Many people around the world can't access the COVID-19 vaccine. What impact could this have on the global spread of the virus?
Many people around the world can't access the COVID-19 vaccine. What impact could this have on the global spread of the virus?
In this episode, Jessica is joined by Professor Jaya Dantas, Dean International of Curtin’s Faculty of Health Sciences to discuss this inequitable distribution of vaccines and the impact it is having around the world.
UN Data Futures: Global dashboard for Vaccine Equity
UNICEF: In the COVID-19 vaccine race, we either win together or lose together
Aljazeera: African leaders highlight vaccine inequity
The Conversation: Australia’s fickleness on COVID vaccines is perpetuating global vaccine inequity
Professor Jaya Dantas,
Dean International in the Faculty of Health Sciences
Professor Dantas is Deputy Chair of the Curtin Academic Board, Dean International in the Faculty of Health Sciences and a Professor in the Curtin School of Population Health where she leads a programme of research in refugee and migrant health.
As a global public health researcher, Professor Dantas has been mapping the COVID-19 pandemic, particularly as it impacts developing countries like India and in Africa.
Curtin staff profile
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Jessica Morrison (00:00):
This is The Future Of where experts share their vision of the future and how their work is helping shape it for the better.
Jessica Morrison (00:09):
I'm Jessica Morrison. Right now, the world is in the midst of another wave in the COVID-19 pandemic. With case numbers rising daily, experts agree that vaccination for all is the key to ending the crisis. While Australians are lining up to receive their third booster shot, many people in low income countries are yet to receive even a single dose. In this episode, I'm joined by Professor Jaya Dantas, Dean International of Curtin's Faculty of Health Sciences to discuss this inequitable distribution of vaccines and the impact it's having around the world. If you'd like to find out more about this research, you can visit links provided in the show notes.
Jessica Morrison (00:51):
Jaya, why is it important for all countries to have equal access to vaccines?
Professor Jaya Dantas (00:57):
One of the things in a pandemic that happens is that the virus is in circulation throughout the world. And one of the things that we have is we have immunity that is through getting the disease, or we have immunity that is caused by vaccines . In most parts of the world now, we've had the virus, but in many parts of the world and Australia was one of this 'til last year where we didn't have the virus. Until delta came to the eastern states, we didn't have the virus here. Also, in other countries like New Zealand, other countries had controlled it too.
Professor Jaya Dantas (01:35):
When there is vaccine inequity, at that time, there is an emergence of new variants as we've seen historically with this pandemic here. So with this pandemic, we started with the alpha strain and the vaccines were developed with the alpha strain. But then, we had the beta strain that emerged in South Africa and spread to several countries of the world.
Professor Jaya Dantas (02:02):
We then had the gamma strain that emerged in Brazil and spread to also many countries of the world, but then came the delta strain in March 2020. And that impacted nearly 170 countries, but it was a strain that was highly infectious, but also severe in disease transmissibility and disease severity causing hospitalisations and deaths in many countries, especially India and Brazil. And the United States also, they had very large impacts of the delta strain. And we had thought we got through the delta strain and everything was okay, and the vaccine roll out began, but then there emerged the omicron strain in November of 2021.
Professor Jaya Dantas (02:54):
And what we found in the omicron strain is that it emerged in South Africa. So South Africa has essentially had four waves of the virus, of COVID-19. It has had the original wave. Then it had the alpha wave, the beta wave, the delta and omicron. So basically, it has had these waves that has impacted the population.
Professor Jaya Dantas (03:20):
With vaccine inequality, many countries in Africa have not even had one single dose. So South Africa is one of those countries that has had a single and a double dose, but you're looking at like 30 to 40% of its population have had the single dose and even fewer the second dose. So this is an issue of concern that the World Health Organisation has. That if we don't equitably distribute vaccines, then we might see the emergence of another variant. And epidemiologists, modellers, as they model the disease, have not been able to predict how this virus will emerge and when a variant will emerge or the severity of the disease. These are unpredictable as has been seen with delta and omicron.
Jessica Morrison (04:11):
So it's really in the world's best interest in developing in non developed countries to ensure everyone's got vaccine equitability, isn't it really?
