In Push for Global Vaccine Equity, US AIDS Program PEPFAR Offers Blueprint

In Push for Global Vaccine Equity, U.S. AIDS Program Offers Blueprint

Health experts warn any vaccination progress in the United States will be threatened without global vaccine equity.
In Push for Global Vaccine Equity, U.S. AIDS Program Offers Blueprint

As the U.S. COVID death toll tops 450,000, the Biden administration is attempting to ramp up its vaccination campaign to slow the spread of new coronavirus variants. Meanwhile, health experts warn any vaccination progress in the United States will be threatened without global vaccine equity. “We need to, as quickly as possible, expand access to the vaccines, both in this country, in the United States, as well as around the world,” says Dr. Wafaa El-Sadr, director of the ICAP at Columbia University and professor of epidemiology and medicine at the Columbia Mailman School of Public Health. She argues that the U.S. needs to do more to supply the world with COVID-19 vaccines, as it did with HIV medications. “This is a model that can be emulated at this point in time in recognition of the fact that viruses know no borders.”

TRANSCRIPT

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: The U.S. death toll from COVID-19 has passed 450,000. Over 3,900 people died of the disease just Wednesday alone. In another major milestone, data gathered by the COVID Tracking Project shows vaccinations in the United States have eclipsed the number of people who have been infected with the coronavirus. More than 27 million have received a first shot, and nearly 6 million have been given both vaccine doses. This comes the Biden administration says it still expects to reach its target of 100 million vaccines in his first 100 days, and the number of deaths and people hospitalized continues to fall. But the Centers for Disease Control and Prevention director, Dr. Rochelle Walensky, warned Wednesday new COVID-19 variants may reverse this trend.

DR. ROCHELLE WALENSKY: Although we have seen declines in cases and admissions and a recent slowing of deaths, cases remain extraordinarily high, still twice as high as the peak number of cases over the summer. And the continued proliferation of variants, variants that likely have increased transmissibility, that spread more easily, threatens to reverse these recent trends.

AMY GOODMAN: As multiple new strains of the coronavirus spread across the United States, the government’s top infectious disease expert, Dr. Anthony Fauci, said Monday people must be vaccinated as quickly as possible to stop more mutations from emerging.

DR. ANTHONY FAUCI: You need to get vaccinated when it becomes available as quickly and as expeditiously as possible throughout the country. And the reason for that is that there is a fact that permeates virology, and that is that viruses cannot mutate if they don’t replicate.

AMY GOODMAN: This comes as health experts warn any vaccination progress in the United States will be threatened without global vaccine equity.

For more, we’re joined by Dr. Wafaa El-Sadr, professor of epidemiology and medicine at the Columbia Mailman School of Public Health and director of ICAP at Columbia University. She recently co-authored an op-ed in The New York Times headlined “The World Is Desperate for More Covid Vaccines,” that argues, “Two decades ago, the U.S. launched a program to help supply the world with H.I.V. medication. It should take a similar approach to Covid.”

Doctor, welcome to Democracy Now! It’s great to have you with us. I wanted to start with this watershed moment that we are in, facing the race between the vaccines and the virus. Explain what’s happening.

DR. WAFAA EL-SADR: Well, thank you. First of all, thank you very much for having me today.

I think we are exactly at this watershed moment because what we have is the potential for garnering the benefits of the vaccines we have discovered thus far, while at the same time we’re also seeing the growth in terms of the numbers of new COVID cases, as well as also the identification of these new variants, these new mutations in the virus, that potentially could threaten the effectiveness of even our vaccines.

So I think what this means is that we have to do two things at the same time. We need to, as quickly as possible, expand access to the vaccines, both in this country, in the United States, as well as also around the world. That’s number one. And number two, we must continue to make every effort to stop transmission from one person to the next, because this is exactly what generates these mutations, these new variants. And that must continue to be done by the usual public health preventive measures that we are all familiar with. The physical distancing, the masking is critically important, avoiding large congregations of people, avoiding socializing at this point in time. So, I think we have to be working on these two pathways: scale up of vaccines locally and globally, and at the same time do everything we can to stop transmission of the virus.

NERMEEN SHAIKH: Dr. El-Sadr, you talked about vaccine access, the importance of vaccine access, in this New York Times op-ed, where you point out that it was Dr. Fauci himself — regarding the HIV and AIDS virus, it was Dr. Fauci at the time who persuaded then-President George W. Bush to start PEPFAR, the President’s Emergency Plan for AIDS Relief, that made AIDS/HIV medication accessible to large numbers of people around the world, saving up to 18 million lives, as you write. What is it that you’re advocating the Biden administration do to enable access globally to the COVID vaccines in a similar way?

