At Joe Biden takes his oath to become the 46th president of the United States, the U.S. should learn three important lessons. Infectious diseases can ambush advanced and developing economies alike; preventing them may create even more wealth than we had thought. What looks like a pocket or a local outbreak can turn into a threat to global wellbeing in as little time as it takes a 787 to fly from one side of the world to the other. Sharing the responsibility for preventing this spread of infections serves American and global interests.
While tens of millions have contracted COVID-19 – suffering direct health effects – the financial consequences of its unchecked spread have impacted the social interactions of billions of people and disrupted national economies to the tune of hundreds of billions of dollars. Business and trade have collapsed, from sub-Saharan Africa to Central America, with extreme poverty projected to quintuple according to a recent World Bank report. The crisis has underscored a truth global health professionals know well – that health and the economy are inextricably linked.
Viruses cross borders. The U.S. will only be protected if the rest of the world is protected, too. Continued spread of the virus also undermines U.S. work to tackle the scourge of hunger poverty, and other diseases worldwide. Near universal COVID-19 vaccination is the only strategy that will get the world economy back on track and enable a full return to global travel, trade, and business. As no vaccine is entirely protective and some people are not able to be vaccinated, each additional person vaccinated reduces everyone’s risk further and will make it easier to achieve an ethical herd immunity.
The Biden administration will face the enormous challenge of bringing COVID-19 under control at home while working to curb its spread abroad. But we can’t revert back to a siloed, single disease approach in response.
The incoming administration should instead seize the opportunity to join with world leaders in cooperative efforts to ensure widespread distribution of an eventual COVID-19 vaccine, but U.S. leadership will also be vital to reverse troubling health trends and guard against the next global health threat. A top priority should be to work with allies to restore routine childhood immunization, particularly measles which has rebounded to the highest levels seen since 1996. And polio – a few hundred additional cases of polio in Afghanistan and Pakistan this year may seem a remote threat; as remote maybe as wild animals being sold in live markets in the interior of China.
The COVID-19 vaccination – once available – also provides a unique opening to administer underutilized adult vaccines that protect against cervical cancer and Hepatitis B, helping to reduce heavy and growing disease burdens. In doing so, the U.S. could prevent millions of deaths while restarting economies and laying the groundwork for pandemic preparedness ahead of future threats.
While this effort would require investment, the U.S. and its partners already have the tools and platforms to take action with few start-up costs. Working with its G-7 counterparts, the United States should commit to Protect Our World (POW), with a four-part preparedness agenda focused on vaccines and disease surveillance:
- Vaccines for the world, starting with sharing excess stock.The U.S. has already pre-purchased 800 million COVID-19 doses with options for another one billion to achieve protection and recovery at home. Assuming that vaccines deliver on their announced efficacy, if we assure two doses to every one of the 328.2 million Americans, we will still have more than a billion doses leftover. Even retaining a modest stockpile, the U.S. could donate the excess vaccine to the COVAX Facility immediately, providing for the protection of an additional 500 million people and transforming the U.S. into the largest COVAX contributor – sending a clear signal to the rest of the world that the U.S. is now committed to equity in COVID-19 recovery.
- Build underutilized but cost-effective adult vaccines onto the COVID-19 vaccine response. As many have noted, vaccine delivery will be a major challenge that requires reaching adult populations at scale for the first time in history. We must not waste this unprecedented effort on a single disease, particularly in lower-income countries in Africa where COVID-19 itself is not a major burden but where the rest of the world needs universal adoption. Let’s therefore use this first-time and likely costly effort to reach adults at risk with life-saving anti-cancer vaccines like HPV, Hepatitis B, and flu vaccine that can also protect against a potential pandemic flu. An effort at USAID plus Gavi, The Vaccine Alliance, and other partners could provide support to develop and scale up these programs to populations at risk.
- Restore routine childhood immunization and other essential services. UNICEF and the World Health Organization have declared a public health emergency associated with drops in childhood immunization that place millions of children at risk of death and disease. But even before COVID-19, vaccination campaigns faced enormous challenges. Vaccination rates for many diseases were lower than necessary for herd immunity, inequitable distribution remained a persistent issue, and vaccine hesitancy and low uptake had begun to erode demand. While the U.S. government has made significant contributions to defeating polio, low levels of polio immunity and poor vaccination coverage have yielded continued outbreaks of vaccine-derived polio virus, posing a significant threat to eradication. The U.S. – through its partnership with UNICEF, Gavi, the Global Polio Eradication Initiative, and a renewed relationship with WHO can work to build back routine immunization, saving millions of lives. Philanthropic and not-for-profit partners like Rotary International and the Bill & Melinda Gates Foundation could serve as allies and co-funders, alongside G-7 members. This will require greater financing – at least a doubling of funding for vaccine delivery. Other essential services like antiretrovirals against HIV/AIDS, TB and family planning must also be assured.
- Build “never again” structures to assure global health security architecture and financing to respond to pandemic threats. No country is prepared until every country is ready, and the U.S. Congress on both sides of the aisle have identified important global health security reforms. It is clear that new investments must be made in disease and biosecurity surveillance, global health preparedness, and stronger health systems in every country of the world. But “never again” architecture starts with the measurable health impact of scaled up COVID-19 vaccines and recovery of essential services.
There are many competing demands for U.S. global leadership and resources, but it’s hard to imagine a more urgent and cost-effective investment, and one that would leave a legacy of healthy lives and restored livelihoods. We must play our leadership role – with partners – to protect our world from today and tomorrow’s threats.
Amanda Glassman is executive vice president at the Center for Global Development and a public health expert.