The failure of the COVID-19 immunization battle in poor countries will also be a disaster for rich countries

The world is on the brink of a scientific achievement – one COVID-19 vaccine (maybe more) will likely be ready by early next year – but we’re also on the brink of a real strategic failing: It has to do with the manufacture and distribution of these vaccines. Right now, that effort is an international bidding war. It almost resembles the cutthroat market for ventilators and PPE at the beginning of the pandemic.

Countries are cutting deals with pharmaceutical companies, securing the right to buy vaccine doses as soon as they’re produced. And like in all bidding wars, the wealthiest bidders are winning: Already, the world’s high-income nations have secured enough vaccine doses to cover more than twice their populations.

But what about the low- and lower-middle income nations of the world? This is a group of countries ranging from South Sudan to Nicaragua to Myanmar. They’re home to nearly half of all human beings, and they don’t have the purchasing power to cut big deals with pharmaceutical companies. As things stand now, these countries won’t have nearly enough doses. They’ll only be able to cover 12 percent of their people.

This is a disaster in the making for poorer countries. But that’s obvious.

What’s less obvious, but equally true, is that it’s also a disaster for rich countries.

New modeling from Northeastern University helps illustrate why. The researchers there analyzed two scenarios. In one, vaccines are distributed to all countries based on their population size. Then there’s another scenario that approximates what’s happening now: 50 rich countries get the first 2 billion doses of vaccine. In this scenario, the virus continues to spread unchecked for four months in three quarters of the world. And almost twice as many people die.

Of course, poor countries would feel the most pain. But rich countries wouldn’t be immune. We’d all become Australia and New Zealand. Both have gone long stretches with very few cases inside their borders, but their economies remain depressed because their trading partners are on lockdown. And occasionally, a new carrier of the virus makes his way across the South Pacific, creating new clusters of the disease. Those clusters grow and spread. Schools and offices are shut down again.

Even with an oversupply of vaccine, wealthy nations risk re-infection in this way. Because not everybody will choose to be vaccinated. No country can become a fortress in a pandemic. The only way to eliminate the threat of this disease somewhere is to eliminate it everywhere.

The most urgent task is closing this vaccine gap between rich and poor countries.

If you lead a wealthy country, success doesn’t look like being able to vaccinate every person inside your borders and still having warehouses full of vaccine to spare. That’s what failure looks like. Success is purchasing enough vaccine supply for your people – and for the wider world that can’t afford to.

They have raised awareness of the coronavirus throughout the country and given out more than one million bars of soap to help keep families in Afghanistan safe.

This is where the ACT Accelerator can help. It’s an initiative supported by organizations like Gavi and the Global Fund. Not many people have heard of them, but they have spent two decades becoming experts in the task of delivering vaccines, diagnostics, and drugs to poor countries. They have technical ability to solve this problem. They just don’t have the financing yet.

Pharmaceutical companies have made the financing much easier. This week, a group of CEOs signed agreement, effectively ensuring that everyone around the world will have access to the latest COVID vaccines, drugs, and diagnostics, regardless of their income. This comes on top of other commitments; many companies have said that they won’t profit on any coronavirus vaccine and that they’ll also cooperate on therapeutic production. If one company succeeds in developing a drug, another could let them use their factory to make it.

More support, however, is still needed. Even if the world’s poorest countries only wanted to vaccinate high-risk people – health workers and the elderly – they still wouldn’t have enough supply. They would need about 1.6 billion doses to do that. And right now, they’re up to 1 billion doses short.

Wealthy nations need to be generous, but they also need to be persistent. The first-generation vaccines ready next year might be highly effective at blocking human-to-human transmission of the SARS-CoV-2 virus, or they could just be very good at preventing mild cases of COVID-19 from turning into serious ones. Either would be useful, but in the latter scenario the world will need to keep investing in R&D until vaccines block transmission. Continued innovation in new kinds of vaccines and drug platforms could help us fight the next novel virus and old enemies, like cancer and HIV, too.

We should also expect that as the elimination effort goes global, it will become more difficult and expensive. One of the most famous photos of the polio eradication effort in India was of a line of health workers. They were carrying vaccine coolers over their heads as they waded through waist-deep floodwaters to reach a remote village.

Spotting COVID-19 cases in the poorest parts of the world will take a similar network of primary health workers – one that can reach places where even roads can’t. With good diagnostics, these workers can also sound the alarm if another disease jumps from a bat – or bird – to a human. That’s an added benefit: Strong health systems can help us prevent the next pandemic.

For 20 years, I’ve been asking presidents, prime ministers, and other policymakers in wealthy countries to give money and help improve the health of people in the poorest. I’ve met with nationalist leaders who are skeptical – and humanitarian leaders who are generous – but COVID-19 has made that distinction irrelevant.

In this pandemic, there’s no difference between helping yourself and helping others. The selfish thing and the selfless thing – giving poor countries the tools to eliminate this disease – are one in the same.

The sooner the world realizes that, the sooner this crisis will end.