Report: Distributing a COVID-19 vaccine equitably could avert hundreds of thousands of deaths

The rush among wealthy countries to lay claim to billions of doses of prospective COVID-19 vaccines could lead to hundreds of thousands more deaths than if the vaccines are distributed equitably, according to a report released today by the Bill & Melinda Gates Foundation.

That’s just one finding from the fourth annual Goalkeepers Report, which is prepared by the Gates Foundation in partnership with the Institute for Health Metrics and Evaluation (IHME). In previous years, the report has documented the steady progress the world had made toward meeting sustainable development goals laid out by the United Nations in areas ranging from educational access to hunger to gender equality. (Bill Gates on how to end this pandemic—and prepare for the next.)

This year, though, nearly all of the metrics have shown a drop in quality of life for people around the world, particularly among those who were already suffering. Most strikingly, the IHME found that the pandemic has ended 20 years of progress lifting people out of poverty and has pushed an estimated 37 million people into extreme poverty since its start early this year.

“The pandemic has, in almost every dimension, made inequity worse,” Gates said during a press conference on Thursday. The new report argues that to save the most lives and end the pandemic as quickly as possible, countries should collaborate to develop, manufacture, and distribute vaccines and treatments equitably across the globe.

Currently, more than 150 vaccines are in development worldwide, and eight are in late stages of clinical trials. Distributing an eventual vaccine among nations proportional to their populations would stop 61 percent of the global COVID-19 deaths that would occur without a vaccine, says the report, citing two scenarios from Northeastern University’s Laboratory for the Modeling of Biological and Socio-technical Systems. By contrast, the report says that allocating the first two billion doses of vaccine to the highest bidders would prevent just 33 percent of deaths. (Dozens of COVID-19 vaccines are in development. Here are the ones to follow.)

“You can't just use whoever's richest to do the allocation,” Gates said in an interview with National Geographic Editor in Chief Susan Goldberg. “You have to figure out your end goal and then say to everybody, For the good of the world, let's cooperate in a way that is unprecedented.”

Successive global crises

In the press conference, Gates outlined a cascading effect of catastrophes created by the pandemic—a health crisis triggering an economic crisis triggering an education crisis and so on—that is exacerbating existing inequities among nations, genders, and races.

According to the report, the global economic recession is the most pernicious of these crises, affecting all countries regardless of their success in limiting the spread of the virus. The International Monetary Fund has estimated that the global economy is losing nearly $500 billion every month and will lose at least $12 trillion by the end of 2021. This recession’s effects hurt developing countries in an outsized way, the report says. The $18 trillion in stimulus funding that has been spent since March is largely concentrated in wealthy countries, while low-income countries such as those in sub-Saharan Africa have had to scramble to stave off financial ruin.

The recession is affecting communities of color disproportionately. In one recent survey, 46 percent of Black and Latino Americans weren’t sure if they could pay their rent in August—compared to 23 percent of white Americans in similar circumstances. (More than half of Black-owned businesses may not survive COVID-19.)

Women and girls have also been particularly affected by the pandemic. A disproportionate number of the 37 million people who have been pushed into extreme poverty are women in low- and middle-income countries, the International Labour Organization reports.

Women and girls are more likely to work in the informal sector, which includes domestic workers and street vendors. Those jobs have been particularly hard hit by the pandemic—and at the same time, unpaid household work usually delegated to women, including childcare and care for the sick, has increased. The pandemic is also likely to affect future generations, as studies from the 2014 Ebola epidemic in West Africa suggest that girls in low-income countries are less likely than boys to return to school when they reopen after an outbreak.

Health care systems have been disrupted as well, making it increasingly difficult for women to access lifesaving care during pregnancy and childbirth. The most recent data show that nearly 95 percent of maternal deaths worldwide occur in low-resource settings, and most would be preventable if proper health care and expertise were available.

Vaccinations for other diseases—such as measles, diphtheria, tetanus, and pertussis—have been increasing steadily for decades, but since the pandemic started the share of people being vaccinated for such diseases has dropped precipitously, to levels last seen in the 1990s. (Before schools reopen, parents urged to catch up on kids’ missed vaccinations.)

Undoing the damage

Beyond the past six months of dramatic regression that the report describes, it projects that the pandemic will continue to affect key sectors in the years ahead. But the data collection itself has been limited by the pandemic and the logistical difficulties it presents, researchers concede. So to compensate for those effects, the report offers two potential scenarios for the future.

The more optimistic scenario assumes that COVID-19 can be eradicated quickly. In that case, the data models predict that the world could be back on track toward achieving its sustainable development goals in just a couple years. In the worst-case scenario—if COVID-19 cannot be swiftly subdued—the world might not resume progress toward those goals for more than 10 years. Which future comes to pass will be determined largely by what companies and countries do in the next few months, Gates says. Solving such complex, connected problems will require collaborative efforts, he says.

Vaccine manufacturing is one area for potential collaboration. Gates is optimistic that a vaccine will be developed by early 2021, but he questions whether facilities will be able to produce the doses needed to combat the pandemic on a global scale. Gates suggests this dilemma could be mitigated if companies developing COVID-19 vaccines—most of which are based in a handful of wealthy nations—team up with manufacturers in other parts of the world that have greater production capacities. (Here’s how we’ll know when a COVID-19 vaccine is ready.)

There is also the question of how countries might join forces to distribute the vaccine in a way that saves lives and doesn’t compound inequity. For instance, although Gates says the U.S. has been exemplary in funding research and development for six of the vaccine contenders, he noted that the country has been absent from the discussion about aid for other nations to buy those vaccines. Earlier this month, the Trump Administration said it would not join a World Health Organization co-led effort to globalize access to potential vaccines.

Gates acknowledged that distribution will tilt toward the countries that are funding vaccine development. But he argued that wealthy countries should be deeply invested in equitable vaccine distribution, because the existence of COVID-19 anywhere in the world will prolong the pandemic’s effects everywhere.

“Not only is there a humanitarian and strategic reason for helping out developing countries,” he said, “there is a selfish reason—because that’s what allows us to get back to normal.”