Why America's "unconscionable" vaccine choice could delay the pandemic's end

As nine coronavirus vaccine candidates push into the third and largest stage of human trials, the world is edging closer to a reality where a vaccine exists. It's tempting to dream about the day when you can get that vaccine, and perhaps take a meaningful step towards normalcy.

But experts say that that normalcy won't come unless we starting thinking bigger than ourselves, our cities, and even our own countries.

When the first coronavirus vaccines get approved, there's not going to be enough to ensure that everyone gets a shot (and likely, a booster shot) right away. On Wednesday, a team of 19 scientists from around the world released a paper arguing that we need to think about allocating those vaccines across Earth – not just within each country's borders.

Their model, called the Fair Priority Model, suggests distributing a vaccine across Earth in three phases each designed to minimized the lives taken, economies shuttered and social consequences imposed by the coronavirus. The paper was published Thursday in Science.

• Phase 1 would focus on those who have the most vulnerability to Covid-19 and aims to prevent premature deaths.
• Phase 2 would focus on reducing the economic and social costs of the virus. It prioritizes places where the vaccine will help raise people above the poverty line and contribute the most to the gross national income.
• Phase 3 would focus on ending community spread, allocating vaccines to the places where the virus is raging uncontrolled.

The Fair Priority model isn't the only suggestion for allocating a coronavirus vaccine on a global scale. For instance, the World Health Organization's COVAX initiative – which has been joined by 172 countries – will focus on healthcare workers first, then distribute the vaccine to the elderly or those with pre-existing conditions before tackling the rest of the population. The goal is to distribute two billion vaccines.

They differ in the details, but both plans speak to a larger idea: Beyond the moral obligation of avoiding excessive death, countries need to start thinking beyond their borders if they want a vaccine to truly usher in normalcy, says Ezekiel Emanuel, the study's first author. He's also the chair of medical ethics and health policy at The University of Pennsylvania.

"There is no way to open up the world to travel or trade unless the whole world is vaccinated," he tells Inverse. "We need the whole world to be vaccinated to get back to pre-Covid normalcy."

Unfortunately, the United States is off to a bad start.

"Selfish and uncooperative" –  On Tuesday, the Trump Administration announced that the US would not join COVAX, the WHO-led operation to ensure that vaccines are distributed around the world. Joining that effort would have meant that the US contributes funds into a global pool that funds nine vaccine candidates.

Some of those vaccines — should they prove effective — would be distributed in the US. Others would be distributed to less-wealthy countries that have not cut their own deals with drug companies to supply vaccines, as the US already has.

Alexandra Phelan is an assistant professor at Georgetown University's Center for Global Health Science and Security. She calls COVAX an "insurance policy." Buying in would have given the US access to the nine vaccines produced by COVAX's facilities. Opting out, she says, denies the US access to that policy, and could cause negative ripple effects around the world.

"The facility will be used to purchase vaccines to provide to 92 to low- and middle-income countries and so the refusal to participate in that is an additional level of fairly unconscionable conduct," she tells Inverse.

Emanuel also calls the US' refusal "selfish and uncooperative."

It also speaks to the exact reason why experts argue we need models like the Fair Priority Model – to ensure widespread access to vaccines. Not doing so can prolong the pandemic for everyone and cause unnecessary loss of life, Phelan says.

Vaccine nationalism– Already, wealthy nations have secured about 2 billion doses of Covid-19 vaccines through private deals with biopharmaceutical companies. The US has deals with six leading vaccine manufacturers for 800 million vaccines, and the UK has secured enough to give each citizen five shots, Nature reports.

There's a name for that impulse: vaccine nationalism. That's the feeling that countries will hoard vaccines produced within their borders and buy up as much vaccine as possible from external manufactures for their own citizens, Emanuel explains.

"We need to show the limits of that nationalism," he says.

The US refusal to join the WHO-led effort is "absolutely" an example of vaccine nationalism, Phelan adds.

Emanuel dedicates a section of his paper to this phenomenon, explaining that vaccine nationalism is a natural reaction when there's no global government. Every country will try to look out for themselves, but it comes at a cost.

What may happen if the vaccine rollout is not equal — The "clear upper bound" for vaccine nationalism, the paper argues, is keeping enough vaccines to keep a pandemic under control. This would mean that the rate of transmission says below 1 — each person who is infected only infects one other person. When a government reaches that limit, it should release vaccines to others, the paper argues.

However, if some nations start vaccinating less vulnerable populations (like healthy people who can work from home) while other countries have at-risk people wanting for vaccines, people around the world are more likely to die, Phelan says.

She says there's a "justice and equity" argument for ensuring that lives around the world aren't lost when they don't have to be. But there's also something in it for countries that may feel inclined to protect their own citizens over the vulnerable elsewhere.

Namely, for international travel and trade to restart, the vaccine has to be everywhere because it will mean less risk of getting coronavirus back at home, Phelan says. The only road to normal begins with caring about other people as much as we care about ourselves:

"This is a marathon. None of us will be able to go back to some form of what day-to-day life was like before until there is a global solution."