The best lessons on coronavirus eradication do not come from the Spanish flu, but from smallpox | Coronavirus epidemic


SSince the outbreak of Covid-19 experts and commentators, the Spanish flu of 1918 is often cited as a useful precedent. But with various pharmaceutical companies moving into the advanced stages of vaccine testing, we should now turn our attention to the history of smallpox. Although smallpox is a different and deadlier pathogen than the coronavirus, the international politics that gripped the campaign for its global eradication during the 20th century offers valuable lessons for the coming struggle we will face. to distribute a vaccine against the coronavirus.

In 1958, the World Health Organization launched a plan to rid the world of smallpox. The virus had long been eradicated in rich countries, but it was still ravaging populations in Brazil, South Asia, Africa and Indonesia. At a meeting of the World Health Assembly that year, Dr Viktor Zhdanov, deputy health minister in the Soviet Union, urged delegates to consider the cost / benefit of a global campaign to eliminate smallpox. Not only would working together to eradicate the virus help keep all nations safe, it would also eliminate the costs of their annual immunization programs.

But the United States, WHO’s biggest funder, has not supported the program. Many other countries that believed that smallpox vaccination was the responsibility of each country also left it unfunded. Smallpox eradication will only remain an idea on paper until, seven years and two presidents later, Lyndon Johnson is brought in to sign a renewed version of the campaign, pledging “U.S. support for an international agenda to to eradicate smallpox completely from the earth over the next decade. “. Thanks to this financial assistance and a donation of 1.7 billion doses from the Soviet Union, smallpox was finally extinguished from the planet in 1977.

As we await news of a successful Covid-19 vaccine, Zhdanov’s advice on the international cooperation needed to fight a deadly virus has never been more timely. It remains to be seen whether politicians will heed his words.

There have been some positive signs. In an interview with activist Ady Barkan, Joe Biden said that if elected President of the United States, he would “absolutely” commit to widely sharing the technology and access to an unpatented Covid-19 vaccine.

In a recent Washington Post editorial, world leaders including Justin Trudeau, Sahle-Work Zewde and Cyril Ramaphosa proclaimed “global solidarity” for the development and distribution of vaccines. These leaders are all signatories to Covax, an initiative of Gavi, a vaccine alliance managed by WHO, Unicef, the World Bank and the Bill & Melinda Gates Foundation. The alliance has launched a vaccine pool, which allows participating countries to support more candidate vaccines while helping poorer countries to secure shares.

But Covax does not have the support of some of the richest countries in the world, and Biden is still just a presidential candidate making promises he is not yet in charge of keeping. Instead of multilateral cooperation, many of the more powerful countries have sought preferential access to promising vaccines through licensing agreements.

Last week, the United States signed a contract with Pfizer for up to 600 million doses of their vaccine, and the EU struck a deal with AstraZeneca for 400 million doses. This bilateral negotiation will make it difficult for the Covax plan to unfold: if the rich countries buy all the initial stock, there will be few vaccines to distribute elsewhere. In addition, the Covax plan could allow rich countries to double their purchases, buying vaccines for themselves through private deals while having 20% ​​of their population vaccinated through the alliance.

Calls for social justice and human rights, while important, are not likely to address these inequalities. As the smallpox eradication program demonstrated, self-interest has often proved to be the most compelling reason for countries to care about a global immunization program. Vaccination campaigns in poorer countries meant rich countries did not have to pay for continued vaccination of their own population or for increased surveillance of the virus at their borders.

But the fight against smallpox has also seen higher principles working in tandem with self-interest. In shock at the international shame of the Vietnam War, Johnson was keen to support the campaign to show America’s renewed commitment to the world. He signed and, in the middle of the Cold War, the USSR agreed to provide the 1.7 billion doses. For this reason alone, WHO and the planet as a whole are right to celebrate the eradication of smallpox as a momentous victory for international cooperation.

Can coordination of this magnitude ever happen again? As in 1958, the United States is unlikely to lead the way. Donald Trump recently said that the United States will no longer fund the WHO and that America and China appear to be entering a new cold war. The recent accusation that China and Russia tried to steal vaccine formulations from US companies follows a series of xenophobic attacks on China that date back to when Trump called Covid-19 a “virus foreigner ”on March 11.

Maybe Biden, if elected, will see himself as Johnson’s heir in the middle of Vietnam. Faced with a world that has deteriorated over America and ‘America First’, and newly suppressed from its own coronavirus crisis, Biden may seek to repair America’s tarnished reputation by working to create global supply chains for a vaccine.

But for now, our only hope for a fair distribution plan lies in the countries that have partnered with Covax. Politicians, scientists, medical professionals and activists from all walks of life must pressure governments around the world to close the loopholes and question how wealthy signatories and manufacturers will be held to account. . With pooled resources, all nations, rich or poor, and all people, should have enough doses of vaccine to at least protect their most vulnerable populations – and we cannot ignore the growing global population. of refugees.

If the history of smallpox eradication tells us anything, it’s that equal distribution is just as important as the vaccine itself, if not more. Once a smallpox vaccine was available, the fight against the disease in the poorest countries took generations and was only accomplished with unprecedented global collaboration. The smallpox vaccine was not patented. Today, the profiteers of pharmaceutical companies and their shareholders have privatized access to a global good, making equitable distribution more difficult and more expensive. If we don’t learn these lessons, we will end up living with the threat of this pandemic for decades to come.

• Stephanie DeGooyer is ACLS Fellow Frederick Burkhardt at UCLA and Srinivas Murthy is Associate Professor of Infectious Diseases and Critical Care at the University of British Columbia


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