Professor Jaya Dantas (04:20):
It is actually in the interest of the world. So that is why we set up the WHO set up what was known as the COVAX Initiative. So COVAX Initiative was to distribute vaccines equitably, especially to developing and low and middle income countries. Many countries in Asia, many countries in Africa and countries in Southern America, what has happened is they wanted at least 10% of these countries to be vaccinated by September 2021, 40% by December 2021 and 70% by the middle of this year. We did not reach either the 10% or the 40% target. And this is an area of concern.
Jessica Morrison (05:09):
What issues does vaccine inequity create, Jaya?
Professor Jaya Dantas (05:13):
So the issues that it creates is that it creates a lack of sharing of intellectual property of vaccine creation. So there are many countries in the developing world that can produce vaccine. India is one of those, which is one of the largest vaccine manufacturers in the world. And before, before COVID, it used to produce more than 70% of the childhood vaccinations for UNICEF. And this is not known. This is not known. Now, it has actually turned its hand to COVID vaccines. South Africa also has that capacity. Algeria also has that capacity in Africa. Brazil has that capacity. Cuba has the capacity. Taiwan has the capacity. Indonesia. So there are many countries that have some capacity to produce that vaccines, but they can do so when intellectual property is shared by developed countries or by big pharma, and this has not been the case in this pandemic.
Professor Jaya Dantas (06:18):
The second aspect that impacts is there's hoarding by developed countries. So many of the developed countries had already pre-ordered the mRNA Pfizer and Moderna vaccines before they could give it to the COVAX Initiative. And this was a big problem. And third problem was helping with the logistical distribution. Now, low and middle income countries cannot do that. So it depends on developed countries to support the COVAX Initiative so that vaccines can be distributed. So when there is vaccine inequality, these aspects have had a significant implication to many countries, especially those in Africa.
Jessica Morrison (07:03):
When developed countries are hoarding vaccines, is there then vaccine wastage? Are they even utilised?
Professor Jaya Dantas (07:09):
That's a very important question, because mRNA vaccines have to be stored at minus 70 and AstraZeneca at refrigeration level. Now, these have a shelf life, vaccines have a shelf life. So you have to use them before they expire. And in many cases, they expire and then they're thrown away. And that I think is a big problem. So it's important that countries share these vaccines. But if you actually share the vaccines with countries that do not have the facility to actually store it at minus 70, then you need the facilities to store it at refrigeration. That's why the AstraZeneca was popular in many countries, because you could store it at normal refrigeration temperatures. And so also with the Novavax. Now, there was a delay in Novavax, but Novavax is a protein based vaccine, it can be stored at refrigeration temperature and for nine months. So the shelf life is longer.
Jessica Morrison (08:06):
So will that be the way forward do you think for these countries that haven't had access to vaccines up until now or as much as what the developed countries have had?
Professor Jaya Dantas (08:15):
So we need to share the vaccines, all vaccines and we've had now quite a few vaccines. So we've had the Pfizer, we've had the Moderna, we've had the Johnson & Johnson, and then we've had the Novavax. We've had protein based vaccines in several different countries. So as of now, on the WHO vaccine page, there are about 30 different vaccines that have been produced. So you have the Russian Sputnik vaccine, you have Sinopharm and Sinovac vaccine that is produced by China. You have about three vaccines that have been produced by India, the bulk of which has been the AstraZeneca. So this has been really interesting for the first time in the world of a pandemic that we've had so many vaccines developed in a short period of time.
Professor Jaya Dantas (09:04):
But one thing that the world doesn't realise possibly this is not shared, is that a lot of the research for both the mRNA vaccines and the viral vaccines had already been undertaken while they were trying to produce a vaccine for malaria and for HIV. So the research had already been undertaken, and after this vaccine was produced, we have now found a vaccine for malaria, which would have huge implications for populations in Africa and especially children.
Jessica Morrison (09:35):
Wow. So there is sort of a positive spinoff to developing a vaccine in a pandemic other than vaccinating the population against the pandemic disease. That's really interesting. What do you think has hindered vaccine equity during this COVID-19 pandemic?
