderna. They’re both very good vaccines and very safe.
“We don’t know when the next pandemic will come, but we know the cost of a pandemic in this case has been tens of trillions of dollars, and has had a negative impact in terms of education and mental health that we have a hard time measuring. You really should study what things were like before GAVI and see that story. For people who care about vaccine equity, what it has done is really a miracle, but there’s still much more to do.” DM/MC
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