Podcast: Vaccine nationalism risks prolonging pandemic, according to Chief Scientist, WHO

TRANSCRIPT: Vaccine nationalism risks prolonging pandemic, according to Chief Scientist, WHO

Soumya Swaminathan:

This virus does not respect borders. It doesn't respect nationalities or religion or age or anything like that. It just spreads where it has an opportunity to spread. It only recognizes human beings.

Ian Bremmer:

Hello and welcome to the GZERO World Podcast. Here you'll find extended versions of the interviews from my show on public television. I'm Ian Bremmer, and today more than half a billion people worldwide have already been vaccinated by the end of March, and that should be cause for celebration. But the vast majority of those shots happened in just 10 nations, and dozens of poorer countries around the world have yet to begin distribution. We're talking about vaccine nationalism today and the impact it could have on public health if new and dangerous mutations of coronavirus continue to spread, not to mention all the people that are going to die because they don't have access to vaccines yet. My guest is the chief scientist at the World Health Organization, Dr. Soumya Swaminathan, Let's get right to it.

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Ian Bremmer:

Dr. Soumya Swaminathan. She is chief scientist at the World Health Organization. Thanks so much for joining us on GZERO World.

Soumya Swaminathan:

Thank you, Ian. Nice to be with you.

Ian Bremmer:

Let me start with a quote from you. You recently said "We cannot win the battle against this virus one country at a time." And that the gap in vaccine inequality worldwide is "becoming more grotesque every day." We certainly see right now that the United States is doing a fantastic job in vaccinating American citizens. What's the state of the global race to vaccinate in your view right now?

Soumya Swaminathan:

Yes. You call it a race. It is a race against the virus. We should not look at it as a race between countries. If we look at the situation today, there are approximately 600 million doses of vaccine that have been distributed, given to people around the world, and that itself is incredible, that in three months since the world started COVID-19 vaccination programs, that 600 million people have already received at least one dose. But about 75% of those doses have been in only 10 countries, and almost a third in one country. So a large number of countries, about 42, I believe, still have not started vaccinating their people, even their high-risk groups like healthcare workers and the elderly, and three quarters of those countries are low income or low middle income countries.

So you begin to see here the real inequity between a few countries. They are high income countries and vaccine manufacturing countries that are moving very rapidly towards vaccinating their entire adult population, that's the targets that they have. And a significant number of other countries that account probably for more than two thirds or three fourths of the world's population, where even if they have received vaccines, it's very small volumes, they've only started vaccinating the very highest risk groups, and they really need to scale up rapidly in order to bring down deaths. We've seen in the last few weeks the global epidemiology again changing. There's been unfortunately an uptick in cases in all the WHO regions with also increasing deaths, and this is very, very concerning, particularly since we now have tools. We have diagnostics. We know how to treat people better than we knew last year, and we have vaccines that we didn't have last year, and yet we are back to the levels that we had last year of cases and deaths.

Ian Bremmer:

If you were advising some of the leaders of these wealthy countries, you obviously understand the pressures that they want to get their citizens vaccinated first. What is the right thing for them to have done for them to be doing that they're not doing right now?

Soumya Swaminathan:

I think because it's a pandemic, we have to consider this problem as a global problem. And yes, political leaders are answerable and responsible for their own populations, but this virus does not respect borders. It doesn't respect nationalities or religion or age or anything like that. It just spreads where it has an opportunity to spread. It only recognizes human beings. And so what we should have done, and what we have been advocating for as the WHO, is in the first instance, to prioritize the high-risk groups so that we can bring down deaths. We've seen now in countries what a huge impact vaccines can have on reducing severe illness, hospitalization, and deaths. Tremendous. And the news from the vaccine is really encouraging. It's reducing deaths, it's reducing hospitalizations, and it's even reducing infections. So as we are learning more about the vaccines, we are getting more and more encouraged. But in some countries, you see death rates climbing every day because they don't have enough people vaccinated in those high risk groups.

If we were to approach this as one global community, we would share the available vaccine supplies, which are no doubt limited. So for the first half of the year at least, supplies are definitely not going to be enough to meet all demands everywhere. If we could share those limited supplies in a way that everyone in all countries who's at the highest risk of dying if they get the infection is protected first, then when the supplies are more, we could actually start vaccinating more of the adult population, which is where we want to get to eventually. If we have to control this infection, we probably have to vaccinate 70, 80% of the population of all countries. But let's first stop people from dying when we have this tool, and it's just reminding me of the days of HIV when I was working in India and patients used to ask me, "Why do we have to die when we know that people with the same infection in other countries are getting the treatment. Why?"

