Maya J. Goldenberg prepares us for the reality that an effective vaccine may stop the pathogen, but it will not establish health.
Great hopes are pinned on new coronavirus vaccines because the novel coronavirus has initiated a deadly pandemic of disease, death, and loss. It is nice to feel hopeful after months of civic disaffection, as we watched the many failures of leadership, both within nations and internationally, to enact robust public health responses.
Public disgruntlement with failures of leadership is wrongly identified as “pandemic fatigue”, which suggests frailty of individual character rather than disillusionment with political failure to contain the virus and minimize harm. The political difficulties started early on in the pandemic, with the noticeable challenge of procuring reliable global health data to steer policy.
On the political stage, governments promised to “follow the science” with little admission that the science was emergent, uncertain, and saying different things. Many leaders then failed to follow the science at all in their policies.
In both international development and health systems research, there have been decades long debates between proponents of basic public health improvements versus single-disease eradication, for example, through vaccination—with the latter being more powerful. The COVID-19 pandemic response is on course for following in that same direction. However, the current pandemic response needs both – more robust public health infrastructure and a vaccine.
There has been disagreement among experts, as well as public resistance, to every nonpharmaceutical public health measure that has been enacted to mitigate community spread of the coronavirus, especially masks and lockdowns. Even the most affluent nations have underinvested in agreed upon health measures, such as personal protective equipment for frontline workers, widespread and rapid testing, and contact tracing.
Coronavirus vaccines offer new hope, but will they deliver?
Public health experts are tempering public expectations, advising that vaccination will not immediately allow for resumption of normal life. Community-wide vaccination will take time, and the immediate and long-term effectiveness of the vaccines are still not known.
The logistics and financial cost of manufacturing, storing, and distributing the new slate of coronavirus vaccines across the globe are staggering, and the planning and investment that has so far been put in place mostly stands to impact the citizens of industrialized nations while leaving the majority of the world’s population underserved. Investment in vaccination for the global South, such as the WHO’s COVAX initiative, remains insufficient. With strong leadership and global solidarity in short supply, the success of a global vaccination effort, of a scale greater than the near-complete global eradication of wild poliovirus, seems unlikely.
“Vaccine nationalism” and “vaccine disenfranchisement” follow from inequitable vaccine licensing and advance purchasing agreements, and are already negatively impacting global access to vaccines. Depleting national health budgets on vaccine purchasing will also come at the expense of investment in other life-saving public health programs. While early media coverage heroized hard working scientists contributing to the global effort to develop a coronavirus vaccine, national pride is now clouding that collaborative ethic.
Many citizens fortunate enough to have access to vaccines in the near future worry about the safety of this highly politicized and profitable vaccine technology – the phenomenon known as “vaccine hesitancy”. For experts to dismiss all such concerns as “misinformation” and “disinformation” is to ignore that highly lauded blockbuster health interventions have at times been mismanaged by the industries that profited from them, and that patients were harmed as a result. The opioid crisis, for example, is still with us. When a large enough population comes to believe that profits were placed ahead of public health, even the most effective vaccine can fail upon delivery. A vaccine program is only good if people want to get vaccinated.
Global health experts have long challenged the Western philanthrocapitalist drive to vaccinate citizens of the global South while permitting basic needs like clean water, food security, and primary health care to go unmet. Investment in the social determinants of health has more impact on the global burden of disease by targeting the conditions that make people vulnerable hosts to pathogens instead of targeting the pathogens themselves. Citizens of industrialized nations may now similarly question whether the leadership that could not adequately contain the virus and protect at-risk communities, especially elderly people in long-term care, ought to be trusted with a complex vaccine rollout even within their own borders.
The message here is anything but “anti” vaccine. It refuses promises of magic-bullet public health. But the rollout of safe and effective COVID-19 vaccines should be a welcome part of a broader pandemic response that includes major rethinking of and action on the social arrangements and institutions that did not respond well to the COVID “stress test” on governance and society. This pandemic has highlighted the need for better strategies for managing ourselves in relation to the environment, to animals, and to other people through more just political and economic systems. The hope ushered in by new coronavirus vaccines is just one step towards supporting public health.
Maya J. Goldenberg is an Associate Professor in the Department of Philosophy at the University of Guelph and author of Vaccine Hesitancy: Public Trust, Expertise, and the War on Science. University of Pittsburgh Press, 2021. @goldenbergmaya1