Podcast: The Consequences of Vaccine Nationalism

While wealthier countries reopen, India and the rest of the world face a terrifying new peak in the pandemic. How did it come to this? What can be done? And with new variants and limited supplies, how does the global vaccine strategy need to change to prevent more coronavirus spikes?

Staff writer Yasmeen Serhan joins James Hamblin and Maeve Higgins on the podcast Social Distance to explain. Listen to their conversation here:

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What follows is a transcript of their conversation, edited for length and clarity:

Maeve Higgins: Could you explain the situation in India for listeners?

Yasmeen Serhan: If you were paying attention to India about a month ago, you probably wouldn’t have thought that we’d be here now. Cases weren’t that high, particularly for a country of 1.3 billion people, and the government was really talking about the pandemic like it was a challenge of the past. The health minister said that India was in the “endgame” of this pandemic.

Meanwhile, you saw large political rallies, religious festivals, even some cricket matches. It felt like people were lowering their guard and life was resuming normalcy. Fast-forward several weeks later, [and we’ve] started to see these incredible increases both in cases and in deaths. Not only is India recording more than 350,000 cases a day, it’s surpassed more than 300,000 new cases for the sixth day in a row. If you look at the charts, it’s not a wave or a curve. It’s like a wall.

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And then, of course, all those numbers hit home when you see the actual images of people waiting outside of hospitals not being able to get in, not having enough oxygen. Doctors who are just struggling, saying they’ve never dealt with anything like this—even during the first wave. It’s a really, really depressing situation.

James Hamblin: Yeah, there’s something that doesn’t come through in the numbers that does when you hear stories that there aren’t enough graveyards, or there’s not enough wood to burn funeral pyres. People are dying because of something as simple as not enough oxygen in a hospital, if you’re even lucky enough to get a hospital bed.

Given what we know about how to prevent this disease, we have some level of vaccination and population immunity—and [it] clearly is far from over—but I didn’t think we would get to a point of that level of severity at this point in the pandemic. How did this happen? Is India really far behind on vaccination? Is there not as much population immunity as they might have thought?

Serhan: There were a number of factors. The first is with vaccination. Despite the fact that India is home to the world’s largest vaccine maker, the Serum Institute, and despite the fact that it’s engaged in a lot of vaccine diplomacy—giving doses to a number of its neighbors—India actually hasn’t vaccinated a large portion of its population. The fully vaccinated population stands at about 1.7 percent. And with all its domestic manufacturing [now] just targeted on India, that isn’t proving enough right now.

So vaccination was part of it, [as well as] what I talked about before—but also the variants. Virtually every variant of concern that we know about [is] in India right now. And we’ve seen the emergence of a new Indian variant, which is also currently being studied; some experts that I’ve spoken to fear that it’s behind a lot of the surge that we’re seeing right now. So it’s a confluence of factors, none of them very good at all.

Hamblin: Something really important to keep an eye on in the coming weeks [is] what we can understand about how many people are being infected. Is this simply a case of an immunologically naive population? Or did immunity wane, and people are being re-infected? Or are the variants hitting people in new ways that we need to understand better?

In any case, it’s clearly, acutely, a crisis for the country—which, as I understand, had been exporting a lot of vaccines but now has to stop that and focus more domestically. Does that mean adjacent countries who were counting on vaccines from India are going to feel ripple effects of this?

Serhan: Yes. And unfortunately, it’s going to be some of the countries that need vaccines the most [and] that currently aren’t getting them. The Serum Institute is one of the biggest providers to COVAX, the international initiative aimed at equalizing vaccine distribution around the world. There are 92 low- and middle-income countries that have been relying on the Serum Institute to begin vaccinations. And the Serum Institute had to go to COVAX and effectively say: “Look, we can’t ignore the crisis at home. We need to turn our attention to India. We’re not going to be able to supply as many doses as we said we would, at least for the next couple of months.”

It’s kind of a domino effect: One country’s crisis is every country’s crisis. Because what happens in India doesn’t stay there—not just with variants, but also with vaccines. If India can’t act as the pharmacy of the world, then other countries suffer too.

Hamblin: Is there a country in the world that has a ton of vaccines and could help out?

Higgins: Yeah, how many extra doses does the United States have?

Serhan: Duke University’s Institute of Global Health has done a lot of work tracking vaccine procurement and manufacturing. And what they found is that the U.S. has secured more doses than it will ever need. [According to] its most recent report, even if you take out the doses that the U.S. will likely need for booster shots and to vaccinate children when they become eligible, the U.S. could have as many as three hundred million surplus doses by the end of July.