Ian Bremmer:

We're probably in a situation where the entirety of the United States, the United Kingdom, Israel, other countries get vaccinated before many countries even get started, even get their first vaccine. That's what we're looking at right now. Aside from the fact that that means a lot more people will die, what does that also mean in terms of real time spread of variants, the difficulty of actually fighting this pandemic globally?

Soumya Swaminathan:

That is the other real concern, that if we allow the virus to spread and multiply unchecked in some parts of the world, the more the virus replicates, the higher the chances of it accumulating these mutations, because this only happens when the virus is reproducing or replicating. There will be, then, these variants emerging, that have already emerged ,and will continue to emerge in some parts of the world, and eventually we've seen how these variants actually spread across the world. There is no way to keep those geographically confined. And so a new variant that is less susceptible to the immunity that's brought about by vaccines, and/or that's more transmissible or makes people more ill, could easily then spread back and infect people in parts of the world where there have been large numbers of people vaccinated and where they think that they are then immune.

I think it makes epidemiological sense as well to distribute these tools that we have fairly across the world so that you are damping down transmission in all parts of the world at the same time and not in an unequal manner as is happening now. To keep the variants down, we need of course also to implement the other public health measures, which as we've seen, have become very lax and people are fed up. They're no longer wanting to do the same precautions they were doing last year. Governments are also tired. Local public health bodies are not implementing the same kind of testing, tracking, tracing, quarantining that was being aggressively pursued last year. And so all of these are resulting, both the changes in individual behavior and the changes in the public health actions, are resulting also in an increase in infection rates. So it has to be vaccines plus public health measures for quite some time to come.

Ian Bremmer:

Just to get back to the vaccine nationalism point for a second, I just wonder, again, as someone who's been in this field for a while, we see that it's India, it's Russia, it's China, it's lower and middle income countries themselves that are exporting the majority of the vaccines that have been exported so far while the wealthy countries use them themselves. It reminds me of resource exploitation, food exploitation, where they're exporting food and resources while their own people go hungry. How do you in the WHO engage with political leaders around the world when this is going on?

Soumya Swaminathan:

I think the director general has really tried to engage with political leaders from around the world from the beginning of this pandemic, long before we had vaccines or any other tools, because it was clear from the beginning once we knew that this had spread globally and that it was a pandemic, that you needed global action, that you needed some rules that everyone used and played by, whether it's travel or trade or whether it's implementation of certain policies within the country, whether it's collaboration on research and development and access to new technologies. Unfortunately, we do not have at the moment any kind of a global treaty on what rules would come into play during a pandemic, and I think this is something that will be discussed in the coming weeks. There's already a call, as you might have heard, for a pandemic treaty from many leaders from around the world because there's a realization that countries acting by themselves in any of these fields doesn't really help solve the problem in a timely manner, and we've seen the consequences of this.

Ian Bremmer:

Given how fast we are seeing production ramp up and how many different vaccines have already been approved with more coming online, do you feel like in three, in six months time, we are on a pathway, despite the complete and utter lack of international coordination, that this problem is going to go away? In other words, if we have 9 billion vaccines that are produced by the end of this year and they're from a whole bunch of countries, are we going to stop talking about this problem, do you think?

Soumya Swaminathan:

Well, I hope that the problem will become less acute because I know that many companies which are currently still scaling up their manufacturing capacities will be in a position to supply more doses. There are also issues of some bottlenecks now in supplies of raw materials and ingredients that needs to be solved. And we are encouraging companies also to do more bilateral voluntary licensing arrangements so that they can use the expertise and the capacity that's available around the world, actually, to manufacture the vaccines. So I think supplies of existing vaccines will increase and there will be new vaccines coming on board in the next six months.

However, because of the evolving nature of this virus and particularly the issue of the variants, it is not clear at this time whether we are going to need boosters, whether we are going to need an annual vaccine shot or every two years. Which groups of people are going to need that? Is it going to be the whole population or not? Are children going to need to be vaccinated or just the elderly? There are still many open scientific questions that will need to be answered, but I don't think that the entire problem is going to be solved later on in this year, though I do think the supplies would be considerably more and hopefully won't be in this acute situation of desperation that many countries are feeling today.