Professor Jaya Dantas (09:54):
So in this COVID-19 pandemic, because the sheer spread of the disease. So I lived in Africa at the time of the HIV pandemic. So the concentration was mostly in Sub-Saharan Africa and then smaller parts of Asia. And in the developed world, HIV was a disease that was really more among the homosexual population, heterosexual in parts of Africa and in Asia. But at that time, the spread of the disease was not as high as the COVID-19 pandemic. So we've had other virus pandemics to a smaller scale. So we've had epidemics. So we had the SARS-COVID one, we had H1N1, which is the avian flu. We had the Middle Eastern respiratory syndrome. Then we had Ebola. We had Zika.
Professor Jaya Dantas (10:48):
So we have had other viral epidemics in different parts of the world, but not a single one of them had the spread that COVID-19 has had. So this has spread to 180 plus countries in the world. Very, very few countries have actually been spared. And what has been interesting is that it spreads through ventilation, air droplets, which initially was not something that was disclosed, but now, it has proved that it has the transmissibility of certain variants was so high just in the air. So it's an airborne virus. And global mobility is at all time high now. People move countries, places, regions. And because of that, it has been able to transmit to all of the parts of the world.
Professor Jaya Dantas (11:43):
So what happened is in the developed world, they found that it had transmitted to their populations. There were huge impacts of the virus on deaths and human lives, and especially those who were more vulnerable like the elderly, people with comorbidities. And because of that, the governments felt we need to do something. And that is why when we had the capacity ... Now, we had also advances in science that was unprecedented say when the HIV pandemic was there 20 years ago, 30 years ago. What we had was the ability to genomic sequencing. So genomic sequencing was done like within a few weeks when the original Wuhan strain was identified. And this genomic sequencing was undertaken in many parts of the world. Australia was one of the countries. Netherlands was another country. And this was shared with Pfizer, the big pharma. And immediately they started developing a vaccine and acting and started the trials with this.
Professor Jaya Dantas (12:53):
When there's such high amounts of transmissibility and hospitalisation, people needing ICU admissions, people needing ventilators and subsequent deaths, then governments felt that they needed to look after their populations. And this led to ordering the vaccines and thinking only about having a very nationalistic view, that we will actually not involve ourselves in vaccine diplomacy in some ways, but look after our own populations. And we've done that.
Professor Jaya Dantas (13:30):
We've set the benchmarks so high, like we want more than 90% of everyone over 12. That's a significant benchmark. That's a very high benchmark that we have not seen in any other part of the world. Most have been vaccinated from the age of 16. Then children from 11 to 16 are starting to be vaccinated, and only few countries have vaccinated children from the age of three to 11.
Jessica Morrison (14:00):
What do you think it will take those countries who have had a very nationalistic point of view with this in this space to practise some vaccine diplomacy?
Professor Jaya Dantas (14:13):
I think the time has come when they've realised that vaccines have to be equitably distributed, because otherwise, a new variant might emerge and this will have implications for all populations. Because what was interesting is when the variants emerge and when the vaccines are developed, so the vaccines were developed for the alpha variant and the original Wuhan strain. Then we had the delta strain and then they had to do further modifications on that and other studies to see how effective it is. And now, we have the omicron strain and there's other research work going on.
Professor Jaya Dantas (14:55):
If there'll be a vaccine or a booster that will actually be effective against any variant too. But we also know so much more than we did two years ago. We know the variants, we know about public health measures. We have good outbreak surveillance in place. We also have the other oral pills that have been started by Pfizer and by Merck. And if these are then rolled out, it reduces disease severity in turn hospitalisation, and in turn deaths.
Jessica Morrison (15:31):
Despite our wealth as a nation, vaccine equity is also a problem within Australia with vaccination rates 20% lower for the Aboriginal and Torres Strait Islander people. What has caused this disparity?
Professor Jaya Dantas (15:44):
One of the things that we have to remember is that they've always been health disparities within our regional areas and our remote areas and among Aboriginal populations and other more marginalised populations. With our Aboriginal populations, they already have huge health issues. There's high amounts of chronic disease within this population. There's high amounts of violence among these population and substance abuse in this population.
Professor Jaya Dantas (16:16):
One of the things that has been quite challenging with the pandemic is our Aboriginal population has lower literacy rates than the wider population. And it is a known fact globally that lower the literacy of a population, less the vaccine uptake. So here, the community health workers play a really important role in strong community messaging that's culturally and contextually relevant to you. So that needs to be done.
