Blaming and hoarding will hasten the next variants
The U.S. is stuck in a fretful pattern of holding on desperately to our vaccine resources and putting up porous barriers at airports, while we await the next COVID variant.
Hoarding vaccines in rich countries and then placing travel bans on other nations for their care in tracking viral mutations is outrageous. But this is also predictable based on what we know about human behavior.
When human physiology is unable to keep a pathogen at bay, we tend to employ psychological defenses instead. We assign an infection to “others” and use discrimination to cut them off from society — rather than doing the hard work of protecting everyone.
This same pattern was seen in HIV, where the U.S. enacted travel bans against HIV-positive people for 22 years. Now, discrimination is well known to be a critical driver of HIV ill-health, and the U.S. invests millions of dollars on stigma research to address it.
Travel bans in the COVID era are a repeat of these forms of discrimination, and they may also drive new variants. When the foe is viral, cutting groups of people off from the resources they need makes us all more vulnerable.
Tourism in South Africa employs 5 percent of the population, so eviscerating that industry is like employing sanctions. Decades of research show that food insecurity and poverty are among the worst drivers of unsuppressed HIV viral load — the exact condition that allows COVID to mutate rapidly inside HIV-positive patients.
So when we consider the best U.S. policy for COVID, sanctions against the nation with 7.7 million living with HIV is not only counterproductive, it’s bad for our collective survival.
There is much to be learned from four decades of battling HIV. HIV vaccine infrastructure sped up our access to mRNA technology, and Moderna and Pfizer’s shots could help HIV vaccines make the leap from a promising new animal study to human protection.
While the biomedical common ground of HIV and COVID have been well articulated, we seem to be missing crucial insights from HIV around human behavior and health systems.
So how do we learn from the lessons of HIV? And how can the latest innovations in HIV behavioral science guide our next steps?
Simplify by sharing the mRNA recipe
Good policy is needed to ensure we do not fall prey to our worst human instincts. A new vaccine tax could equitably share doses by asking wealthier countries to pay their fair share.
An antidote to the human tendencies towards hoarding and discrimination is to make things simpler.
When early HIV treatment was complex and protected by company patents it meant richer nations benefited much more. Once HIV drug bundling and generic production began, patients benefited, but it also led to greater financial gains for pharmaceutical companies.
The Biden administration should compel pharmaceuticals to “share the recipe” to mRNA vaccines — especially since Moderna’s shot was 96 percent taxpayer funded. Legal experts and activists have already laid out plans for the TRIPS Waiver to make technologies free-to-use. Scientists who are doggedly copying the formula in Cape Town could reduce their vaccine production timelines by three-fold.
Couple effective COVID vaccines with community-level global health efforts
Getting vaccines to the right places is certainly the first step to global protection against COVID.
But an under-supported aspect of vaccination lies in securing the infrastructure — space, staff, refrigeration, good communication campaigns — to get doses into arms. The Economist Health Funding Tracker shows only 3 percent of global investment towards health systems.
Underpinning all of this is persistent support to treating HIV, since its compromising effect on the immune system may allow for longer incubation times — and more viral mutation.
The best way to address COVID is to tackle its viral cousin HIV in the same efforts.
Sadly, funding streams that typically go to HIV are now being diverted to COVID. But modeling suggests an estimated 296,000 lives will be lost and new infant HIV infections will increase by 80 percent if this pattern continues.
Urgent community health efforts could be supported by the well-established PEPFAR platform, leveraging the continent’s extensive lay health workforce to pay for dedicated vaccination teams.
Remember: medicine is as much a social effort as a technological one
The biggest challenge for the COVID era is making our hot-shot medical technologies easy to access and safe to use repeatedly.
In HIV, a game-changing innovation was distributing treatment in 3-month supply through community clubs or mobile vans, helping avoid a monthly trek to a local clinic.
Why couldn’t we provide rapid tests much the same way? In England, the national health service mails out at-home tests to school children at monthly intervals, and a new $3 antigen test could help us do this relatively cheaply.
Another advance in the HIV field is using private funding for good health outcomes through what’s called a “social impact bond.” A government asks third party investors to pay upfront for the most compelling solutions to a health problem — it’s most useful to test huge portions of the population or keep HIV infection rates below a certain threshold.
Imagine if cities were incentivized to get vaccination rates up using their own knowledge of the local community?
We should be synthesizing these lessons through better social science streams from National Institutes of Health, as its outgoing director has publicly noted. And while there have been impressive investments in domestic COVID research, we urgently need funding streams for global social science efforts in the COVID era.
Just like in the HIV field, where the “big wins” of the past decade simply are not working in real-life, we have excellent biomedical advances for COVID but human behavior limits their reach.
Good medicine means developing cutting-edge technologies and making sure they are reaching the right people — inside the U.S. and around the globe.
Abigail M. Hatcher, PhD, is a social scientist at University of North Carolina in Chapel Hill with expertise in designing and trialing social interventions for health, specifically HIV care and treatment. She holds an honorary appointment at the University of the Witwatersrand in Johannesburg.
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