Gavin Yamey is a physician and professor of global health and public policy at Duke University, where he directs the Center for Policy Impact in Global Health. Boghuma Kabisen Titanji is a physician-scientist and infectious-disease fellow at Emory University.
Congressional negotiators have reportedly decided to remove foreign aid from their bipartisan emergency covid funding package. If they do not correct this error, they will be choosing to prolong the pandemic, leading to needless suffering and death and harming the global economy — and our own.
While it is true that coronavirus cases have fallen in the United States, we should be stepping up — not rolling back — our efforts to vaccinate the world. We should recommit to and further invest in country-led vaccination campaigns in low- and middle-income countries. While high-income nations were starting to offer fourth vaccine doses, 2.8 billion people had not had even a single dose as of March, and booster doses for low-income countries are barely discussed.
Coronavirus vaccines are extraordinarily safe and effective, which is why rich countries with high vaccine coverage have successfully weakened the link between cases and deaths. It is unjust that only those in the wealthy world have been able to protect themselves from covid.
Rich nations have been hit hard by the pandemic, but in fact, less wealthy nations have fared even worse. Contrary to what some may believe, lower-middle-income nations, not high-income nations, have experienced the highest excess death rates. The ripple effects of the pandemic have also derailed efforts to control other infectious diseases and further stretched already fragile health systems.
We could prevent an estimated 1.5 million covid deaths in low- and lower-middle-income nations if we vaccinated and boosted everyone in these settings. That ought to be reason enough to act, but there is another argument that any serious policymaker should understand by now: The world cannot truly move on from the pandemic if large swaths of individuals are unprotected from the virus and remain vulnerable to infection.
Vaccinating these populations is not only essential for those countries but also for our own. The uncontrolled spread of the coronavirus risks new variants of concern, just as we saw with the emergence of the delta and omicron variants. We cannot assume the next variant will be less severe than omicron. In fact, global assistance for pandemic control is most crucial at this moment to bolster virus surveillance systems to better position the United States and other countries to respond to future variants of concern.
In addition to the large toll on human health, uncontrolled spread of the coronavirus harms economies everywhere. The International Monetary Fund estimates the economic losses caused by covid will reach $13.8 trillion through 2024 relative to pre-pandemic forecasts. The global inequity in vaccination is causing economic disruptions worldwide. This is especially true of the United States, given our economic interdependence with the rest of the world. One study from a group of international economists estimates that high-income countries could bear up to half of the global economic losses arising from global vaccine inequity.
The decision by Congress to slash aid for global covid-control efforts also sets a dangerous precedent for how we prepare for and respond to future pandemics. Prematurely declaring victory and taking the proverbial foot off the gas at this critical moment could be devastating for everyone.
Lawmakers must urgently change and restore global aid in their funding package. This includes stepping up U.S. funding to support Covax, the multilateral initiative tasked with distributing coronavirus vaccine doses to lower-income nations. They should also support countries directly with their own country-led national vaccination efforts, helping to overcome health-system bottlenecks such as gaps in the health workforce, supply chain constraints and weak data systems. Funding is also needed to support testing and worldwide access to antiviral treatments, as well as for ongoing surveillance efforts to help policymakers adapt their responses to the next phases of the pandemic.
Congress should also support efforts to globalize the manufacture of coronavirus vaccine doses, so that lower-income countries can become self-sufficient in making their own doses, rather than depending on the unsustainable strategy of donations from wealthy countries. In doing so, we can transform covid-19 into something akin to a worldwide common cold by vaccinating everyone and giving everyone equitable access to testing and treatments.
This is a moral imperative with the potential for real life-or-death consequences. In other words, passing this funding should be a no-brainer.