When I contracted Ebola virus disease in August 2014 while working as a medical doctor in a well-known private hospital in Lagos, Nigeria, I was denied access to a potential cure.
For 15 days, I battled for my life in a debilitated isolation ward, not knowing if I would survive. But American aid workers who contracted Ebola were administered Zmapp, a monoclonal antibody treatment, which reduces the relative risk of death from Ebola by 40% as well as shorten the duration of stay in the Ebola treatment units. They survived.
We were told that Zmapp was expensive, in limited supply and only reserved for a few people. Although Zmapp missed the mark of effectiveness as a cure, its benefits could not be denied when compared to the standard of care alone at the time.
Imagine fighting the same disease but not having equal access to the available tools.
This is what universal health coverage is about: That quality health should not be sold to the highest bidder. It means that we must do all we can to prevent vaccine monopoly and have global collaborations to ensure that these vaccines get to the poorest of people so we can put an end to this pandemic
Imagine the psychological trauma of knowing that there might be a cure and not having access to it. Now, I see history about to repeat itself at a large scale- millions of people around the world, especially in impoverished communities may not have access to COVID-19 vaccines.
There has been excitement within the medical and public health community this month over early results of phase 3 clinical trials of the Pfizer and Moderna COVID-19 vaccines which showed them to be over 90% and 94% effective in preventing COVID-19 respectively. This is comparable to the efficacy of measles vaccines which has led to a 99% reduction in its incidence compared to the pre-measles vaccine era. To date, there are over 50 COVID-19 vaccines at different stages of development.
An effective vaccine against COVID-19 is one of the many measures (in addition to testing, tracing, isolating, social distancing and providing health care workers with personal protective equipment) that we can use to combat this pandemic and stem future ones. And as exciting as the news of a potential effective vaccine is, the question, however, is how do we ensure that we all get access to it, including people living in impoverished communities, work multiple jobs and have no primary health care provider? Will it get to people of color who continue to be disproportionately affected?
Data shows that Black, Latinx and other people of color are more adversely affected by COVID-19 as is it the case in cities like New Orleans where I currently live and work as a medical doctor. Will it get to illegal immigrants in the U.S. who try to hide from the system because they do not want to risk being deported? What about the poor in Nigeria, where I am from, who have not seen a doctor in years and have no access to essential health services?
This inequitable access to health is not new. Gardasil, the first vaccine to be approved by the US food and drug administration in 2006 against Human Papillomavirus (HPV), the virus that causes gential warts and cervical cancer, is effective in preventing cervical cancer and is administered to girls and boys at the age of 11 in the U.S. However, in Nigeria, a country that contributes 10% of the global burden of cervical cancer, a national HPV screening and vaccination program is non-existent. HPV vaccine is available in the private health sector but cost and weak health infrastructure remain a significant barrier to access.
A study in 2016 showed that Eastern Nigerian women were willing to pay about $11.68 dollars out-of-pocket to get their daughters vaccinated, in a country where more than half of the population earn less than $1.25 a day.
The last thing we need in the global fight to contain the COVID-19 pandemic is vaccine capitalism which we are already seeing unfold. High-income countries have bought over 80% of the Pfizer COVID-19 vaccine stock leaving the poor with little or no access to it. In May 2020, Politico reported that President Donald Trump had offered German vaccine company, CureVac, large sums of money to move their research site to the U.S. and develop the vaccine for the U.S. only.
We cannot end a pandemic without collaborations and empathy for humanity and the millions of lives that have been lost since December 2019. If the COVID-19 vaccines are equitably distributed globally, it would cut down death by over 60%. But, a recent modelling study showed, it would reduce death by only 33% of wealthy countries buy them all up.
Thankfully, the World Health Organization (WHO), Coalition for Epidemic Preparedness Innovations (CEPI), Gavi- the Vaccine Alliance, European Commission and France came together in April 2020 to launch an initiative called COVAX with the goal of ensuring a fair distribution of COVID-19 vaccines globally.
COVAX aims to distribute 2 billion COVID-19 vaccine doses fairly by the end of 2021 so that people – regardless of their socio-economic status, race, ethnicity, gender, political affiliations – can have equal access to a promising vaccine.
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This is what universal health coverage is about: That quality health should not be sold to the highest bidder. It means that we must do all we can to prevent vaccine monopoly and have global collaborations to ensure that these vaccines get to the poorest of people so we can put an end to this pandemic.
On December 12, 2020, as we mark the international Universal Health Coverage day, let us hold our leaders accountable to their commitment to achieve UHC. If Zmapp was the only proven cure for Ebola virus disease, I would not be here now writing this, because I did not have access to it.
May my dreams of a world with health for all come true.
Dr Adaora Okoli is a medical doctor who survived the Ebola virus disease, working to strengthen health systems in order to reduce the burden of infectious diseases in low-income communities and achieve equitable access for health to all. She is also an Aspen New Voices Fellow. Follow her on Twitter @DrAdaora.