The highly transmissible Delta variant of COVID-19 has highlighted a fear shared by infectious disease experts worldwide: That increasingly dangerous mutations will continue to crop up until most people around the globe are vaccinated.
"There are going to be more variants and they may eventually be variants of concern or variants that pose problems for the vaccine," said Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security in Baltimore.
"The best way to guarantee against that is getting the world blanketed with vaccine," Adalja said in an interview with HealthDay Now.
How to achieve that goal is what divides health experts, politicians and many others.
What about suspending the drug company patent protections that some believe are prohibiting countries from manufacturing COVID vaccines within their borders?
Last year, India and South Africa proposed that the patent rights for the COVID-19 vaccines be temporarily suspended, to give generic pharmaceutical companies a chance to crank out doses as quickly as possible to cover the world.
The proposal currently is being debated by the World Trade Organization. U.S. President Joe Biden also supports the idea, but other developed nations have dug in their heels against it.
Hiding the knowledge
Bangladesh entrepreneur Muhammad Yunus is chairman of the Yunus Center in Dhaka, a research organization focused on alleviating poverty. He's also former managing director of the "microcredit" loan pioneer Grameen Bank.
Yunus supports a temporary waiver of patent rights, arguing in a HealthDay Now interview that "you cannot hide the knowledge from everybody which can solve the problem. This knowledge should be global knowledge to save the global population."
Bangladesh has a population of nearly 165 million people, but only about 4% of the people there have been vaccinated against COVID, according to the Dhaka Tribune. More than 6 million have been fully vaccinated, and another 16 million have received their first dose.
Bangladesh had contracted with the Serum Institute of India to buy 30 million doses of vaccine, but only received about 10 million doses, said Yunus.
India is where the Delta variant first appeared, and to stem the tide of COVID its government halted exports of vaccine, Yunus said.
"India decided to stop all export of vaccines, so we became the victim of that," he said.
Yunus believes the best path forward now is to release the knowledge behind the COVID vaccines so countries can fend for themselves.
"Knowledge is not the missing part. We know how to protect the people. It's easy. It's simple. But that knowledge is not shared with everybody else," Yunus said. "Money-making companies made the decision that they will hide this knowledge behind their profit wall.
"That's the only chance we've got, to allow people to produce as much vaccine as they can, wherever they can," Yunus said. "The production is the key."
The full interview is here:
Back at Johns Hopkins in the United States, infectious disease expert Adalja agrees that the world needs to be vaccinated as quickly as possible. But he disagrees that patent waivers are the answer.
"I don't think it's a sustainable solution because we know we need innovation in vaccines. We know we wouldn't have these vaccines if it weren't for the innovators at places like BioNTech and Moderna to develop these vaccines. It disincentivizes companies to invest, so I would not support any intellectual property right waivers," Adalja said.
Instead, Adalja believes that the sort of export restrictions on COVID-19 vaccines imposed by India (and other countries) need to be lifted worldwide. When that happens, Adalja said, nations in need can get doses either by purchasing them outright or having them donated.
"What we've seen is a lot of vaccine nationalism from many different countries," Adalja believes. "Certain countries still have export restrictions. When a company wants to sell outside of the country of manufacture, they have to get permission from the government. That needs to evaporate. That never should have been initiated in the beginning."
Groups set up to equitably distribute vaccines globally -- COVAX and the Bill and Melinda Gates Foundation, for example -- are working to get millions of doses out to places like Bangladesh, but export restrictions continue to hamper their efforts, according to Adalja.
"It's strange that we're still seeing vaccine nationalism now in highly vaccinated countries where there's plentiful supplies of vaccine," Adalja said. "I do think those export restrictions and thinking about third doses in highly vaccinated countries doesn't make sense, if our goal is to make the whole human population resilient to COVID-19."
First vs. third shots
And what about the rush by the Biden Administration and many Americans to get a third booster shot of vaccine?
Both the World Health Organization and the European Union have counseled against booster shots for the time being, urging that nations instead focus on getting shots into the arms of the unvaccinated. That includes America, where 38% of people eligible to be vaccinated have resisted getting the shots.
Focusing on more first shots, rather than boosters, is an approach Adalja and many other infectious disease experts are promoting.
"The longer this virus is unchecked anywhere in the world, the more likely we are to see variants. Until we control this pandemic in all corners of the globe, we're still going to have variants," Adalja said. "The way we control this pandemic is by getting first doses, second doses into people's arms all around the world, even in the United States.
"The important thing to remember is this is being driven by the unvaccinated," he added. "That's what's in the hospital right now. It's not vaccinated people that are the issue in this pandemic."
The World Health Organization has more about COVAX.
SOURCES: Amesh Adalja, MD, senior scholar, Johns Hopkins Center for Health Security; Muhammad Yunus, PhD, chairman, Yunus Center, and former managing director, Grameen Bank, Dhaka, Bangladesh