Ian Bremmer:

So many people now, as they are getting vaccinated that are watching this show, and I know we're learning more every day, but how comfortable should people feel? They've gotten their jab, second jab in the case of Moderna and Pfizer, they've waited their two weeks. At this point, do you think people can go back to pretty much living their lives or not, and where would you make exceptions?

Soumya Swaminathan:

I don't think any country is at the point where they can say "Let's go back to living lives as we were before the pandemic". Even in those countries which have vaccinated 40, 50% of their adult population, most of them have had a single dose. And unless you get both your doses, and a significant number of people in the population have had two doses, and you know that you've got that population-level immunity, you can begin to relax a little bit.

But I would say that for the majority of us at this time, whether we've had the vaccine or not, we still need to maintain the guidelines. We still need to wear a mask when we are in a crowded place or with a group of people. Try to maintain physical distancing as much as possible. If you have to meet, meet in outdoors rather than indoors, so ventilation is really, really critical. The hand washing and hand hygiene, I think some of these probably have become second nature to us now, and it's great because we are also reducing the burden of other respiratory infections like influenza. But I don't think this is the time that any of us can think that we can go back to normal, regardless of which country we live in.

Ian Bremmer:

You know I'm going to ask you about the new WHO report that just came out that was looking into the origins of COVID-19 and hopefully shedding some light on that. What can you tell me that we have learned on the back of that report?

Soumya Swaminathan:

I think the report... I haven't read the 300-page report, and it's obviously very, very detailed and comprehensive. It involved a lot of in-depth work that was done by the international scientists along with their Chinese counterparts when they went to China earlier this year, and basically they looked at every possible hypothesis on how this virus could have made that jump into humans and begin to spread from human to human, and then they laid out the likelihood of each of those potential scenarios. And while they could not come to a conclusion on the origin of the virus basically, which means that they have laid out a plan for more research and more work that needs to be done. But looking at the most likely scenario that this came from bats, because the beta coronaviruses are very, very common in bats, and there's a lot of genetic similarity between the SARS-CoV-2 virus and many of the viruses in the Rhinolophus bat species, and so a lot more work needs to be done. But how and where it moved from bats into humans and what that intermediate animal was, most likely they believed there was an intermediate animal like the civet cat for the original SARS virus and the camel for the MERS coronavirus. Those are still open questions.

Ian Bremmer:

Do they feel comfortable confirming that despite those questions of the exact process and intermediacy of which animal, that it did indeed emanate from China?

Soumya Swaminathan:

Well, again, I haven't read the report, so I don't know whether they've spoken to that, but I do think that they say the most likely was that it happened in China because that's where the first cases were detected, but which animal, when it happened, and how it happened remains to be determined.

Ian Bremmer:

And I'm sure you've seen that the former US CDC director, Robert Redfield, has come out and said that he believes that this virus initially emanated from a biolab in Wuhan in China. Is that definitively not a theory that the WHO finds plausible right now?

Soumya Swaminathan:

It was the least likely. I told you that there were many different theories that were considered. Everything was on the table, but that was considered the least likely of the possibilities.

Ian Bremmer:

We all know that the WHO is the most important international organization that's tasked with coordination and education and fighting pandemics. We also know that the Biden administration has recommitted American cooperation with your organization, but there has been a lot of you guys in the crosshairs, both from Trump saying that you are basically an arm of the Chinese government to now Secretary of State Tony Blinken criticizing the WHO pretty directly for influence of China on this report. You're a scientist, you're not a political figure. How do you react when the Secretary of State from the United States levels those allegations that your report was influenced by the Chinese government?

Soumya Swaminathan:

As you say, Ian, I'm a scientist, and I've been trying really to work on the science side of things, and that's been a truly rich and amazing experience to just see where we've come in a matter of 12 to 13 months, from when we first found out the genetic sequence of this virus thanks to the Chinese scientist who posted it publicly on the 10th of January last year, which enabled all of these amazing vaccines as well as diagnostics to be developed, to all the other research that's been done where we are today in a position where we understand the disease, the virus, the epidemiology, the transmission, and the modes of control so much better and we have so many tools. So I've really been focusing on that and not on the politics.

