The editorial last week dealt with the need to immunize as high a proportion of the U.S. adult population as possible.  Current projections, given availability of vaccines and logistic restraints to administration suggest that all who are willing to receive a vaccine will be immunized by June.  The rate of administration of the two mRNA vaccines now available is increasing and despite the temporary problems caused by inclement weather, as many as two million doses can be administered per day.

The broader issue in relation to suppressing COVID is the need to vaccinate as many of the World’s population as can be accomplished.  The longer that populations are susceptible, the faster the spread of COVID-19 and the greater is the probability that variants will emerge.  Dense populations in urban areas in India, China, Brazil, South Africa, and Nigeria represent an extreme risk of encountering variants, some of which may be refractory to immunity stimulated by existing vaccines. 

COVID-19 has clearly demonstrated the differences between industrialized and developing nations.  Countries in the E.U. and the U.S. have implemented various levels of lockdown to reduce transmission.  China imposed draconian restrictions on regions where COVID-19 emerged during the first quarter of 2020, successfully reducing spread and suppressing infection.  This action, only possible in a non-democratic society, contrasted with the rapid dissemination of virus, soaring incidence rates and high mortality in many E.U. nations including in the U.S.  Developing nations cannot afford to impose lockdowns, practice social distancing and implement expensive measures possible in industrialized nations.  Accordingly, universal vaccination will be critical to reducing the worldwide incidence of COVID-19, the emergence of variants, and reintroduction of the infection into nations where infection will be reduced to low levels. 

Accordingly, vaccines must be manufactured and administered at rates consistent with control.  It is estimated that more than 300 COVID-19 vaccines are in various stages of development and evaluation.  Eight products have received regulatory approval by the U.S., the U.K., the E.U., and by the WHO.  These include the Pfizer and Moderna mRNA vaccines, the AstraZeneca adenovirus-vectored product two vector vaccines from China, the Sputnik V adenovirus-vectored vaccine from Russia, and soon to be approved Novavax, and Johnson & Johnson products in the U.S. and elsewhere.

The February 13th edition of The Economist documented the quantum of doses ordered by major nations and regions classified as to manufacturer.  The analysis also calculated the number of ordered vaccines in relation to adult population.  It is clear that the U.S., the E.U., U.K., Japan, Australia, and Canada have committed to purchase more vaccines than will be required by their respective populations, even assuming universal uptake and eventual administration to children.  In contrast, many nations have yet to select or order vaccines and may well fail to accomplish acceptable levels of protection imposing a risk for the entire world.  Nations in deficit include Iran, Iraq, Pakistan, Cambodia, Myanmar, Paraguay, Belarus, and Kazakhstan.

Covax, an international consortium working in cooperation with the WHO, intends to source and distribute vaccines.  It is expected that close to two billion doses will be allocated to 90-low income nations during 2021 based on population.  Covax will rely heavily on AstraZeneca, Novavax, and Johnson & Johnson vaccines that do not require a low temperature for storage and distribution. 

In evaluating current orders for vaccines, the 54 richest nations with 18 percent of World adult population have ordered 40 percent of available vaccine representing 2.5 two-dose regimens per individual.  Russia and China are considered to be in balance with their domestic production but many nations will be in deficit with has few as 0.2 doses per person ordered. It is apparent that China and Russia are applying ‘vaccine diplomacy’ to gain favor in nations devoid of vaccine. 

Organizations such as the International Chamber of Commerce have pointed to the need to expedite worldwide vaccination.  The interconnectivity of trade presumes that factories, many of which are located in high-risk nations with susceptible populations, must continue to export.  The recent need to suspend automobile assembly in the U.S. as a result of a shortage of microchips illustrates the interdependence of industrialized and developing nations.  International trade and shipment of manufactured goods presumes movement of commodities, products and people, adding to the risk of transmission.  The fact that a U.K. variant appeared and was widely disseminated  in the U.S. within a short time of being identified illustrates the futility of imposing rigid travel restrictions.  Although some nations such as New Zealand have achieved success in closing borders, introduction of variant strains of SARS-Cov-2 will be inevitable in the nations of the E.U. and in the U.S., given the extent of international travel.

Vaccination is ultimately the only practical method of suppressing COVID-19 on a worldwide basis.  Policies previously implemented by many nations involving travel bans from specific countries are an exercise in futility. Attempting to restrict vaccines to a specific nation is regarded as both morally indefensible and ultimately self-destructive. Residents of Kalamazoo are biologically more connected to citizens in Kabul than they would like to think.  Until the world achieves acceptable herd immunity through vaccination, no nation is safe.