“Everyone in my family is sick, madam, our father has been having high fevers for several days. My wife sickened 5 days ago. She was pregnant and had to have an emergency c-section delivery…baby is in the NICU…now my brother has developed a cough. They were unable to be vaccinated ma’am, they went to the center but by the time they got there, all vaccines were gone…”
On the monitor, the man gulped visibly, obviously distraught. He was the first of several patients whom I would triage remotely – a volunteer effort led by non-resident Indian physicians to help with the COVID-19 surge currently ravaging India. I had already seen many patients with similar stories: recently symptomatic, terrified of having to seek care in overburdened hospitals, and frustrated with the inability to access the life-saving vaccines being administered in other countries.
As the newspaper headlines report on a daily basis, the toll of COVID-19 IS skyrocketing in India. Patients must “hospital shop” to find beds and oxygen. The situation is dire and could have been mitigated if the population had better access to vaccines. It is imperative to promote resource equity: pandemics cannot be managed by political agendas and microbes disregard both party lines and geographic boundaries. This is why I applaud the Biden administration’s decision to support a waiver on intellectual property (IP) rights for COVID-19 vaccines. It is a critical first step towards ensuring sustainable access to vaccines, particularly in hard-hit countries like India and Brazil.
Over 80% of the more than 1 billion COVID-19 vaccine doses distributed globally have gone to high-income countries, while low-income countries have received a paltry 0.3% of the supply. Pharmaceutical companies, profiting from filling orders of wealthy countries first, have not made countries like Brazil and India a priority until now when their monopoly control on the vaccine was threatened by the possibility of an IP waiver. Yet, these are the countries where a resurgence could cause incredible upheaval and are the most vulnerable to the sequelae of this pandemic.
Moreover, there is a growing risk of prolonging the pandemic as the virus rages on unchecked. Science confirms that fact: the longer the virus is allowed to replicate in a population, the greater the possibility of mutation, which ultimately jeopardizes the health of every nation, resource-rich, or poor. History has also shown that since the original SARS epidemic in 2003, there have been dramatic leaps in the genetic variation of these viruses, which have increased transmissibility and virulence. The likelihood is that this pattern will continue into the next decade, creating more rapidly mutating and perhaps more lethal viruses, which is a threat to all humanity. Expanding vaccine equity now will help to combat our current crisis and may even quell the incidence of new mutations in the future.
The U.S. announcement is a humanitarian, practical response to the global phenomenon of a rapidly mutating pandemic. It is a great first step. The hard work is yet to be done. The World Trade Organization must meet to hash out the specifics of the policy. Other nations will need to commit to the waiver in order to for the policy to be actionable. Simultaneously, there must be commitments to compel technology transfer and resource allocation to the countries that are suffering the most.
My hope is that eventually these life-saving health care innovations will not be treated as the spoils of free-market competition and will be available to patients like my own without negotiation, wherever they are most needed.
Maya Nambisan is a physician in San Joaquin County. She is of Indian ancestry and still has many family members there. She has an M.D. from the University of Illinois and an MPH from Yale School of Epidemiology & Public Health. She is currently volunteering her time with eglobaldoctors.com, an effort by nonresident physicians of Indian origin to help with the covid surge in India.