I don't want to comment really on what anyone said, but it is true that WHO is a member state driven organization. The director general often says that our budget is less than a 10th of a budget of a medium size US hospital in one of the big cities. And with that kind of a budget, we try to serve the whole world and for the whole of public health, not just for emergencies. And so I think it's for the member states that formed the WHO in 1948 to think about its future and how it should be funded and empowered really, so we can do even a better job than what we do today.

Ian Bremmer:

Before we close, let me ask you a little bit just about long-term trajectory. One is the children. You've seen that we have millions of kids that are out of school and some that aren't going to be returning as a consequence. I wonder, given the scientific consensus that appears to be that COVID is not widely transmitted in schools, why hasn't the WHO recommended that all students return to school worldwide?

Soumya Swaminathan:

I think that's a really good question, and the evidence on this has been very mixed. Unfortunately, there haven't been very many good studies done on transmission in schools, and the evidence that's come from different settings has been mixed. And the reason for that is that schools don't exist as an island in themselves. They are part of the community, and whatever happens in the community is going to be reflected in the schools. So if you have a raging outbreak in the community, it is likely that you will have a lot of infections if you keep schools open. That's why we've always said that we need an approach to schools where we prioritize schools. We've always said schools must be prioritized over other things like shopping malls or cinema halls or pubs and things like that. We've advised governments, please prioritize schools.

Ian Bremmer:

When do you think the World Health Organization will be in a position to recommend that that children should be vaccinated?

Soumya Swaminathan:

The trials have started. Many vaccines are now being tested in children down to the age of six or even lower, and they're going to be looking at safety, they're looking at dosing, and they're looking at the immune response. So as soon as there's data, as you know, we've put guidelines out for four vaccines so far. We have policy as well as we have the emergency use listing. And as soon as we have data on children, we will update those to include children.

Ian Bremmer:

You've said recently that better vaccines are coming. You could even see vaccines without needles. Can you talk a little bit about that?

Soumya Swaminathan:

Yeah, so there are a number of vaccines in development that are being given either through the nasal root as a spray, and that would have a lot of advantages because it would generate local mucosal immunity in addition to systemic immunity. There are oral vaccines that are being developed, and there are also vaccines that could be given through the skin, through transdermal applications. So there are all of these innovative vaccine designs coming through. There are single dose vaccines coming as well, vaccines that can be stored at room temperature, and that's why I'm so optimistic that eventually we are going to have a range of vaccines, hopefully many of them affordable and able to manufacture at scale, and that will be easy to use. We have to deploy so many healthcare workers now to do these mass immunization campaigns. It's incredible. It's going to take away from essential health services in many countries in order to do these campaigns. So if we could have a nasal vaccine that people could self-administer, that would be fantastic.

And so the WHO's working with developers around the world to really encourage those ... Many of them are small biotech companies and we'd like to support them as much as possible so they can take their vaccines through clinical development.

Ian Bremmer:

Have you learned, personally, more in the last year than at any other time in your life?

Soumya Swaminathan:

Absolutely. There's no doubt. I've worked on tuberculosis and I'm appalled that we've made so little progress in tuberculosis. It takes a decade to do a clinical trial and get a new drug as part of the regimen for TB. It takes 30 years to get a vaccine from phase one into phase three, and it's been very depressing. And just seeing what's happened with COVID gives me renewed hope that we can address some of our other public health challenges with the kind of global collaboration that we've been able to bring to address this problem of Covid-19. It's a question of having that mission and that goal, and scientists around the world agreed to work together. It was just an unsaid commitment that people had, and that's what resulted in where we are today. So I hope we can do this for some of the other big killers like TB and malaria, hopefully HIV as well.

Ian Bremmer:

Dr. Soumya Swaminathan, thank you so much for joining me today.

Soumya Swaminathan:

Thank you.

That's it for today's edition of the GZERO World Podcast. Like what you've heard? Come check us out gzeromedia.com and sign up for our newsletter, Signal.

Announcer:

The GZERO World Podcast is brought to you by our founding sponsor, First Republic. First Republic, a private bank and wealth management company, places clients' needs. First by providing responsive, relevant, and customized solutions. Visit firstrepublic.com to learn more.

This podcast is also brought to you by Walmart. With 150 million customers and members passing through our doors each week, Walmart and Sam's Club pharmacists can safely and easily reach customers who might not have access to a vaccine. That's why we're working hard to bring vaccines to the nearly 4,000 medically underserved communities we serve. Because we're not just in your community, we're part of it. Learn more at walmart.com/covidvaccine.

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