Professor Jaya Dantas (16:48):
The second thing that has happened is because of historical intergenerational trauma, we have had a distrust of the health system out of the government by our Indigenous population. So this is something that's historical. And to overcome this, needs effort, so that's the second thing. The third thing is also logistical. So transporting vaccines to remote communities or regional communities requires effort. And it's important to put this into consideration, especially when vaccines require storage facilities.
Professor Jaya Dantas (17:24):
So in many parts of the world, mobile clinics work really well with vaccine distribution and vaccine delivery here. So basically, if vaccines could go to the population, they are more successful in uptake. And we've seen some amazing pictures around the world, among the Bedouins in Turkey, among the Sherpas in Northern Nepal, among the Amazonian tribes in Peru, where the health workers have actually gone to these tribes and delivered the vaccine, and people have taken the vaccine. So often communities in remote areas may not go to an outpost. They would need the vaccines to come to them.
Professor Jaya Dantas (18:10):
And then the fourth thing that's really, really important is the constant messaging in these communities and understanding of the pandemic that once it comes in, it might actually then impact the whole community and how it is in their interest to get the vaccination and then the booster and the second dose, if possible.
Jessica Morrison (18:35):
We've obviously touched on the Aboriginal and Torres Strait Islander population within Australia. What about the refugee and migrant communities within Australia? Has there been a good uptake with the vaccine or is it similar to our Aboriginal and Torres Strait Islander population?
Professor Jaya Dantas (18:49):
So it has been lower than the main population. So when we look at population numbers, we look at states. So I've been actually looking at vaccination rates in different states of Australia, and they look at local government LGAs rather than population groups. And certain LGAs have a lower uptake than others. So it's important to see that LGAs that might have a lower uptake to see the reasons behind these and to improve the uptake. So we know historically refugee and migrant populations might lag behind, but in migrant groups that are working, the mandates help, because then people actually go and get the vaccine because they want to work or they have to work.
Professor Jaya Dantas (19:40):
Asylum seeker hotels have been a vulnerable group. And that's where there've been outbreaks. We've known that there've been outbreaks in Melbourne and in Sydney at these hotels. There have been outbreaks in our prisons. So we have it. We have a moral imperative to vaccinate our vulnerable populations.
Jessica Morrison (20:01):
Experts have criticised Australia's reluctance to use the AstraZeneca vaccine saying it's caused vaccine inequity on a global scale. How has Australia's hesitancy to use this particular vaccine impacted other countries?
Professor Jaya Dantas (20:14):
I was surprised by what happened with the AstraZeneca. I was one of those who has taken the first and second dose of AstraZeneca and then the third dose with the Pfizer. And it was a vaccine that was widely distributed initially. And because of how it can be stored, many of the countries actually ordered AstraZeneca, and we ordered 51 million or more doses of the AstraZeneca. But because of a small number of adverse reaction, and these adverse reactions were picked up by the media and that caused this hesitancy in taking the vaccine, which I think was problematic and which the government did not do anything to allay fears of the population. And that is important in a pandemic situation.
Professor Jaya Dantas (21:08):
So they had been criticised for that, because AstraZeneca was wasted. We had the capacity to manufacture it here at the CSL laboratories in Melbourne. We could have distributed it to our neighbours in Papua New Guinea and Indonesia. Indonesia had a very bad delta outbreak, and we could have actually distributed the AstraZeneca there rather than not use it or discard it.
Jessica Morrison (21:34):
So it just went to waste?
Professor Jaya Dantas (21:35):
Quite a lot of it just went to waste because it was not used. They did send it to Fiji, PNG, Indonesia, but not enough.
Jessica Morrison (21:44):
Jaya, you are a prominent voice for vaccine equity in the media, so a voice that we need. What drives your interest in this area?
Professor Jaya Dantas (21:53):
So any form of health equity is something that I'm passionate about. I was born in India and I grew up in India, and I myself had lived experience of communicable diseases as an adolescent. So I have the experience of what a health system can do and how important health prevention and health promotion is. I then lived in Africa for 10 years, and whilst I was there, I experienced the HIV pandemic. I experienced malaria. I caught malaria six times and it was very debilitating for me. I had my children in Africa at the height of the HIV pandemic.