DR. WAFAA EL-SADR: Yes, I think we do have this historic precedent that I think is probably one of — people do recognize that PEPFAR, the global HIV program that’s supported by the United States government, is probably one of the most successful ever foreign assistance programs, that has received bipartisan support for decades now. And I think this is a model that can be emulated at this point in time in recognition of the fact that viruses know no borders, and that what happens in a country in sub-Saharan Africa has — with regards to COVID, has an impact on what happens right here in our own country.

So, the model is the importance of prioritizing the procurement, the support for the development of these vaccines around the world so that they can actually reach the largest numbers of people possible, particularly in low- and middle-income countries. So it’s both making available the vaccines themselves or making available the technology that supports the development of these vaccines, at the same time also investment, investing the resources to be able to support vaccination programs. We know that you need the vaccines, obviously, but we also need to have effective, large-scale vaccination programs in order to get the benefits of these vaccines anywhere.

NERMEEN SHAIKH: Dr. El-Sadr, you also say in the same piece that the mRNA vaccines, which both Moderna and Pfizer use, are easier and faster to manufacture than most other vaccine technologies. But, of course, these vaccines are extremely difficult to transport and to store, given the temperatures at which they have to be kept. Could you talk about what you think — I mean, the Russia vaccine, Sputnik V, has just been shown to have 92% efficacy. There are other vaccines that developing countries are attempting to access, the China vaccines, Sinopharm, Sinovac. How easy or difficult is it, given the technologies those vaccines use, to manufacture and produce and disseminate widely and quickly?

DR. WAFAA EL-SADR: I think, in the end, we’re going to need really a mix of different types of vaccines. And it depends, really, on the setting. There are some settings where it is quite feasible to be able to keep some of these mRNA vaccines available, if there are freezers, for example, refrigerators and so on. And then there are other settings where it is going to be very difficult because of the lack of these kinds of resources. So, in the end, I think it’s going to depend on the setting and the location within different countries and so on.

So I do think we need to be flexible. We need to be cognizant of the realities on the ground and do the very best that we can to enable that, in the end, countries would have different options, that they can then seek whatever option fits best within their reality and that fits best within their own context. I think there’s not going to be one answer, but I think there needs to be work on all fronts to enable, ultimately, that people from these countries have access to the vaccine, because it is the right thing to do, but it also is in the self-interest of our own country, as well.

AMY GOODMAN: Dr. Wafaa El-Sadr, can you address the issue of those concerned about the vaccine? A new study has come out today from Monmouth University that says in the United States maybe half the people plan to get vaccinated as soon as they can, but a quarter say they never will. We see very little information about negative side effects of these vaccines, though millions have gotten them. Would it help people to believe more in the vaccine if we heard about the thousands of, well, complaints and concerns that people have with the vaccine?

DR. WAFAA EL-SADR: I think that, absolutely, I think we are all very — as public health professionals and researchers, we’re very concerned about what has been called vaccine hesitancy, which is — it could be because simply people don’t have the accurate information about the vaccine itself. So that’s very important, just disseminating information about the vaccine and how it was developed and what it does and what it doesn’t do.

I think another aspect of hesitancy sometimes is because of a legacy of mistrust, for example, among certain groups of our own population and global populations in terms of mistrust of government, mistrust of research. And for that, we need to engage individuals from these same communities, trusted messengers, trusted champions, who can talk to their peers about what the vaccines do and what they don’t do.

We also need, at the same time, to also share information as information arises, in terms of any side effects from these vaccines and the magnitude of such side effects. I think it’s really important to be transmitting the information, thinking about what are the best channels for transmitting the information. And very important is being very transparent about the information that we have.

We’re very fortunate that, thus far, with all of the vaccines for which we’ve seen results, have been, first of all, remarkably effective — they work — and also have been remarkably safe. The safety profile has been very comforting, and I think that’s really of great importance.

AMY GOODMAN: So, why do you think it is, Dr. El-Sadr, that perhaps up to a third of healthcare professionals say they will not take the vaccine? That does not inspire confidence. And what is the reasoning?

DR. WAFAA EL-SADR: There are multiple reasons for this. I think, again, healthcare workers are not — are also a part of our society, our community. And there are, again, many people who are from certain subsets of our communities, particularly amongst African Americans, for example, Hispanics and Latinx populations in this country, who, because of the legacy I mentioned, the legacy of mistrust and prior abuses in research, are leery of anything that comes from the government, including these very valuable vaccines.

And I think it’s going to take a lot of work for us to be able to gain their trust and keep sharing the information. But most importantly, beyond the knowledge, it is really reaching people from the same communities who can then talk about their own experiences, why they were vaccinated, and then demonstrate to others that it is in their interest and the interests of their families and communities to be vaccinated. It’s not going to happen overnight, but we need to be working on this very diligently, engaging with the communities that have the fear of these vaccines, so that we can gain their trust. It will take a lot of work, a lot of partnerships, a lot of commitment, and being willing to listen to their concerns and answer their concerns.

