Ingrid Katz

Although the U.S. has begun to vaccinate millions of Americans each day against the virus that causes COVID-19, it is likely that 80 percent of people in low-resource countries will not receive a vaccine in 2021. In a recent Perspective piece in the New England Journal of Medicine (NEJM), Brigham researchers and co-authors highlighted one international trend perpetuating this inequity: “vaccine nationalism,” or the pattern of high-resource countries acquiring the overwhelming proportion of available vaccines to protect their own populations.

CRN sat down with the lead author of the paper, Ingrid Katz, MD, MHS, of the Department of Medicine, to discuss the origins and impact of vaccine nationalism. Katz, an associate professor at Harvard Medical School and associate faculty director at the Harvard Global Health Institute, spent a decade promoting the equitable delivery of HIV treatments. She believes the lessons from that public health crisis can inform a more effective response to this one.

How would you define the concept of “vaccine nationalism”? Where does it come from?

IK: Vaccine nationalism is a term that describes the inequitable acquisition and distribution of vaccines globally, with countries — particularly high-resource nations — protecting their own populations first and not considering the needs of the rest of the globe. The concept is reflective of the inherent global inequalities left by colonialism and the expansion of economic powerhouses, which have created unequal situations for health and health care.

Beyond its health impact on lower-resource countries, what are the other consequences of vaccine nationalism?

IK: Viruses do not stop at borders. Lines that we’ve drawn in the sand are not going to hold up to the virus. We are living in an interconnected world, which is evident from the initial spread of this virus, and variants are continuing to emerge. When we have neighbors whose health systems are struggling, both on local and global scales, it not only impacts the U.S. from an ethical or moral standpoint; there are health and economic reverberations globally.

We have to be thinking much more coherently about our response, both in this moment and for all future moments. I don’t think it’s going to be 100 years again until we get our next big pandemic. We are increasingly interconnected, and going forward, we need to develop new ways to support nations in creating their own vaccine supply chains locally.

The U.S. is part of the COVID-19 Vaccines Global Access (COVAX) program, which is committed to vaccinating at least 20 percent of populations of participating low- and middle-income countries by the end of 2021. What initiatives beyond COVAX are needed to further vaccine equity?

IK: COVAX, which is co-led by the Coalition for Epidemic Preparedness Innovations, Gavi, and the World Health Organization, has encountered substantial delays, due in part to concerns surrounding the safety and efficacy of the AstraZeneca vaccine. Roughly 36 COVAX countries had not started inoculations as of early April. Beyond COVAX, we need to be looking at how to empower the countries that have the potential to manufacture and distribute vaccines to do so. The Serum Institute, in India, for instance, has anchored massive manufacturing and distribution in that region of the world. South Africa, where a lot of clinical trials were taking place, and China, also have the potential to do so as well.

Intellectual property rights are an important factor here. India and South Africa have petitioned to have patents removed in order to create generics and start manufacturing vaccines themselves. The petition is controversial: some people wonder what the incentive will be for pharmaceutical companies to produce vaccines and therapeutics if there is no potential financial benefit. In our article, we generally support a patent waiver during a global health crisis like this one. But there should also be ways for pharmaceutical companies to be reimbursed for their contributions and the work they’ve done. It’s a very complex dilemma.

What efforts are underway within the Brigham community to help address vaccine nationalism?

IK: Many of us at the Brigham care deeply about ensuring that there’s equitable vaccine distribution globally, and we have passed on information to the Biden administration to support this work. My colleagues and I, especially those of us who have worked in HIV research, have seen the global health impact of large governmental investments. The 2003 President’s Emergency Plan for AIDS Relief really was a game-changer in ensuring equitable distribution of HIV treatments. In our article, we expressed support for an initiative with a similar mindset, which is being called the President’s Emergency Plan for Vaccine Access and Relief (PEPVAR). PEPVAR integrates global health needs into funding priorities to ensure that low-resource nations have adequate infrastructure to support the delivery of vaccines. Drizzling funds here and there can put a band-aid on the situation, but especially when we’re fighting against time, we have to be thinking in a much bigger and broader way.

What are the major challenges of establishing a relief program at this scale?

IK: The challenge that this presidential administration is facing is that the vaccine roll-out in the U.S. was initially very slow, and public health measures were deeply devalued. It can be a hard sell in Congress to allocate resources to global vaccine equity when we still have to address equity in the United States. But I don’t think the two are mutually exclusive. It does require a large investment, but the U.S. doesn’t have to do this alone. Many nations could be critical players here, and this is a moment in which the U.S. has the opportunity to take the lead in doing the right thing.

What can individuals do to make an impact on something as large-scale as vaccine nationalism?

IK: This is an opportunity in which we, as citizens, can remind our congresspeople of the need to cover the whole spectrum of equity, locally and globally. I hope people use their voices, use their social media, or call up their congresspeople, because elected officials do keep track of what their constituents care about. Our response to the pandemic will not work if we are not supporting all the people of the globe.


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