18. The hidden price of vaccine nationalism

and the economic case for vaccinating poor countries

Welcome back to Giving to Strangers, a newsletter about how social change and how it happens, written by me, Anya Marchenko. Every two weeks I explore a topic in social good and offer sane donation advice. Many subscribers are new here this week, so welcome!

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In the last Giving to Strangers, we talked about liberal vaccine guilt -- how when vaccines are scarce in America, many low-risk, eligible people feel guilty for getting a shot. This week, I want to talk about vaccine nationalism, the idea that countries should do everything possible to get vaccines for their citizens first, often at the expense of poor countries. 

What I’ve come to believe while researching for this post is that the pandemic will not be over in America when all Americans are vaccinated. It will be over in America when we solve the problem of vaccine equity, and people around the world (even and especially in poor countries) are vaccinated too.

Unfortunately, this is a goal we’re nowhere close to reaching. 

One bad map

Let me show you a scary map. This is the number of vaccine doses administered as of yesterday (per 100 people) around the world. Notice how most of Africa is a white spot on the map, with parts of the Middle East and West Asia, Central America, and Southeast Asia all having incredibly low vaccination rates.

In Africa, for example, the first COVID-19 vaccine doses were administered in Ghana and Cote d’Ivoire only two weeks ago. Those doses could scarcely have been more urgent, as Africa has been massively lagging behind the rest of the world in vaccination rates. In Bloomberg’s Africa Next newsletter, Antony Sguazzin writes that “to date, just 140,000 of the 213 million shots administered worldwide have been in sub-Saharan Africa,” and that despite 300 million doses from Russia, “Africa is the least vaccinated continent, and it’s likely to remain so.”

Why should we care?

To understand the costs of inequitable vaccination, let’s look to research by economists Cem Çakmaklı, Selva Demiralp, Ṣebnem Kalemli-Özcan, Sevcan Yeşiltaş & Muhammed A. Yıldırım. They measure the global economic losses if rich countries are vaccinated, but the rest of the world remains unvaccinated.

Giving to Strangers spoke with one of the authors over email, Sevcan Yeşiltaş, who is an assistant professor at Istanbul’s Koç University, about the implications of the paper.

“The main [takeaway] is that wealthy countries still suffer from the economic costs of the pandemic even if they achieve universal vaccination at home,” she writes, “because they have trade linkages with unvaccinated countries.”

The authors model the course of the pandemic throughout 2021 under several different vaccination scenarios: from no vaccinations or lockdowns in poor countries, to gradual vaccination of the population. They then trace out how economic disruptions from inequitable vaccinations reverberate through trade and global connections. 

The takeaway is that even if rich countries are fully vaccinated by the end of April 2021, but only half of the people in developing economies are vaccinated by early 2022 (already a reach goal), “the global economic costs might be as high as $3.8 trillion,” with “up to 49% of these costs are borne by advanced economies.”

To explain why using a toy example, imagine a poor Country A. If covid infection rates are high, more workers in Country A get sick. If those workers can’t come to work (or come anyway and get their coworkers sick) more factories and other centers of production operate at lower capacity. The overall economic output of Country A goes down. 

Say rich Country B trades with Country A. As long as poor Country A remains partially or un-vaccinated, it might:

  1. Buy fewer final goods and services from rich Country B (TVs, cars)

  2. Buy fewer intermediate goods from Country B (plastics, car parts)

  3. Sell fewer intermediary inputs that rich Country B needs for its factories

  4. Sell fewer final goods to rich Country B

When all of these losses add up, they add up big, especially for rich countries -- to potentially trillions of dollars at worst. To put that in perspective, simply helping make sure poor countries have equitable access to COVID-19 vaccines and treatments would only cost an additional $22 billion in 2021 (150 times less)!

Globally, we’re nowhere near on track to even the “best case” scenario in the paper, or 50% vaccination of poor countries. However, there are a lot of commendable efforts at ensuring vaccine equity. The doses that arrived this month in Ghana and Cote d’Ivoire were made possible by COVAX, an international consortium working to get vaccines to developing countries by accelerating their development and manufacture. Its goal is to get at least 1.3 billion doses to 92 poor and middle-income countries by the end of 2021 through something called the COVAX AMC (1.3 billion corresponds to around 30% of those countries’ population).