NERMEEN SHAIKH: And, Dr. El-Sadr, as I’m sure you’re aware, vaccine hesitancy is not just a problem in the U.S., but also across the world. France has one of the highest rates, but also places like South Africa and Kuwait. So, could you talk about how views of vaccination and why views of vaccination have changed in this way, and what the implications are if large numbers of people, or even significant numbers of people, around the world refuse the vaccine when it’s made available to them?

DR. WAFAA EL-SADR: I think that’s an issue, globally, of great concern. Like you said, it’s not just in the U.S.; it’s in almost every corner of this globe. And people are — you know, when you think about, when you ask individuals, they’re on a spectrum. There are people who are ready and willing to get vaccinated. As soon as they’re eligible, they’re going to really be at the front of the line. They are convinced. They’re ready to act. And then, on the other extreme are people who simply don’t believe in vaccines, for a variety of different reasons — vaccines overall, not just this COVID vaccine. And then, most people are somewhere in the middle. And they are seeking answers to their questions. They are seeking reassurance. They’re seeking — they’re looking for others like them to have been vaccinated.

And I think we’re now focusing on these individuals who are on the spectrum of these people who have concerns, who have issues, who have certain beliefs, and working with them diligently to try to overcome some of the myths they may believe, and also to try, like I said, to engage people whom they trust. This is very important. What I’m seeing now is some of the narratives, storytelling around the vaccines, people who are standing up from some of these same communities and saying, “You know, I went and I got vaccinated because I did it for my family. I did it for my community.” And that can be a very powerful statement coming from someone from these same communities. And we need to be doing this in the U.S., as well as around the world, as well.

And I think, in this day and age, it’s particularly important to do this very actively, because, of course, of social media and the ability to disseminate sometimes erroneous information about side effects of vaccines. And I think we need to be very nimble to be able to, again, respond to some of this erroneous messaging very quickly.

AMY GOODMAN: Dr. El-Sadr, I wanted to ask you about the current controversy in the United States. This is CDC Director Dr. Rochelle Walensky, speaking during a briefing with reporters Wednesday about the reopening of schools and vaccines for teachers.

DR. ROCHELLE WALENSKY: I would also say that safe reopening of schools is not — that vaccination of teachers is not a prerequisite for safe reopening of schools.

AMY GOODMAN: President Biden has said he wants to reopen a majority of K-8 schools in his first hundred days. But during a meeting with teachers’ unions last Thursday, Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, said it may not happen.

DR. ANTHONY FAUCI: That may not happen, because there may be mitigating circumstances.

AMY GOODMAN: So, can you, Dr. El-Sadr, address this issue of whether parents, teachers and kids should be concerned about in-person learning, and what it means for Dr. Walensky to say, yes, people should go back to school, even if teachers are not fully vaccinated?

DR. WAFAA EL-SADR: Well, I think we have data now that are very reassuring. So, over the past year, since the beginning of this pandemic, there’s been accumulating data that have shown again and again that transmission in schools is not the problem. It is not that schools have been breeding grounds for transmission of COVID-19. This has been shown in a variety of different programs around this country and around the world, for a lot of different reasons. One is that we have some data that transmission from children to adults seems to be less efficient than from adults to adults, so that’s important, and also that there are data that have shown that the rates of transmission within schools, again, are very limited. Most of the infections amongst teachers and so on and other school personnel have been acquired in the community; they’ve not been acquired in the schools themselves.

So the most important thing is to make sure that the schools are safe. And that means, of course, paying attention to ventilation, to the spacing between the students, to face covering if they’re of the right age and can wear a mask. And I think we have — again, we have the evidence that said that this has kept our schools as safe environments. Certainly, again, teachers who are involved in in-classroom instruction, they are part — at least in New York state, they are part of the group that is eligible to get vaccinated. But, again, the data, overall, are quite reassuring about the situation itself of COVID in schools even without the vaccine. So the vaccine can be an additive protective measure, but it’s not necessary to restrict return to school until every — not just teacher, but every staff person at a school is vaccinated.

AMY GOODMAN:

AMY GOODMAN: Dr. Wafaa El-Sadr, we want to thank for being with us, professor of epidemiology and medicine at Columbia’s Mailman School of Public Health. We’ll link to your piece in The New York Times, “The World Is Desperate for More Covid Vaccines.”

When we come back, we look at China’s crackdown on Uyghurs and other Muslim minorities in Xinjiang province, as reports emerge of mass rapes and sweeping surveillance. Stay with us.

[break]

AMY GOODMAN: “Dark Eyes” by Lila Downs. To see our interview with her and her performance in our studio, go to democracynow.org. I’m Amy Goodman, with Nermeen Shaikh.


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