COVID, Diplomacy and Populism

Guest: Bill Moss, Executive Director of the International Vaccine Access Center and professor of epidemiology and immunology at The Johns Hopkins University

The world spiraled into chaos as COVID took over. Now some countries are back, while others in the developing world still have a long way to go. How do we bridge this ‘vaccine inequality’?

This was a first of a series of joint podcast episodes in which Altamar partnered with The Johns Hopkins University to co-produce podcast on the global vaccine response, the future of the COVAX initiative, and what we can expect from COVID-19 in months to come. Dr. Bill Moss, Executive Director of the Johns Hopkins School of Public Health’s International Vaccine Access Center, takes us on a tour of the global vaccination effort. Dr. Moss is a Professor in the Departments of Epidemiology, International Health and Molecular Microbiology and Immunology at The Johns Hopkins University. He is also the Deputy Director at the Johns Hopkins Malaria Research Institute. He is a pediatrician with subspecialty training in infectious diseases, and has worked in Ethiopia, Kenya, South Africa, Zambia, Zimbabwe, and India, among other countries. Dr. Moss serves as an authoritative voice on the COVID-19 virus and its international implications during a time of crisis.

The worldwide vaccination effort has only deepened the fault lines between rich and poor countries. While many developed countries are welcoming a long-anticipated reopening, many developing countries continue to live through a severe public health crisis. The dangers of health access inequality have become increasingly clear during the global pandemic. Can we solve it?

There’s no straight answer, but multilateral organizations have partnered in a global vaccine initiative called COVAX to resolve the issue of vaccine access. Spearheaded by the WHO, GAVI (the Vaccine Alliance), CEPI (the Coalition for Epidemic Preparedness Innovations), and UNICEF, COVAX aims to provide participating countries with equal access to vaccines. “[It’s] a coalition that was founded in April 2020 when no one really knew when vaccines would become available. But early on, it was recognized that there was going to need to be a mechanism in order to get fair and equitable distribution of vaccines,”explains Dr. Moss. 

COVAX is just one part in a larger effort to develop lasting infrastructure against the global health crisis that COVID started. “[COVAX is] one of the three pillars in what is called the ACT Accelerator. And ACT is Access to COVID-19 Tools Accelerator. And the goal here is to have equitable and fair access to vaccines, diagnostic tests, and treatments for COVID-19. COVAX is one part of this ACT Accelerator focused on vaccines,” describes Moss. “The way COVAX is set up is in two components. One is for what are called self-financing countries or economies. These are countries that have the capacity to set up bilateral arrangements with vaccine manufacturers. A lot of the high-income countries have obviously set up bilateral arrangements with the vaccine manufacturers and have purchased a large proportion of the vaccines that will be manufactured in 2021. And under this arrangement for the self-financing countries, they can either have a commitment where they basically get an insurance policy at a pre-specified price for COVID-19 vaccines. They also have an optional choice where they can kind of opt in or out, but again, they have this insurance policy,” elaborates Moss.

The equal distribution of vaccines around the world isn’t simple. National interests and political influence are often a caveat in foreign intervention and aid, and the global vaccine distribution is no exemption. “We’ve seen Russia and China with their respective vaccines use vaccine diplomacy so effectively. Meanwhile, the United States and Europe were actually late to reach out to the developing world. How have you seen the long-term consequences of this delay play out?” asks Altamar’s Peter Schechter. “China as we know has invested heavily over the past decade or two in many Sub-Saharan African countries: in building roads and building facilities like hospitals. There’s a trade-off there, because many minerals and resources go to China to help their industrial base. And so, at least in Sub-Saharan Africa, where a lot of my work is, and where I see the impact of the Chinese investments, I see this as kind of an extension of that. China has particularly provided the Sinopharm vaccine,” replies Dr. Moss. “Being able to provide COVID-19 vaccines to countries in Africa is really important. The Russians have their Sputnik V vaccine that they have also made available to many countries around the world, particularly in the Eastern European region and South America. And the United States is late to the table in being able to provide vaccines to many of these countries,” he points out.

The U.S.’s tardiness affects its influence and presence in many of the world’s developing regions. “What could be the long-term consequences of delaying this much? And how much has this self-interested vaccine diplomacy actually helped to curb the pandemic?” asks Altamar’s Muni Jensen. “There’s obviously a humanitarian component to [vaccine diplomacy], but there’s also self-interest. There’s public health self-interest. As long as the virus is circulating in parts of the world, particularly with unchecked transmission, we get variants. But there are also potentially the political implications in terms of influence on various countries,” responds Dr. Moss.

The vaccination distribution effort became politicized very early on. “I think part of this had to do with the way former president Trump and the Trump Administration dealt with turning this into a political football. It also occurred in the context of a highly polarized political climate in the United States, in terms of politicizing many of the public health measures. There’s also a long history in the United States of vaccines being a politicized issue. This tension between public health and vaccine mandates/requirements on individual liberties is a tension that’s always existed,” answers Dr. Moss. 

The episode delved into the political reality of vaccinations, and especially leadership – or the lack thereof – when it comes to dealing with the public health emergency. “I think where populist governments have really gone astray is in not being transparent, not telling the truth, and not following the scientific advice. And so, when all of that is spun and turns into disinformation about the pandemic itself, the extent of the transmission, the severity of disease, and the steps necessary to get on top of this pandemic, where all of that is twisted for political purposes, that’s where I think the populist governments have really taken their countries and their populations down a wrong path. And we’ve ended up in this very tragic situation with massive numbers of cases and deaths,” laments Dr. Moss.

And then, the million-dollar question, is there a life after COVID? “I’m not sure we’ll reach a world without COVID. COVID will be with us, but it will be managed much better than the way we have now…as [certain] populations either get vaccinated or get infected, I think we’ll see a lower level of virus transmission. That still may be one year, two years away where we enter that kind of post-pandemic period, but we’re going to continue to have to battle this virus at a low level. Slowly, we’ll get back to where we were, and maybe this will become another somewhat routine kind of respiratory virus that tends to be more severe in older individuals, in adults, and hopefully we’ll have those populations protected through vaccination or natural infection,” reflects Dr. Moss.

Want to take a deeper dive into the global vaccination effort? Find out more by listening to the latest Altamar episode, available wherever you get your podcasts. You can download the episode here.

Image Source: Nastco / Getty Images