Opinion: COVID can’t become endemic like HIV

We must all understand that no one will be safe from COVID unless everyone is safe, and that real success is contingent on ensuring the most vulnerable are vaccinated quickly, equitably, and fairly.

In May 1981, a small newspaper out of New York City reported on “rumors of an exotic new disease among homosexuals,” – the first story in the United States on what was, at least in sub-Saharan Africa, already becoming the AIDS epidemic.

Since then, over 30 million people have died from AIDS-related illnesses across the globe. After 40 years of scientific and medical effort, our response to AIDS has come a long way. We have effective treatments that reduce transmission of HIV, and people living with an undetectable viral load don’t transmit it sexually.

Yet, even today, there are close to 50 million people living with HIV/AIDS, with nearly 2 million new infections and 600,000 deaths annually. Most of these cases continue to happen in sub-Saharan Africa, devastating the most vulnerable people in the poorest communities, in low-income countries. So, while we have succeeded in combating a global epidemic, in many areas of the world, AIDS has become endemic and entrenched, particularly the Global South. It will still take years and millions more lives before we can truly defeat it.

We can’t let the same thing happen with COVID-19. We can’t allow hard-to-reach populations to be relegated to living in endemic hotspots – like those where AIDS is still killing people.

Credit: contributed

Credit: contributed

To do this, we must all understand that no one will be safe from COVID unless everyone is safe, and that real success is contingent on ensuring the most vulnerable -- from frontline health workers, women and girls to those people affected by conflict and crisis such as refugees and migrants – are vaccinated quickly, equitably, and fairly. But it seems the lessons of fighting HIV are being forgotten, even as new deadlier variants of COVID emerge.

Since the start of the pandemic, the Atlanta-based humanitarian organization I lead, CARE, has built a rapid response infrastructure to address the economic devastation caused by the crisis around the world. Our goal now is to help 100 million of the most marginalized people have fast and fair access to the vaccines in the coming years, including hundreds of thousands of healthcare providers and frontline workers, close to 70% of whom are women. We have seen firsthand here in the U.S. that vaccines are only as effective as their delivery systems – especially last-mile delivery.

Low-income countries are facing not only a dearth of vaccine supply but also critical challenges with logistics and cold chain capacity, human resources and training, and mistrust and misinformation among citizens. For example, Axios reports that vaccines that arrived in the Democratic Republic of the Congo on March 3, “are still sitting in a warehouse in the capital, Kinshasa,” while across the developing world Newsweek reports “massive quantities of vaccines delivered to dozens of countries have yet to be distributed, meaning they may expire, and many may have already spoiled.”

Despite public commitments to equitable distribution of vaccines, rich countries accounting for just 14 percent of the world’s population have already bought up 53 percent of the most promising vaccines. Moreover, some have even tapped into the 5 percent emergency COVAX stockpile of globally available COVID-19 vaccine doses reserved for the world’s most vulnerable populations.

True, according to the WHO, $8.5 billion has been formally committed to help COVAX buy enough vaccines to cover 20 percent of the people most at risk around the world. But, while this funding is very necessary, it still falls far short and fails to account for any of the costs of delivery.

A new CARE report revealed that a comprehensive vaccine delivery strategy – that includes support for frontline healthcare workers – requires policy makers to invest $5 dollars in delivery for every $1 they spend on vaccines themselves. It also shows that $2.50 must go to funding, training, equipping, and supporting health workers who administer vaccines, run education campaigns, connect communities to health services, and build the trust required for patients to get vaccines.

That means that donor countries, like the U.S., must consider the true cost of vaccine delivery, which CARE estimates to be as high as $48 billion and support low-income countries so they can deliver vaccines, not just purchase them. They must also continue to ensure an equitable and coordinated approach that makes up the current funding gap of billions of dollars for vaccine procurement that has been identified by COVAX.

Pharmaceutical companies – who met an historic challenge by developing effective vaccines quickly – must now provide transparency on licensing, technology transfers, costs and data. And, both companies and governments must be sure regulatory approval is based on clear demonstration of safe, effective, and quality vaccines.

Unless we all do our parts, we will not succeed.

Like 1981, 2021 finds us at a crossroads. One road leads from pandemic to endemic – and what some may see as “acceptable apathy” where the lives of the vulnerable in low-income countries are deemed less valuable. The same road taken over the last 40 years with AIDS.

The other road is built on understanding the true cost of vaccines and the human cost of failing to deliver vaccines to the most vulnerable, and a joint commitment by all who walk it together to equity, equality, and human dignity. Our destination is a place where each of us is safe because all of us are safe.

Let’s not take 40 years (and 30 million deaths) to get there.

Michelle Nunn is the president and CEO of CARE USA, an Atlanta-based international development and relief organization that works around the world to save lives, defeat poverty, and achieve social justice.

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