At the end of February 2021, 2.495 million people had passed away as a result of the COVID-19 pandemic.[1] Over the past year, public health officials have tried to contain the spread with measures such as social distancing and masks, but there is a general consensus that vaccination could greatly expedite the path to herd immunity while reducing the burden on healthcare systems.
Vaccines are a biological preparation for infectious diseases, introducing parts of antigens from non-dangerous parts of an organism’s pathogens. This strengthens the immune system, prompting the creation of the appropriate antibodies. Both the Pfizer and Modern vaccines are mRNA vaccines that train the immune system with a SARS-2 spike protein, which is a glycoprotein that protrudes from the surface of the virus.[2] When the body is introduced to the real virus, it is already prepared to fight back.[3] Vaccines are especially effective in preventing symptomatic spread, and the Pfizer vaccine is recognized as being 94% effective against asymptomatic spread.[4] But regardless of the brand, all of the vaccines will be ineffective if they are not distributed to a significant percentage of the global population.
The first disease eradicated from the world by way of vaccine was smallpox, a type of orthopoxvirus. The vaccine was first developed in 1796 by Edward Jenner, but a global push for eradication emerged in 1967, with a special focus on surveillance in addition to immunization. The virus was fully eradicated by 1977.[5] No other illnesses have been fully eradicated since, but immunization has been an important factor in fighting other infectious diseases.
In 2020, there were only 441 polio cases worldwide due to comprehensive immunization efforts. There are only two countries where the wild poliovirus persists—Afghanistan and Pakistan. In August of 2020, Africa was deemed free of wild poliovirus, though some vaccine derived cases remain.[6] The weakened vaccine-derived poliovirus was a result of previous underimmunization.[7]
But why does polio persist in these countries? In Pakistan, some speculate that the failure of local leadership to promote foreign vaccination programs has stalled the effectiveness of immunization efforts.[8] In Afghanistan, political instability was cited as a deterrent against immunization efforts. Many national leaders in the fight against polio were removed in the wake of the Taliban.[9] Nigeria, the last African country to report polio cases, cited Boko Haram as a problem, as well as the rapid spread of misinformation.[10] As the world collectively takes on the challenge of distributing the COVID-19 vaccine, issues related to low vaccine confidence and political instability come into play once again. In the fight for global herd immunity, these issues must be addressed head-on.
The United States of America
In the U.S, the federal government relegated significant power to the states when it came to COVID-19 vaccination efforts. This bureautic distribution process initially inhibited vaccinations. In December of 2020, there was much cause for concern when only 2.8 million people were vaccinated, which was a far cry from the goal of 20 million. The issue at hand wasn’t supply, but distribution. On the issue of the 20 million doses, in December of 2020 U.S. President Donald Trump wrote: “The Federal Government has distributed the vaccines to the states. Now it is up to the states to administer. Get moving!” Local health officials cited issues with funding for distribution and available staff.[11]
Since then, efficiency has greatly improved. In the past month, distribution efforts have increased by 40 percent. Distribution sites are expanding, and more and more citizens are becoming eligible to receive the vaccine. An important consideration has been expanding equal access to vaccines, with a special focus on communities of color.[12]
But even in a relatively wealthy country such as the U.S., vaccine confidence and accessibility are issues. Around 12% of parents refuse at least one recommended childhood vaccination, and around 30% will delay childhood vaccinations. Immunization rates are even lower among adults, with less than 45% of adults getting the seasonal flu vaccine.[13]
The threshold for full herd immunity is variable for different diseases, but it is consistently very high. For measles, 95% of the population must be vaccinated or otherwise receive immunity, and for polio the percentage is 80%.[14] The flu is on the low end, requiring between 33% and 44% of the population to be vaccinated. The estimation for COVID is between 50% and 80%.[15] With around 10% of the population immune from infection, at minimum, 40% of the population will need to be vaccinated, and ideally the vaccination percentage will be much higher.[16] The barriers to vaccine confidence must be addressed to achieve herd immunity.
The Republic of the Philippines
On February 18, 2021, the Philippines had vaccinated zero healthcare workers, even with over half a million cases at the time. Unlike the U.S., distribution wasn’t the issue. Supply was. Rich countries were the first to purchase the vaccines, leaving significantly less for middle and low income countries.[17]
The Philippines is also a country that struggles with low vaccine confidence. After complications involving a dengue vaccine that sickened many people, full vaccine confidence dropped from 82% in 2015 to 21% in 2018.[18] Consequently, the rate of routine immunizations has been dropping rapidly. Tuberculosis vaccine rates fell from 72% in 2015 to 42% in 2020. It is fair to assume that this lack of vaccine confidence may be relevant in distributing COVID-19 vaccines as well. This is on top of the logistical challenges of distributing vaccines across 2,000 islands.[19] The historical negative impacts of vaccines in many countries is a significant obstacle to immunization. The situation in the Philippines is parallel to that of many African countries as well.
Israel
As of March 12, 2021, 55% of Israelis over the age of 16 had been vaccinated—four times the rate of the U.S. The success can be attributed to strong encouragement from political leadership and early stockpiles. Israelis have been subject to several strict lockdowns, including one that restricted citizens to within 1,000 yards of their homes. The populous was already familiarized with disciplined procedures to reduce the spread, even with the added difficulty of addressing orthodox religious communities.[20]
An issue in Israel’s vaccine distribution efforts is the inequity in distribution in the occupied territories of the West Bank and Gaza. While Palestinians living in East Jerusalem have been able to access vaccines, those in the West Bank and Gaza are heavily restricted by Israeli blockades and political issues with Hamas. The fatality rate in Israel is 0.7% compared to 1.1% in the West Bank and Gaza. However, per the recommendation of the World Bank, the Israeli government shared 5,000 vaccines.[21] This was an important step in recognizing the necessity of increasing immunization efforts, despite political and militaristic conflicts, in order to improve global health.
