Health equity is a topic featured frequently on this podcast. We have watched a renewed emphasis on healthcare disparities and health inequity with the advent of the COVID-19 pandemic. As the vaccines were rolled out, we watched once again as inequity reared its ugly head. Vulnerable populations were often late to receive access to the vaccines and often had to overcome significant obstacles to be vaccinated.
Although vaccine inequity still exists in the US, over half of our adult population has received at least one dose of a COVID-19 vaccine, there is still work to be done.
In this episode, I shift the focus to Global COVID-19 Vaccine equity. How does the US and other developed countries compare to our fellow humans in countries that have low to mid socio-economic status. What can (and should) we do to correct this global disparity.
Welcome to Curbside Ethics. So happy you tuned in. Please share with your fellow clinicians and leave a rating or comment on iTunes. Visit www.StevenBradleyMD.com to request a personalized ethics consultation from our host.
Transcription:
Hello and welcome back to curb side a think. So, dr stephen bradley, your host, i am in an assioot and medical ethicist. I realize i haven’t really adequately introduced myself. I started putting these episodes out initially, this podcast was they supplemented. The black doctor’s podcast is a different podcast that i am a host for and that i manage. I wanted to produce content specifically regarding crinita medical ethics, so i started to an ex episode. Every week it was entitled ethically sourced to be supplemented, black outers podcast in the last month or so outside to switch this out and start a completely different podcast. I can separate the two topics, and that was the beginning of curb side ethics. For my background, i completed medical school at the howard university college medicine. Before going on to the university of chicago medical center for my residency and antossing during my last year of residency, i was able to do a fellowship at the mc lain center for clinical medical ethics. A fellowship was a year long and covered all types of topics. In the realm of clinical medical ethics. It started with a summer long didactic series where, every day of every week that first month, we were meeting with philosophers and parishioners lawyers positions ethicist and really going through some of the deep down literature on the subject. We had monthly and weekly case conferences where we discussed different ethical scenarios that were going on and the beauty the program was. It had perspectives from very broad ranges of life. We had physical therapists in our cohort. We had nurses, we had residents, we had attending positions. The specialties represented were anywhere from tetris and gynecology to pediatric surgery, to manisty eology, to internal medicine, and, coming together we able to discuss different ethical scenarios that were presented. We also took turns covering the ethics service at the university and were able to help impact and make decisions. These complex ethical scenarios that’s a little bit about my background, as have as past for medical ethics, and that stems from some of the time i spent work in the intentive hear unit in some of the situations that occurred there. Now today, this episode, the topic i’m going to be talking about global cobo vaccine health equity. I mentioned this in a previous episode back when the show was called ethically sourced and compared kind of how developing countries were working with and living with, this cubit nineteen pandemic as opposed to more developed countries and how there is a wide, ranging disparity in both the medical care, as well as liberties and freedoms that different countries have. I try to review a lot of the medical ethics literature that comes out a lot of its opinion pieces, but these pieces provide a lot of perspective on different things. To consider this article is published in the july edition of the journal of american medical association. It was published july, twenty, eight, twenty nine of two thousand and twenty one. It is entitled sharing technology and vaccine doses to address global vaccine and equity and end the cogit nineteen pandemic. The authors of this paper are matthew: cavena, a phd out of georgetown university law center laurence, gastin he’s a lawyer out of georgetown and a madhavendra who’s. Another lawyer out of georgetown. This article makes some incredible points. It kind of puts things into perspective. What like for us to come away with is just the overall picture of where we are from a global perspective with vaccine and equities we’ve looked at it a lot in the states which communities are suffering more from covet nineteen and which communities are or have less access to vaccination. But let’s look at this from a global perspective in the us as a whole. If we compare our numbers of active covin nineteen infections or sars cove to infections and a number of people with covin nineteen, the disease that are hospitalized, we have honestly made a lot of progress compared to where we are or where we were. Last year. The number of cases are declining in the states. We have a very high numbers of patients and citizens that are vaccinated against covin, nineteen or regatting against ours, cope to. We have reached records, highs and lows, however, in lower and middle income