Professor Jaya Dantas (22:36):
So for me, inequalities are something that really impact populations and especially vulnerable and marginalised populations in many parts of the world, both in the developed world and in the developing world and in low and middle income countries. So because of this passion, I have been looking at the aspects, not only about vaccine equity, but how we message public health measures to certain communities.
Professor Jaya Dantas (23:04):
So within Australia, refugee and migrant communities, how do we support them when we had lockdowns or when people actually live in households that have a large number of family members or where there are poorer households and how do we manage this? So I was looking at all of that before the vaccine distribution. And then came the vaccine distribution and the entire aspect of delivery of vaccines, arrival in a country and roll out of the vaccine was of interest to me.
Professor Jaya Dantas (23:42):
And because India and China have such large populations, it was really important for me to see how they would be managing the rollout of the vaccines in this country. So with all of this in mind and having actually been mapping the pandemic for the last 20 months, I also have family members who work as frontline workers. So one is a nurse in a government hospital in Sydney. And one is a frontline doctor in Mumbai, India. And I have friends who are medical doctors who have been at the frontline of say cancer treatment during a pandemic in the United States or an intern and a young student in Uganda. So I've been talking to all of them to get an idea of how different this pandemic has played out in different countries, in even access of say PPE or personal protective gear for frontline workers in certain countries, or access to vaccines for frontline or health workers. So all of these were in important considerations for me, and I continue to observe and evaluate it in some ways.
Jessica Morrison (24:54):
What would you like to see happen to ensure vaccine equity in the future? What needs to change?
Professor Jaya Dantas (25:00):
So between now, we have a target that has been set by the WHO and the COVAX Initiative. I think it's really important that the developed world work with the COVAX Initiative, work with Gavi and with WHO and UNICEF to see that we achieve this target of 70% double vaccinated population in nearly all parts of the world. And it's important to do that sooner rather than later. So we have a target, we have a target. It's between early February 'til July, that we have to meet this target. So my wish is between now and then that developed countries really put all effort in helping the COVAX Initiative meet that target.
Jessica Morrison (25:51):
So what work needs to be done by developed countries to support the COVAX Initiative?
Professor Jaya Dantas (25:56):
The developed countries know the scenario. They have surveillance and data from all around the world, so they know what needs to happen. But what needs to actually happen is really the sharing of the vaccines and giving the vaccines to the COVAX Initiative. If the COVAX Initiative, which is the global vaccine initiative for COVID, doesn't have the vaccines, they can't distribute it. So it's really important to ensure that the vaccines are there in time for them to reach the low and middle income countries.
Jessica Morrison (26:31):
And do you think that the developed countries may do this once maybe they perceive that their own countries are safe and set and okay, now we can share, do you think that that's going to be, what's going to move this along or it just a matter of ...
Professor Jaya Dantas (26:46):
So in countries where 70% of the population and more has been vaccinated with two doses and perhaps the booster to about 50%, I don't see the reason why they need to hoard. I know there's always this fear that a new variant could emerge, but countries are producing the vaccines. You will get vaccines and you have actually vaccinated your population. So it's important that vaccines are shared with low end middle income countries, especially in Africa.
Jessica Morrison (27:21):
Because that's where the next variant may emerge. Right?
Professor Jaya Dantas (27:21):
And because there is an urgency. You can't have a country like Burundi, which until first few weeks ago did not have a single dose of the vaccine.
Jessica Morrison (27:31):
Professor Jaya Dantas (27:32):
So that's a reality. You cannot have that in many countries. That is the case where they've not had a single dose. We need those countries to have the doses. And in other countries, there's been very, very few doses. So we need to boost countries to get more of the doses and this to be distributed and then administered.
Jessica Morrison (27:56):
Thank you Jaya for coming in today. It's been wonderful to talk to you about this really important topic. So thank you very much for sharing all of your knowledge and your wishes for the future. And hopefully that happens.
Professor Jaya Dantas (28:08):
My pleasure. It's always a pleasure to come and share my thoughts and especially on a topic that I'm passionate about.
Jessica Morrison (28:14):
Thank you. You've been listening to The Future Of, a podcast powered by Curtin University. If you've enjoyed this episode, please share it. And if you want to hear from more experts, stay up to date by subscribing to us on your favourite podcast app. Bye for now.