Increased transmissibility is an exponential threat. If a virus that could previously infect three people on average can now infect four, it looks like a small increase. Yet if you start with just two infected people in both scenarios, just 10 iterations later, the former will have caused about 40,000 cases while the latter will be more than 524,000, a nearly 13-fold difference.
Morally and practically, this emergency demands immediate action: widespread vaccination of those most vulnerable where the threat is greatest.
Waiving vaccine patents is fine, but unless it’s tied to a process that actually increases the supply of vaccines, it’s a little bit more than expressing thoughts and prayers after a tragedy. Officials from all nations that produce vaccines need to gather for an emergency meeting immediately to decide how to commandeer whatever excess capacity they have to produce more, through whatever means necessary. Because of the threat of increased transmissibility, and since the evidence at hand indicates that all of the vaccines, even the Chinese and Russian versions, appear to be highly effective against severe disease or worse, the focus should be on manufacturing and distributing the highest number of doses possible as fast as possible.
If the choice is between no vaccine and any vaccine, the precedence should go to whatever can be manufactured fastest, regardless of patents, nation of origin, or countries prioritizing their allies or wannabe allies.
Vaccine supplies need to be diverted now to where the crisis is the worst, if necessary away from the wealthy countries that have purchased most of the supply. It is, of course, understandable that every nation wants to vaccinate its own first, but a country with high levels of vaccination, especially among its more vulnerable populations, can hold things off, especially if they also had big outbreaks before. In addition, excess stockpiles can go where they are needed without even slowing down existing vaccination programs.
Right now, Covax, the global alliance for vaccine equity, does not have enough vaccines to distribute, and what supply it does get is allocated according to national population, not the seriousness of outbreaks. This needs to change. Our fire department needs more water, and should direct it to where the fire is burning, not to every house on the street.
The responses could vary. The elderly and health care workers could be prioritized wherever a crisis is worst. Dose-sparing strategies could be applied — delaying boosters has been successful in Britain and Canada when they faced surges. The details can be decided by the global health authorities.