Higgins: And that’s what you call vaccine nationalism—when one country is, at the expense of other countries, just looking out for themselves.

Serhan: Exactly. The way that I think about vaccine nationalism is like the instructions on a plane for when the cabin pressure drops and oxygen masks fall in front of you: “Put your mask on before helping others.”

The way that predominantly wealthy countries have kind of done this, they’ve basically said: “We’re going to put on our own mask; we’re going to take care of ourselves first and vaccinate our population. But we’re also going to take some of these other oxygen masks on the plane, just in case. We may not need to use them, but we’re just going to keep them.”

And there are a finite number of masks, just as there are a finite number of vaccines.

Higgins: That is a really horrifying metaphor.

Serhan: It’s the way I’ve figured out to drive home the fact. Because to hear that wealthy countries “hedged their bets and bought a lot of doses because they have that purchasing power” doesn’t quite drill home the impact that has on countries who didn’t have that purchasing power and who couldn’t purchase those doses.

Higgins: Are there examples of other countries stepping in and offering to help?

Serhan: Well, India was one of those countries doing a lot of “vaccine diplomacy,” as it’s come to be known. Russia and China have also been quite aggressively sending their doses around the world for free, or at a very cheap price. Other countries, predominantly those in Europe or the United States, have largely stayed out of this game. And the main reason given is that they have doses, but they don’t have enough of them. In the meantime, other countries like China and Russia are stepping in and filling that void.

Hamblin: What about export controls on the materials that go into making vaccines? Could more be done to support India’s manufacturing?

Serhan: Definitely. Both India and South Africa appealed to the World Trade Organization to temporarily waive rules around intellectual-property protections for patents and regulatory data, which would basically allow other countries to produce COVID-19 vaccines and therapies without fear of being sued. This is an appeal that’s been supported by around a hundred mostly developing countries, several former leaders, and even some U.S. lawmakers.

Hamblin: It seems to me we’re sort of behind the ball. Some of these vaccines you can’t immediately ramp up production of—certainly not very easily—but people think that if we open the intellectual rights right now, a country like India might be able to make more than they currently are.

Serhan: Yeah; that’s the hope. Critics will probably say that it’s not a silver bullet. Some of the lawmakers in the U.S. that I’ve spoken to about this see it as a way to effectively lift the burden on other countries and say: “We need to give countries that need vaccines the means to make it themselves. We shouldn’t just be hogging this intellectual data.”

And it’s a temporary waiver. The idea is that desperate times call for desperate measures. As for whether it will happen—at the moment, the U.S., the E.U., the U.K., and a host of other countries are opposed to it. So it remains to be seen whether there will be enough pressure to change that. We’ve already seen so much movement in the last few days. Before just a few days ago, the U.S. wasn’t sharing raw materials. A few days ago, the U.S. wouldn’t countenance sharing its doses, at least not any time soon. Now we’re seeing the U.S. do both of those things. So maybe the U.S. will reconsider its position on this, but it remains to be seen.

Higgins: Can I ask about the variants? Something you have both written about and we’ve talked about on the show before is: Until it’s gone for everybody, it’s not gone. Jim, can you explain this “double mutant” variant? Is it more transmissible?

Hamblin: We don’t know yet. And I don’t like the term "double mutant." It is being advanced by officials and by media, but all these strains are constantly mutating. When a mutation becomes significant, it gets a name. Like, the worst one is E484K, which is the one in South Africa and Brazil that seems to help evade immunological protection, at least partly.

The strain in India, B1617, has many mutations but two of note. Two ominous ones. But we don’t know more. And that’s one of the things you suggest in your story, Yasmeen—that maybe other countries could help do more genomic sequencing of the strains circulating in India to help better understand to what degree this variant is actually spreading, because that’s in everyone’s interest to understand globally.

Serhan: Yeah; as I understand it, India’s sequencing very, very few cases right now. Which is a problem, because you don’t really know what’s happening on the ground beyond the fact that hospitals are overwhelmed and that death counts are rising. But until you can ramp [sequencing] up further, it’s hard to really know what risk this variant poses and whether it can evade vaccine immunity or anything like that.

We don’t know anything about it yet, so there’s no suggestion to say that it’s that serious. They’ve not even labeled it as a “variant of concern” yet, just a “variant of interest.” But I think the broader lesson is that the world really needs to start treating these variants like they could be variants of concern—like they could, God forbid, evade vaccines or be more transmissible and more deadly.

I think we’re soon going to find that real political leadership is going to mean looking to the rest of the world and figuring out: How do I protect my population and everyone else from looming threats? Just because you vaccinate your population doesn’t mean that they’re automatically safe if this pandemic is ravaging the rest of the world.