COVID-19 fact of the day: worldwide vaccine distribution is a shrewd investment

Pandemics can serve to remind us how interconnected we are as human beings. In 1918 and 1919, with American involvement in World War I ramping up and then quickly ending, huge population shifts worldwide led to the dissemination of a horrific novel influenza virus that ended up killing some 50 million people worldwide, including 675,000 Americans. 

This “Spanish flu” did not originate in Spain at all; Spain was stuck with this unfortunate label because its reporters best described the illness. There is strong evidence that the virus actually originated in Kansas in late 1917 and early 1918, spread to Europe and worldwide with American soldiers, and returned with a vengeance later in 1918 and 1919 with horrific results. Two of my grandmother’s brothers died on the same day from this influenza in 1919. 

Controversies still exist regarding the true point of origin of the 1918-19 influenza virus. However, what that pandemic made clear was that interconnectedness can make a virus born anywhere a problem for all humanity. 

In 2014, we were again reminded of our interconnectedness. The largest outbreak of the Ebola virus in history occurred in West Africa, causing about 11,000 deaths between late 2013 and 2016. Ebola kills nearly half of those infected with a horrific hemorrhagic fever; the kidneys and the liver eventually fail leading to internal and external bleeding. Four cases eventually made it to the US, but excellent public health measures led to isolation of those infected individuals, and the Ebola virus never gained a footing. 

Although the Ebola virus threat faded, for years we were reminded of our interconnectedness in hospitals and emergency departments around the nation, as standard questionnaires of all patients asked “in the last three months have you traveled to the Western African nations of Liberia, Sierra Leone, or Guinea?”

Vaccination against COVID-19 virus in the US is proceeding fairly well. The effective- ness of vaccination is aided by incredible efficacy numbers which, in the case of currently available mRNA vaccines, decrease the risk of symptomatic disease by over 90%, likely decrease the risk of hospitalization by over 99%, likely decrease the risk of death by COVID-19 to near zero, and likely significantly decrease transmission. Mostly due to vaccination, there is a solid chance that COVID-19 cases in the US will fall to very low numbers by summer. 

Viruses cannot replicate on their own. Viruses are simply genetic material encased in a protective coating. In order to replicate, viruses must take over the machinery of animal cells; in the case of COVID-19, the virus first takes over the cells of the human respiratory system and creates billions of copies of itself. 

Whenever a virus replicates within a cell, there is the opportunity for random mutations of genetic material. Most mutations are dead ends and do not lead to a new viral variant. However, a very small but real number of mutations will lead to a beneficial mutation that allows the new mutation to spread, often more effectively than existing viral types. COVID-19 viral mutations first described in Great Britain, South Africa, and Brazil (like the “Spanish flu”, the place where a virus is first described does not necessarily mean it originated there) have spread worldwide. Fortunately, these viral types do not appear to be resistant to most existing vaccines, and those previously infected with COVID-19 appear to maintain immunity against these new mutations. 

However, if the COVID-19 virus is allowed to spread through human populations, it is probably only a matter of time before mutations develop that evade existing immunity, including that provided by vaccination. 

Thus, it is in our interest to ensure that vaccine distribution is widespread and speedy. Laying aside the moral arguments for effective worldwide vaccine distribution (there are many), the United States has a large self interest in ensuring that vaccine distribution is not confined to the rich world. 

True eradication of the virus worldwide means fewer opportunities for viral mutation, and thus fewer chances that a mutation develops that evades our hard-earned societal immunity. 

There is a strong moral argument for furthering justice by distributing COVID-19 vaccines to poorer nations worldwide. There is, however, a strong self-interested motive as well. Like other pandemics have throughout history, the COVID-19 pandemic reminds us again how interconnected we are as human beings.