As we begin year three of the Covid-19 pandemic, hunkering down again to survive the viral blizzard that Omicron has brought, it is painfully clear that we are failing to learn from the past. 

Predictably, rich nations have made boosters and border controls their primary response to the Omicron crisis, while vaccine apartheid, the 800-pound gorilla in the room, is completely unaddressed. If we do not vaccinate the world, the pandemic won’t end, more variants will emerge, and the world will continue to lose millions of lives, along with trillions in economic losses.

While some political leaders might claim that they “didn’t see Omicron coming,” health experts have been shouting from the rooftops about this. For months.

In April 2021, as the delta variant devastated India, causing millions of excess deaths, we had this warning in the Washington Post: “We cannot just vaccinate rich countries and hope that we will be safe. The only way to end this pandemic is to end it everywhere. Otherwise, we will forever play whack-a-mole with a constantly mutating virus.”

In January 2022, we are still playing whack-a-mole with this virus. One single infected individual can harbor anywhere from 1 billion to 100 billion viral particles during peak infection. And with infections now running unchecked as is the case globally – any one of them has the potential to accumulate mutations that allow it to not only evade immunity but also spread at a mind-boggling rate – 2-4 times higher, as is the case with Omicron. 

And unfortunately, even with this as background, we still do not have a global plan to end this crisis everywhere. On paper, we do. The G20 Rome Leader’s Declaration endorsed the WHO plan to vaccinate at least 70 per cent of people in all countries by mid-2022. But, in reality, we are far away from achieving this goal, since mid-2022 is now just six months away. And even 70 per cent global vaccine coverage might not be sufficient to end the global crisis.

As of January 2022, more than 3.3 billion people, mostly in low and middle-income countries, are still waiting for their first vaccine dose, even as rich nations are rushing to deliver booster doses to their populations. Whereas 76 per cent of people in high-income countries have received at least one Covid-19 vaccine dose, as of 1 January 2022, the rate was only 8.5 per cent in low-income countries.

Even after a full year of Covid vaccination globally, three in four African healthcare workers remain unvaccinated. According to WHO, only half of WHO Member States have reached the target to immunise 40 per cent of their populations by the end of 2021.

While 80 per cent of high-income countries are offering boosters, 0 per cent of low-income countries are doing this. In fact, nearly six times more boosters are administered daily than primary vaccine doses in low-income countries.

This shameful vaccine inequity can only worsen with Omicron, since every rich nation is rushing to buy up more vaccines for boosters – some countries are already trialling fourth dose and even planning a sixth. And if the definition of ‘fully vaccinated’ is now a series of three doses in all, then full vaccine coverage in low-income countries is effectively zero.

With the panic over Omicron, the ‘booster hunger games’ are now forcing rich nations to make a dash for extra doses, and hoard vaccines they already have, potentially slowing down their donations to COVAX. By end of 2021, only about 27 per cent of the donation pledges have actually shipped. 

WHO has already warned that Omicron could spark new vaccine hoarding by rich nations. Despite initial commitments from COVAX to ship two billion doses by the end of 2021, only 1.4 billion doses were projected to be available to COVAX by the end of 2021. 

If we have any hopes of vaccinating the world, production and distribution of vaccines must be dramatically increased. For that to happen, rich nations must stop vaccine hoarding, urgently redistribute surplus vaccines to meet their pledges to the COVAX, support the TRIPS intellectual property waiver, and force pharmaceutical companies to transfer know-how for diagnostics, vaccines, and therapeutics. 

There are more than 100 companies that are capable of making mRNA vaccines, if they are adequately supported. We need to think beyond the Big Pharma model and support non-profits, state-run enterprises, and universities to make life-saving products. The recent approval in India of Corbevax, developed by scientists at Texas Children’s Hospital and Baylor College of Medicine before it was licensed, with no patents or strings attached, to Biological E. Limited (BioE) is a positive exemplar.

Unlike 2021, it is important to remember that we begin 2022 with an experience of the last two years and tools that work: vaccines (especially mRNA vaccines), rapid antigen tests, KN95 and N95 masks, and new anti-viral medicines such as Molnupiravir and Paxlovid (both were recently US FDA approved). Unfortunately, currently these tools are largely concentrated in rich nations, and inaccessible to large swathes of the world’s population.

While sharing vaccines is critical, countries need more than that to deal with the current surge of Omicron. Greater access to rapid antigen tests, high-filtration face masks, and better therapeutic options are urgently needed, as healthcare systems are already getting overwhelmed with the sky-rocketing Omicron case counts. If healthcare systems in Europe and North America are straining, we can only imagine the state of fragile, under-resourced healthcare systems in low-income nations.

In summary, science has delivered many tools that work against Covid-19. But equitable distribution of these tools is where we are failing. If we can find a way to share effective tools equitably and increase their production across the world, then we have a real shot at ending this pandemic. If we hoard these tools, block TRIPS waiver, and think we can boost our way out of this pandemic in the global North, we will begin 2023 by playing whack-a-mole with the rho, sigma, tau or Omega variants.

• Madhukar Pai is a professor of epidemiology and global health at McGill University, Montreal, Canada. Manu Prakash is an associate professor of bioengineering at Stanford University’s Center for Innovation in Global Health.

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