The COVAX AMC is a way to finance and buy vaccines, which (1) promises specific vaccine manufacturers that if they produce a vaccine before it is even licensed by the WHO, they are guaranteed that COVAX will buy a certain volume; (2) and then, once a vaccine is actually licensed by the WHO, COVAX AMC funds will then pay for the purchase of doses for poor and middle-income countries.  

I cannot commend this effort enough and the massive international cooperation that it implies. Without COVAX, it doesn’t seem that poor countries would have any vaccines any time soon. And stakes of an equitable vaccine rollout are incredibly high:

"As the epidemiologists as well as Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) always stress, [if] we wait longer to provide vaccines, tests, and treatments to all populations in the world, the virus will take hold [faster], the potential for more variants will emerge, the chance today’s vaccines could become ineffective will increase,” says Prof. Yeşiltaş. “With the revival of international travel and tourism, new strains of Covid-19 like the UK, Brazil and South African variants will continue to circulate around the world. Therefore, Americans should understand that they are also protecting themselves by getting everyone else vaccinated." 

Vaccine nationalism -- and its underlying logic that “a vaccine for them is not a vaccine for us” -- speaks to a bigger problem of seeing humanitarian aid as zero sum. Politically, giving aid is seen as an extracurricular activity that the US does because we’re so rich and benevolent, but when the shit hits the fan at home, we have every right to withdraw that aid.

That’s why I think it’s important to highlight evidence showing that providing humanitarian aid is often practical. And in the case of funding vaccines for developing countries, the evidence is especially clear: the “selfish protectionism” and “moral aid” goals are the same

Even if you don’t care about the moral obligation to help people in need, or a way to pay reparations for past wrongs, the economic reality of our interconnected world remains. And in this world, policies that put “America-first” are often myopic, operating from a delusional worldview that our economy will improve if we isolate ourselves from global relationships as easily as taking out a puzzle piece. 

Prof. Yeşiltaş argues against this view based on her research:

“The message of our paper is very simple, yet eye-opening: no one is safe until everyone is safe, and no economy is an island. No economy can fully recover until we have global equitable access to vaccines.”

Which strangers should you give to? 

1) You can donate directly to COVAX to buy vaccines for poor countries. I hope by now, along with being excited for your own dose, I’ve also convinced you how incredibly important vaccine equity is. This link will take you to the website of Gavi, the vaccine alliance, one of the governing bodies of COVAX. And the donation will go to COVAX fee-free:

Donate to COVAX

2) Donate to preventing future pandemics. People are notoriously bad at caring about future bad things. Over the last year, the world has been learning the cost of pandemic un-preparedness. I hope that in the next few years we will see a movement to shore up resources and funding for organizations that work to prevent pandemics and other biological risks before they happen. 

To help, you can donate to the Johns Hopkins Center for Health Security, which Open Philanthropy called “the preeminent U.S. think tank doing policy research and development in the biosecurity and pandemic preparedness (BPP) space”.

Donate to Center for Health Security


I did not write down many quotes this week, so here’s one and a couple from the archive

I want to see new things while I still have time to change my mind.

— My friend’s coworker on applying to a more generalist position than her speciality in graduate school

One of the mixed blessings of being twenty and twenty one and even twenty three is the conviction that nothing like this, all evidence to the contrary nonwithstanding, has ever happened to anyone before.
— Goodbye to All That, Slouching towards Bethlehem, Joan Didion

Although I believe the computer to be a vastly overrated technology, I mention it here because, clearly, Americans have accorded it their customary mindless attention; which means they will use it as they are told, without a whimper. Thus, a central thesis of computer technology - that the principal difficulty we have in solving problems stems from insufficient data – will go unexamined. Until, years from now, when it will be noticed that the massive collection and speed of light retrieval of data have been of great value to large-scale organizations but have solved very little of importance to most people and have created at least as many any problems for them as they may have solved.

— Neil Postman, Amusing Ourselves to Death, Dec 2020, pg 8

Maybe the desire to make something beautiful is the piece of God that is inside each of us

— Mary Oliver, Franz Marc’s Blue Horses, Jan 2021