Vaccine ‘apartheid’ a threat to public health

The divide threatens to be between those who get the elite COVID-19 vaccines and the rest, write Adjunct Professor Nicholas Agar and PhD candidate in Philosophy Snita Ahir-Knight.

There is much discussion of a COVID-19 vaccine apartheid. The vaccine-rich countries having enough vaccines to cover their population, and then some. And the vaccine-poor pleading for anything to help manage horrific outbreaks. As the French critic Jean-Baptiste Alphonse Karr said, “plus ça change, plus c’est la même chose”. The more the things change, the more they remain the same.

We think looking at the vaccination approaches of Aotearoa and Australia suggests a different vaccine apartheid. The experts assure us any vaccine vetted in clinical trials offers protection. But in the vaccine popularity contest, the high-tech mRNA vaccines of Pfizer and Moderna have come out as clear winners. And this creates challenges for public health.

Ours is an Anzac focus. One of us—Nick—is a New Zealander who recently crossed the ditch to Australia in search of opportunities to teach and research on the ethics of data. The other—Snita—is a Brit ​with Indian ancestry who moved to Aotearoa nearly eight years ago with her New Zealander husband.

As we write, Australasians seem to have pivoted from winners in the global competition to keep COVID-19 out to laggards in the race to get enough people vaccinated to reopen borders. Both Queensland and Queenstown badly need tourists from wealthy Sweden but we worry about importing some of Sweden’s more than one million COVID-19 cases.

There are reasons for reopening beyond the narrowly economic. Australian historian Geoffrey Blainey coined the expression “tyranny of distance” to refer to the geographical separation of descendants of European colonisers from their ancestral homes. Australians and New Zealanders are champion travellers used to round-world trips to connect with relatives. But the coronavirus has exaggerated a feeling of separation. People have leapt at the travel bubbles to go, well, anywhere. Perhaps in the age of COVID-19 it’s not so much wanderlust that characterises Anzac travellers as cabin fever.

Anzac vaccine approaches

Australia placed a big bet on the AstraZenica vaccine co-developed by the British–Swedish multinational AstraZeneca and the University of Oxford. This is a weakened version of a common cold virus taken from chimpanzees and altered to contain genetic material from the coronavirus. In what seemed at the time to be a farsighted move, Australia developed a domestic capacity to manufacture and distribute the AstraZenica vaccine.

Now the vaccine is mired in controversy associated in the public imagination with rare but terrifying blood clots. In one recent poll, only 40 percent of Australians said they would accept the AstraZenica vaccine. This number would leave Australia short of the herd immunity required to let those big-spending Swedes safely take their Queensland holiday.

The AstraZenica vaccine has proven its efficacy in clinical trials. But in the vaccine popularity contest many are judging, it is losing out to the mRNA vaccines—made by Pfizer and Moderna—based on a newer technology. The mRNA vaccines seem to offer better protection, to be more easily tweaked to respond to new strains, and are not currently associated with clotting syndrome.

Here’s where Anzac success at keeping the virus out comes back to bite us. Talk about the potential for blood clots from the AstraZenica seems like a purely academic concern if you’ve just witnessed your beloved uncle die of the coronavirus. But in Aotearoa and Australia we feel like we don’t need vaccines to protect us from a COVID-19 bullet that we’ve already dodged. If there’s no hurry, why settle for the vaccine that works but has such bad PR.

Australia’s response to concerns about the AstraZenica vaccine was informed by an apparently higher risk of blood clots to young people. The Australian Technical Advisory Group on Immunisation (ATAGI) stated that “the COVID-19 vaccine by Pfizer is preferred over COVID-19 Vaccine AstraZeneca in adults aged under 50 years”. So the 50s and over get AstraZenica deemed too risky for the young.

Nick received his first AstraZenica shot last week. His side effects were real, but minor—a day of feeling queasy. Certainly no indication of the feared blood clots. But he found the experience of queuing with a bunch of other over-50s deemed unworthy of the Pfizer vaccine memorable. When he asked the young man who delivered his injection about what he thought about his expected Pfizer vaccine, he received the laconic reply, “Yes, the Pfizer vaccine has been less in the news recently.” He wonders how well his AstraZenica jabs will protect him when those vacationing Swedes rock up to the Barossa Valley.

Viewed in this light, New Zealand’s current picture of solidarity—Pfizer-for-all—looks good.​ In Australia, some of the over-50s are gaming the system, failing to front up for jabs in expectation the Government will relent and offer them Pfizer or Moderna. The resulting delay is dangerous in a world seemingly filling with ever more contagious coronavirus strains.

What if Australia does relent and belatedly follow New Zealand’s lead by offering mRNA vaccines to all? What will happen to all those expensively produced AstraZenica doses? New Zealand has a plan to send 250,000 doses of AstraZenica to Fiji. Wouldn’t it be convenient if these gifts of vaccines rejected by the Australians and New Zealanders could count as credits in their foreign aid budgets?

We need to face the challenge of a new international vaccine apartheid in which the divide is not between the vaccinated and unvaccinated but instead between those who get the elite vaccines and the rest. There’s a good chance today’s demands for more vaccines will eventually lead to a global oversupply. This suggests a future in which tourists vaccinated with the most up-to-date mRNA vaccines are free to resume their international holidays served by waiters protected by vaccines that offer scant protection against the latest coronavirus strains.

Nicholas Agar is an adjunct professor of ethics in the Philosophy programme at Te Herenga Waka—Victoria University of Wellington and Snita Ahir-Knight is a PhD candidate in the programme.

Read the original article on Newsroom.