Why aligning global and local health needs is key to sustainable vaccine delivery

The ongoing COVID-19 pandemic is a stark reminder of the havoc infectious disease agents can cause to human lives and livelihoods. Vaccines are among the most potent tools for safeguarding public health by preventing infectious diseases – they represent the tangible power of science and technology to advance the human condition.

Vaccines prevent the loss of at least 2.5 million lives annually from infectious diseases, such as tuberculosis, diphtheria, pertussis, tetanus, bacterial pneumonias and measles. They offer the most efficient tool to stop the pandemic, save lives and begin to restore economic damage, which so far has cost the global economy at least US $22 trillion.

However, is important that in the push for COVID-19 vaccines we recognize the need for building basic health care systems to deliver routine vaccines and the essential services needed by communities. Reconciling the global felt needs (health security) with community felt needs (immediate causes of diseases and death) will be key to fighting the current pandemic and addressing other preventable causes of diseases and deaths in the poorer parts of the world.

Vaccines protect more than 100 million children annually from deadly preventable diseases, many of them in poor and vulnerable countries – smallpox has been eradicated by vaccines, and the wild poliomyelitis virus is close to being eradicated. The effects on reduced mortality, reduced desired number of children and increased life expectancy means that population structures become less dependent, enabling countries to reap the demographic dividends in economic growth.

To harness the power of safe and effective vaccines at scale requires functioning, well-governed and adequately financed primary health care systems, with cold chain infrastructure and capable human resources extending to the frontlines in communities. It also requires secure data and information systems, as well as trusted communication with families and parents on the safety and efficacy of the vaccines. Without the delivery infrastructure, millions of children and adults may never experience the benefits of these powerful tools.

The widening global COVID-19 vaccine inequity is a mirror reflecting the state of our world. While developed countries who have immunized more than 70% of their populations are contemplating booster doses and extending eligibility to children less under 12 years of age, many developing countries have barely started expanding the coverage of COVID-19 vaccines among their populations. In Africa, COVID-19 vaccine coverage is less than 5% in most countries. This is largely due to developed countries hoarding doses of the vaccines for their own populations and the failure of global leadership to rally around and fund a common multilateral mechanism that ensures access for all populations regardless of their income.

While a two-track world has emerged, based on access to COVID-19 vaccines supplies, the evolving viral pandemic is being mirrored by a pandemic of misinformation on the safety, efficacy and value of vaccination. Advanced economies, belatedly realizing that for their countries to be truly safe, every country must also have access to the vaccines, and have intensified pledges to donate their excess COVID-19 vaccine doses.

Single-minded focus on COVID-19 vaccines based on global felt needs, without recognizing the felt needs of poorer communities, could inadvertently fuel resistance to COVID-19 vaccines and to other life-saving vaccines.

In 2009, during the polio eradication effort in northern Nigeria, I recall a key reason local communities rejected the global effort to eradicate polio was due to conspiracy theories that highlighted the disconnect between global and local felt needs. Community leaders questioned why the global community was pushing for oral polio vaccines by going house to house, while primary health care centres in northern Nigeria had no measles vaccines or malaria treatments, which were causing more visible illnesses and deaths.

Elements of this are now also surfacing in the polio efforts in Afghanistan and Pakistan. In the case of Nigeria, when we reframed the polio eradication effort and made it an arrowhead for transforming routine immunization and primary health care, traditional community leaders became more enthused in supporting the global polio eradication initiative and contributed to the successful interruption of the polio virus as part of broader efforts to improve the system for delivery of essential services at a community level.

Global health and economic security are tied to universality of coverage for the basic health needs of families and communities and engendering trusting relationships all over the world. The push to increase funding for pandemic preparedness and global public goods, such as the proposed Global Threat Fund of $10-15 billion per year, is warranted based on the lessons of the pandemic. But, if the additional resources are applied with the lens of global security for the wealthier countries without addressing the reality that half of the world’s population do not have access to basic life-saving health services, the investment is not likely to lead to sustainable health security in the long run. Pursuing universal health coverage based on foundations of reimagined primary health care is a better path toward sustainable global health and economic resiliency.

It is in developed countries’ enlightened self-interest to ensure that no country, no population, is without access to the most basic health services, of which vaccination is the most powerful.