Conclusion
Global immunization efforts are vital in order to guarantee herd immunity, or at least heavily reduce future COVID-19 outbreaks. Countries must work together to overcome organizational issues, low vaccine confidence, and political struggles in order to bolster public health internationally.
Works Cited
[1] “COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU).” Johns Hopkins University. Accessed March 19th, 2021. https://coronavirus.jhu.edu/map.html
[2] Branswell, Helen. “Comparing three COVID-19 Vaccines Developed by Pfizer, Moderna, and Johnson & Johnson.” Stat News. February 2nd, 2021. https://www.statnews.com/2021/02/02/comparing-the-covid-19-vaccines-developed-by-pfizer-moderna-and-johnson-johnson/
[3] “How Do Vaccines Work.” World Health Organization. December 8th, 2020. https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work
[4] Silberman, Dr. Eric. “Pfizer Vaccine Shows 94% Effectiveness Against Asymptomatic Transmission of COVID.” ABC News. March 11th, 2021. https://abcnews.go.com/Health/pfizer-vaccine-shows-94-effectiveness-asymptomatic-transmission-covid/story?id=76389615
[5] “Smallpox.” World Health Organization. Accessed March 19th, 2021. https://www.who.int/health-topics/smallpox#tab=tab_1
[6] “World Polio Day 2020.” Center for Disease Control. Accessed March 19th, 2021. https://www.cdc.gov/globalhealth/immunization/wpd/index.html
[7] “Poliomyelitis: Vaccine Derived Polio.” World Health Organization. April 19th, 2017. https://www.who.int/news-room/q-a-detail/poliomyelitis-vaccine-derived-polio
[8] Asghar, Rana Jawad. “Why is Polio Still Here? A Perspective from Pakistan.” The Lancet. February 2020. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(19)30524-8/fulltext
[9] “Polio Eradication.” Unicef. Accessed March 19th, 2021. https://www.unicef.org/afghanistan/polio-eradication
[10] Scherbel-Ball, Naomi. “Africa Declared Free of Wild Poliovirus.” The BBC. August 25th, 2020. https://www.bbc.com/news/world-africa-53887947
[11] Spalding, Rebecca, and Carl O’Donnell. “U.S. Vaccinations in 2020 Fall Short of Target 20 Million People.” Reuters. December 31st, 2021, https://www.reuters.com/article/us-health-coronavirus-usa-vaccinations/u-s-vaccinations-in-2020-fall-far-short-of-target-of-20-million-people-idUSKBN29512W
[12] “COVID-19: Pace of U.S. Vaccination Accelerates.” New York Times. Accessed March 19th, 2021. https://www.nytimes.com/live/2021/03/12/world/covid-19-coronavirus
[13] “Featured Priority: Vaccine Confidence.” Health and Human Services. Accessed March 19th, 2021. https://www.hhs.gov/vaccines/featured-priorities/vaccine-confidence/index.html
[14] “Herd Immunity, Lockdowns, and COVID-19.” World Health Organization. December 31st, 2020. https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19#:~:text=The%20proportion%20of%20the%20population,those%20who%20are%20vaccinated.
[15] Erzurum, Serpil. “How Much of the Population Will Need to be Vaccinated Against COVID-19 to Slow This Pandemic?” Cleveland Clinic. January 23rd, 2021. https://health.clevelandclinic.org/how-much-of-the-population-will-need-to-be-vaccinated-until-the-pandemic-is-over/
[16] “Herd Immunity, Lockdowns, and COVID-19.” World Health Organization. December 31st, 2020. https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19#:~:text=The%20proportion%20of%20the%20population,those%20who%20are%20vaccinated
[17] McCarthy, Julie. “The Vaccine Situation in the Philippines.” NPR. February 18th, 2021. https://www.npr.org/sections/goatsandsoda/2021/02/18/969008730/the-philippines-has-vaccinated-zero-health-care-workers-so-far
[18] Larson, Heidi J, Kenneth Hartigan-Go, and Alexandre de Figuerido. “Vaccine Confidence Plummets in the Philippines Following Dengue Vaccine Scare.” Taylor & Francis. October 12th, 2018. https://www.tandfonline.com/doi/full/10.1080/21645515.2018.1522468
[19] Lema, Karen. “Rumours and Fear Dog Philippine Plan for Coronavirus Vaccine Drive.” Reuters. January 27th, 2021. https://www.reuters.com/article/us-health-coronavirus-philippines-vaccin/rumours-and-fear-dog-philippine-plan-for-coronavirus-vaccine-drive-idUSKBN29X00A
[20] Varadarajan, Tunku. “How Israel Became the World Vaccine Leader.” Wall Street Journal. March 12th, 2021. https://www.wsj.com/articles/how-israel-became-the-world-vaccine-leader-11615576463?mod=searchresults_pos2&page=1
[21] Varadarajan, Tunku. “How Israel Became the World Vaccine Leader.” Wall Street Journal. March 12th, 2021. https://www.wsj.com/articles/how-israel-became-the-world-vaccine-leader-11615576463?mod=searchresults_pos2&page=1