OPINION

Covid-19: What is the global vaccination strategy?

Jake Gordin argues that the current 'every nation for itself approach' may end very badly for everyone

It’s bad practice – I’ve been told – to start any piece of writing with a discussion about, say, abstract logic. But since the following will concern nothing but examples of bad practice – medically, morally – I thought I may as well be thematically consistent.

To wit, there is a lovely fallacy in logic called the fallacy of composition. It’s the mistake people make when assuming that what is true of parts is true of the whole. An example would be:

  1. Single atoms are not alive.
  2. Humans are made of atoms.
  3. Therefore, humans are not alive.

This example runs the risk of getting sidetracked by discussions of what it means to be alive and human consciousness and so forth, so let’s rather consider two more humble cases:

  1. If I cut the line in the bank, I get served faster.
  2. Therefore, if the whole line cuts, we all get served faster.

OR

  1. A tyre is made from rubber.
  2. A tyre is part of a car.
  3. Therefore, a car is made of rubber.

Both conclusions are obviously false. There are some cases where this line of reasoning is true; for example, books are made from paper. Paper burns – ergo, so do entire books. The point is not that the one should never think parts and wholes share properties, it’s simply that one should not think this is always the case.

The world is going through something of a global health crisis (if you haven't noticed). But human beings, forever resilient and possessing great ingenuity, have managed to produce several – more than one! – vaccines in little under a year. We certainly, it seems, can rise to an occasion: we meet the emergence of what might be the largest-scale halt of the world with what may be the fastest vaccine production time on record. Even better, they work! (Since quelling naysayers seems out of the question, sometimes it’s best to ignore them. Trust me: vaccines work, get inoculated if you have the opportunity.)

The challenge to which we have not quite risen, however, is our vaccine distribution strategy. And no, I don’t mean in South Africa specifically – although there is much that could be said about here – but globally. Indeed, one is tempted to ask: what is the global vaccination strategy?

The short answer: there isn’t one. It’s every government for itself. South Africa has a plan (well, we’re sort of vaccinating some people – but let’s not go there); the US has something of a plan (surprised they could find the time balancing nationwide inoculation with everything else that happens in the greatest nation on earth); the EU had a plan (before they decided they wouldn’t be outdone by the US in the vaccine paranoia race); the UK has one; Israel does (if you’re not a Palestinian – but again, we won’t go there); Russia has had one for months if your surname is Putin, etc.

You may well wonder what this has to do with the fallacy of composition? Well, the above strategies are all, of course, independent. Therein lies the problem. This is the fallacy of composition at work:

  1. Each country will vaccinate their own population and achieve herd immunity, albeit at different rates.
  2. Therefore, the whole world will be safe from Covid-19.

It is true that if every nation state could vaccinate the required number of people in a short enough timeframe, then yes, the whole world would be safe. However, the catch really is the “albeit at different rates” part. All countries are equal, but some are more equal than others, as a certain pig once remarked.

The US, as of writing, has vaccinated more than the recorded population of South Africa (> 60 million). Israel has given the jab to about half of its population, roughly 5 million, in just more than a month. South Africa, meanwhile, has not managed to reach 100k. Indeed, this week we were told by the president that we’d receive 20 million Johnson & Johnson doses. When will these arrive? Unclear. Over what period will they be distributed? Also unclear. But they’ll be here, just now, now-now.

You may be thinking, “Okay, this is fine. Annoying to be one of poor schmucks settled in the Global South, but the world is unfair and nationalistic, and everyone has gotta look out for themselves first, right?”

Alas, no. This piecemeal strategy that the world seems to have adopted – of looking out for one’s own nation and then maybe turning an eye to the world beyond – may end very badly for everyone. In places where vaccinations will take a long time, sustained transmission of Covid-19 will continue for many more months, if not years. And the longer the period of sustained community spread, the more likely that Covid-19 will mutate. That’s the rub.

It already has mutated. Where has it mutated, you ask? In SA, in the UK, and in Brazil. This is hardly surprising; these countries are very densely populated places, which had a mixture of containment measures and then runaway periods of infection – ideal conditions for a favourable mutation to run rampant.  (Favourable to itself, of course; Covid doesn’t care about us.)

It’s a simple evolutionary calculus for the virus: spreading to many people means the virus will replicate, and replication induces random chances of mutation (all biological entities mutate over time – that’s what cancer is, for example: a random, harmful, mutation).

If the spread is stopped somewhat – through the usual ways, washing hands, social distancing, mask-wearing, zoom-calling, etc. – then a favourable mutation will be one that transmits very quickly, such that even a slight lapse in our Covid-safe behaviour leads to runaway spread. Enter our own homegrown variant, 501.V2, which is – again, surprising no one, given the conditions under which it began – more infectious than the vanilla Covid-19.

If the poorer nations of the world are left to fend for themselves, because companies and governments won’t share the intellectual property for everyone to produce vaccines themselves, because the poorer countries can’t produce vaccines anyway, because countries with capital and connections procure vaccines for their own people, regardless of the death toll or infection rate elsewhere, then we run the risk of a new mutation.

This one may be deadlier, may be more infectious, and it may not be counteracted by our extant vaccines. This would cause worldwide reinfection, and we’d begin 2020 all over again. We risk being drawn into a vaccine/mutation arms race – a race I fear we could lose.

There are, in fact, preparations right now for a world in which some are vaccinated, and some are not. The US and the EU are proposing a “vaccine passport” and will only allow people to travel if they’ve been vaccinated. This is not the solution when the world is so tightly interconnected – look how quickly Covid got to almost everywhere on Earth – and vaccines could be rendered useless if a nasty mutation develops.

The ideal solution is that we take the same approach that we take “internally” in a country – but do so externally as well. Much as we prioritize risk-groups and healthcare workers first, and then older people, and only then the youth and children and those without comorbidities, the best way to beat Covid-19 is for all governments to prioritize inoculation in global regions where high community transmission is likely. This includes places like here, like the US, like Brazil – but does not include places like, say, China or Australia (which register less than a 100 new cases per week).

I recognise this is, unfortunately, a tough sell. The world is as divided as it is interconnected, and people don’t want to help others, especially when costs are considered, nor do they want to help others to help themselves. What government in its right mind would divert resources to help those who don’t live under its flag?

But Covid doesn’t care about countries or borders, about laws or certificates. If it can infect a person, it will. The correct course of action, ethically, knowing what we know about viruses, is for us all to work as one whole to save the whole. Parts cannot save the whole, not with the conditions we have in place.

This argument might seem a bit (co)morbid. One could argue that I don’t know this will happen. It’s true; there is no guarantee that a tragic mutation will occur. But I personally wouldn’t want to bet that it won’t happen. Yet the world seems to have decided to take the bet, for reasons that we all know.

We better just hope our luck (such as it is) doesn’t run out.