Duke researchers urge US support of global vaccinations in new paper

As health officials express concern over a slowdown in sign-ups in the U.S., a group of Duke doctors are urging the U.S. to be more proactive in providing global vaccine assistance.

In a 12-page report released this week, the four researchers pointed to inequities disproportionately impacting low-income countries, namely over purchasing powers.

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It states: "Just four nations or regions with less than half the world's population have administered seventy percent of all COVID-19 vaccine doses, while the poorest countries have barely begun vaccinating due to lack of funding and supply. The world's wealthiest nations have locked up much of the near-term supply. Indeed, while confirmed purchases of vaccines globally cover 8.6 billion doses, the world's high-income countries, with a population of 1.2 billion (16% of global population), account for 4.6 billion doses (53% of all purchased doses), while low-income countries hold just 770 million doses."

"It's definitely something we need to do for humanitarian and ethical reasons. It's also important to protect our own health. As long as this pandemic continues anywhere in the world, we're going to see more variants emerge and more and more of a risk that they'll be less susceptible to our current generation of vaccines, so we will not be protected," said Dr. Krishna Udayakumar of the Duke Global Health Innovation Center, one of the report's authors.

Dr. Udayakumar believes a lack of vaccinations elsewhere can present limitations to business and international travel capabilities.

"We may start to see the emergence of travel corridors where specific countries or regions are opening up borders and travel in small waves. But we will not see anything near normalcy in terms of global travel or global trade until we have a much better handle on the pandemic and it's response, which is largely going to come from vaccinations on a global basis," Dr. Udayakumar explained.

The researchers are calling for a multi-pronged approach to address the issue, ranging from greater financial support for COVAX to increased dose donations, pointing to a recent pledge to provide 4 million AstraZeneca doses, which the US is not using, to Mexico and Canada. COVAX is a global initiative aimed at creating equitable vaccine access.

While the report was completed prior to comments made Thursday by Pfizer CEO Albert Bourla about the possible need for another vaccine shot in a year, Dr. Udayakumar said the US is in a strong position from a supply perspective.

"I think there are two really important aspects that are going to impact demand. One is really whether we start to see variants for which new vaccines are going to be necessary. And the second is the duration of immunity, so if we do see the need for seasonal vaccinations down the road, that obviously increases the need for vaccines in the US an the rest of the world significantly. However, neither of those are likely to happen over the summer, and if by the fall or winter we do start to see the need for another round of vaccinations, what we're projecting is by the fall and into the winter, just the US-based manufacturing capacity will be 200 to 300 million doses a month. So we'll be much better positioned by the fall and into the winter so we really don't need to horde vaccines over the summer, especially if it's to deal with variants," said Dr. Udayakumar.

At the current rate, the paper states that low-income countries "may not reach 60% coverage until 2023 or later."

"Elsewhere in the world, without as much vaccinations, especially in low-income countries, the pandemic is still really surging. So that's going to have a huge impact not only on those countries, but on economic recovery for the world and on the risk that we all face because of travel. As we've seen in the pandemic already, if the pandemic is spreading anywhere, it's a risk everywhere," said Dr. Mark McClellan, the Founding Director of the Duke-Margolis Center on Health Policy at Duke and co-author of the report.

The big vaccine news this week revolved around the FDA and CDC's recommendation to pause use of the single-dose Johnson & Johnson vaccine. Friday afternoon, ABC11 spoke exclusively with Dr. McClellan, who is also an independent director on Johnson & Johnson's Board and co-author of the global vaccination report.

Q&A with director on J&J's board after vaccination pause


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ABC11 spoke exclusively with Dr. McClellan, who is also an independent director on Johnson & Johnson's Board, on Friday.



"It's really good that we have such a sensitive and extensive safety surveillance system in the United States that when there's this very rare amount of cases, we can detect that and take action appropriately. So I think it makes a lot of sense to take a pause, look at the data, and see if there are any more cases out there," said Dr. McClellan, who previously served as FDA Commissioner under George W. Bush.

The CDC and FDA's recommendation followed six reports of serious blood clots in individuals who received the Johnson & Johnson vaccine; one of the individuals passed away. All six cases involved women 18-48, with symptoms beginning six to 13 days following the vaccination. Prior to the announcement, Johnson & Johnson had administered about 6.8 million doses.

"Now that the vaccines are being used in millions people, we can learn a lot more about very rare side effects and learn what the effective actions are. So in this case it may be for certain types of individuals, if they are at a small, very small risk of this complication, we can take further steps, we can let them know. We know there are effective treatments for this kind of blood clot. And that's what the federal government and the expert independent advisors for the federal government are sorting through right now," said McClellan.

Blood clot risk no higher in J&J vaccine recipients than that of the general population, experts say

The pause has impacted trust in the single-dose vaccine, with a The Economist/YouGov poll finding 37% of people believe the Johnson & Johnson shot is safe, while 39% believe it's unsafe; prior to the recommendation, 52% of people believed it was safe, and 26% believed it was unsafe.

"I hope they can do that in a very timely way because exactly as you said - people want to know, have a good understanding of the vaccines that are available," said McClellan.

Friday, the CDC announced that more than 200 million vaccine doses have been administered, with nearly half of US adults receiving at least one dose. In North Carolina, 45.8% of adults have received at least one dose and 1/3 of all adults are fully vaccinated. However, some providers have shared reports of open appointments, as they continue to urge people to get their shots.

"With the degree of relaxation of restrictions that we've seen thus far, if we didn't already have a large share of Americans vaccinated, and also a large share that had previously been infected, we'd be seeing a lot more spread now. So the good news is that in people over 65 (years old), it's a very highly vaccinated group, over 75% of that population. (There's) much, much lower hospitalization rates and complications. Unfortunately, with more reopening, with more people letting down their guard a little bit more, we're seeing more hospitalization, more complications in younger age groups," said Dr. McClellan.

While North Carolina's metrics have been fairly stable over the past few months, NCDHHS announced Friday that metrics are leveling off.

"We want to see our trends in new cases, hospitalizations and percent positive of tests decline again," said NCDHHS Secretary Dr. Mandy K. Cohen in a press release. "The best way we can do that is by having as many people get vaccinated as quickly as possible and keep wearing our masks when out in public."
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