What is the Global Covid-19 Vaccination Strategy?

The current ‘every nation for itself’ approach to vaccination will not work if we hope to be rid of Covid-19. The whole world should work together to collectively vaccinate if we hope to avoid runaway mutations.

It may not be the best thing to start a piece of writing with a discussion about something in logic. But since the following will concern examples of bad practice – morally, anyway – I thought I may as well be thematically consistent. To wit, there is an informal 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. A basic example would be:

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

The conclusion is obviously false, but there are some cases where this line of reasoning is true. For example, books are made from paper and paper burns – ergo, so do entire books. The point is not that one should think parts and wholes nevershare properties, it’s simply that one should not think this is always the case.

It is true that if every nation could vaccinate the required number of people in a short enough time frame, then the whole world would be safe. But having each country do this independently presents a potential massive problem.

The world is going through an unprecedented global health crisis. But human beings, being forever resilient and possessing great ingenuity, have managed to produce several vaccines in little under a year. We certainly can, it seems, 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. 

The challenge to which we have not quite risen, however, is our vaccine distribution strategy. Indeed, one is tempted to ask: what is the global vaccination strategy?

The short answer: there isn’t an effective one at present. COVAX, a vaccine distribution consortium, aims to supply vaccines to countries that would otherwise be left without. They have supplied about 1.5 million vaccines to a variety of countries so far. Their projected distribution goal, however, is to supply vaccines for about three percent of each recipient country. This is not a substantial enough fraction for herd immunity to be attained. COVAX’s primary obstacle to its effectiveness is what might be called “collective buy-in”. Enough countries with the money to do so, need to commit to helping COVAX supply vaccines to other nations. In practice, however, COVAX receives pledges from various governments, but not actual vaccines or financial support. 

This is reflected by how the world has responded to vaccinations in general: In practice, it’s every government for itself. My own country, South Africa, has something of a vaccination plan (we’re planning on vaccinating some people – but haven’t quite gotten 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 has a plan (notwithstanding the AstraZeneca fuss); the UK has one; Israel does (if you’re not a Palestinian – but we won’t go there); Russia has had one for months if your surname is Putin.

You may well wonder: What does these vaccination programs have to do with the fallacy of composition? Well, the above-mentioned strategies are all independent. Therein lies the problem. It is true that if every nation could vaccinate the required number of people in a short enough time frame, then the whole world would be safe. But having each country do this independently presents a potential massive problem. Not all places have gotten their act together; some places don’t have resources to get their act together. All countries are equal, but some are more equal than others, as a certain pig once remarked.

As of writing, the US has vaccinated more than the recorded population of South Africa (over  sixty million people). Israel has given the jab to about half of its population, roughly five million people, in just more than a month. Norway plans to have everyone vaccinated by the end of July. South Africa, meanwhile, has managed to reach about 200,000 vaccinations – less than one percent of South Africans. We are ostensibly to receive 20 million doses of Johnson & Johnson (to cover about one third of the population). It is unclear, however, when these will arrive, and over what period they will be distributed (notwithstanding that South Africa suspended rolling out J&J on the 14th of April). 

It’s not surprising that this is the situation. Not everyone will be vaccinated at the same time, but each government would be expected to deal with its own peoples first. However, this piecemeal strategy may not be a way to beat Covid-19 worldwide. 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. It already has mutated. It is no coincidence that the mutations happened in South Africa, the UK, and Brazil. These countries are very densely populated places, which have had a mixture of containment measures and runaway periods of infection. In other words, ideal conditions for a new mutation to run rampant.  

It’s a simple evolutionary process 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 halted through the usual ways – washing hands, social distancing, mask-wearing, zoom-calling – 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. For example, South Africa’s variant, called 501.V2, is more infectious than the original Covid-19. 

Much as we prioritise vaccination according to risk and need, the best way to beat Covid-19, on a global scale, is for all governments to prioritise inoculation in global regions where high community transmission is more likely to occur.

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 or 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 mutation may be deadlier, more infectious and 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 may 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. This kind of travel zone mentality could be sustained short-term, but not for too long. And indeed, it would only serve to isolate places which can’t vaccinate quickly enough. It would mean that the global north would isolate the global south, more so than it has already.

It seems to me that the ideal solution is to extrapolate the approach we take “internally” in a country, globally. Much as we prioritise vaccination according to risk and need, the best way to beat Covid-19, on a global scale, is for all governments to prioritise inoculation in global regions where high community transmission is more likely to occur. This includes places like South Africa, the US, Brazil and southern and central Europe. Ignoring national pride for a moment, it seems strange that places like, say, China or Australia, should vaccinate millions of people when they both register less than a hundred new cases per week, before other places with far more cases – and deaths. 

Unfortunately, this is 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. Indeed, 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 – and if a new variant emerges that is not counteracted by vaccines, the whole world is at risk again.

Knowing what we know about viruses, I would claim that the ethically correct course of action is for us all to work as one whole to save the whole. Parts cannot save the whole by working independently, but parts can inadvertently mitigate the progress of the whole. If half the world is vaccinated, it does not mean the world is half safe. That, would indeed be to commit the fallacy of composition. No one is properly safe until everyone is.

Of course, I don’t know if a tragic mutation will happen. It is a reasonable cause for concern, regardless, given how long it will take countries with millions of people – with slow vaccination programmes and no help from the outside – to vaccinate their people sufficiently. We can only hope the odds are in our favour.