countries, that’s not the case. The worst of this covin nineteen pandim exactly shift it to the global south, so the south east asia regions, latin america, these regions to the globe represent over seventy five percent of global weekly deaths. Currently, this is the end of july in two thousand and twenty one. Currently, latin america has the highest rate of death per capita. Essentially, if we look at the data that we have, we can see that the pandemic is now wherever the vaccine is not i’m going to throw out some numbers and going to try to highlight the important numbers here. Approximately one point: two percent of the global vaccine supply has been received by low income countries, and only fourteen per cent of the lebel vaccine supply has been received by lower to middle income countries. These countries account for almost forty percent of the world’s population. We can contrast that with the population of the united states, where over half of our us adult population is fully vaccinated, if you recall the priority initially was to vaccinate health care workers and individuals from vulnerable populations, individuals and careers that directly contributed essentially to the economy and for maintaining our standard of living. Over half of the united states, adults have been vaccinated in subsee in africa there they only have enough doses the vaccine to cover maybe eighteen percent of their health cap workers. An older or vulnerable individuals, what is the cause of this disparity in vaccination distribution and this vaccine and equity is driven mostly by insufficient supply in an unfair allocation of vaccines. Essentially, these powerful high income countries like her own, has pre purchased enough vaccine for their own population and then some sometimes up to twice the number needed to vaccinate their population, and this brings us to the cobas organization, which is the covin nineteen vaccines global access group. This is kind of a non profit and a world wide initiative. That’s aimed at equitable access to covine vaccines. It’s a partnership between a couple different organizations, including the gave organization of world help organization and the coalition for epidemic preparedness. So a couple of organizations kind of got together and the goal is to provide equitable access to the cobi nineteen vaccines to vulnerable populations to help in this pandemic. So through cova is global initiative to procure and equitably allocate vaccines. Unfortunately, it fell to secure enough doses even for its modest goal of covering twenty percent of lower income country populations. This year, the company fizer agreed to sell kovacs only forty million doses and has only delivered just over a million doses as of may of twenty twenty one again. The agreement was for forty million doses, but only one million has been delivered thus far in june of this year that g seven countries they all got together and decided to share one billion vaccine doses, half of which would actually come from the out of states. This, however, represents only a fraction of the approximately eleven billion doses needed to vaccinate the world. What can we do to improve access to this vaccine to help other countries that are less fortunate that are lower to middle income, start to fight back against this deadly pandemic? There’s a couple things that his article lays out: one would be waving intellectual property. This was actually proposed by the biden administration. It was joined by other countries that together have sought to temporarily wave countries, world trade organization obligations to enforce an electral property with regards to covet nineteen technology. This is just a proposal and it’s going to take a while for us to work his way through the world trade organization. This wouldn’t completely remove us. Patents on vaccines, however, would give governments this option to allow local manufacturers to produce important export. Sars cove two vaccines immediately increasing access when it comes to this messenger rna vaccine technology. They are over a hundred patents and there are many different patent holders. This blanket waver if it comes to the world trader ization, could help eliminate these complex regulations and facilitate the manufacturing of more vaccines. But they remember that these covin in teen vaccines were developed with significant public funding they’re also going to yield high propheties companies. So there is an ethical obligation there to help increase the access to this life. Saving technology, giving different countries of freedom to produce vaccines could address both the market and the ethical failures that have been encountered thus far as the pandemic continues to worsen and lower to middle income countries. A broad, simple, an electral property labor that covers all intellectual property, including patents and trade degrees and extends to all covenantin acknowledges, is urgently needed. In a side as the bond organization and other countries begin to push for this intellectual property waver, a may concinis other countries in other companies to be more proactive about providing additional doses of the vaccine in the wake of the bid administrations announcement to support this intellectual property waver, both moderna and fizer, by an tech pledged additional doses of vaccine to be made available to lower to middle income. Countries to this threat of potentially losing some electoral property may help inspire these companies to be more generous. In addition to waving his intellectual property right, we can consider and we must consider sharing technology expanding manufacturing capacity just because we waved in electral property, as i mean that these countries have the means to reproduce this vaccine when maderna needed additional manufacturing capacity, actually contracted autoist swiss company and transferred some of their technology confidentially and were able to make additional supplies of the vaccine and to expedite their development process. If we share technology more openly, we can enable many pactor in africa, asia, latin america to make more doses of vaccines for themselves. The bidon administration has a leverage to ancenis sharing the technology because of the extensive public funding that was used to develop these vaccines. The maderna rna vaccine was developed jointly with the national institutes of health in the us. The national situdes of health also owns key patents in its development operation of warp speed allocated two point: five billion dollars to maderna to cover development and clinical trials. The use of public funds should come with ethical obligations to share this knowledge for the good of the global public. Once this technology is shared, there are labs and institutions across the globe. That would then be able to make components of these vaccines. There may be some concern for quality control, but again this is a side issue. There are many global companies and government run facilities with excellent records and strong oversight and the world health organizations pre qualification or bidding to use can work out a process to insure high quality and safety in the manufacture of these vaccines. A third way to address this vaccine inequity would be to reallocate the procured and ordered doses as we’re working on ways to increase to production. The pastes way to vaccinate higher is populations globally would be to reallocate doses that have already been ordered by high income countries of the cobas two billion doses goal for two thousand and twenty one. Only eighty, eight million doses have been delivered less han. A third of this is forecasted to reach three percent of lower demitte income populations by late june vaccine minty factures could give priority to lower middle income countries and their orders for the vaccine. Hiak countries could donate more doses that have already been delivered and received. The master card fodan actually donated one point: three billion to the african center for disease control for vaccine procurement and production. However, african countries still need access to these supplies. The us has ter to do something. In contrast, the us has shipped over three hundred and fifty million dozes to the states out of the order for one point, two billion doses globally as if made thirty four different countries of donated doses, with hundreds of millions more pledged to kovacs. However, lower middle income countries account for six point. Five billion people high in on countries have purchased five point: nine billion doses faster and broader donation strategies could help vaccinate health care workers and vulnerable populations globally. To whom much is given much is required. It is incumbent upon these wealthy high income countries to consider their global partners and to pitch in for a global good until covin nineteen is eradicated or managed better on a global scale. We have not done much to move a needle in tess deadly pandemic. In summary, when it comes to equitable allocation for the future of global healthcare crisis, there’s three principles that this paper are us for: first pandemics require the surge funding. Kodak was established rapidly without inclusive governance or sufficient funding. We need to source a robust financing mechanism possibly being triggered by world health mortisans when it declares a public help emergency of international concern. Second, we need to increase funding to address today’s multiple pandemics, which build a capacity for future response. Specifically, there is global funds fighting aids to berculosis malaria. All these libel pandemics, that are being managed could use additional funding and that would help set the stage for future novel pandemics. Finally, this temporary wavered intellectual property doesn’t necessarily need to be negotiated. Whenever it’s a crisis, we could institute an agreement to share technology and allow countries to wave electro property and global public health emergencies and have this as a standing policy where it doesn’t need to be negotiated in the face of a global pandemic each time. So what are your thoughts on global vaccine tepid? Are we doing all we can to help our neighbors across orders? What more can be done? How do you feel about how the us has handled vaccine, alicata and distribution internally? Is it time for us to shift our focus externally? Who can help the rest of the world open up? Thank you for turning in to curb side ethics. I’m dr stephen bradley your host. I really enjoy digging deep into these typical dilemmas and looking at health equity and what we can do to improve the care we livered. If you enjoy topics like days, please subscribe, follow the show share with someone else who may benefit from listening to the episode.