Vaccine Diplomacy and End of Covid-19

By Paul E. Lemanski, MD, MS, FACP

In my first seven articles on Covid-19, lifestyle-based risk mitigation strategies – including masking, social distancing, hand washing, targeted quarantine, and, when necessary, lock downs – were recommended to keep the population well until a safe and effective vaccine was developed and “in the arms” of a majority of Americans. In this way, vaccinating the majority would result in so called “herd immunity” (see Non-Medicated Life, February 2021) and stop the transmission of the virus to the remaining minority who were not vaccinated.

Currently, with the number of people vaccinated increasing, the rate of viral transmission has been reduced and hospitalizations and deaths are declining across the country. Despite this success, herd immunity, has not yet been realized. To achieve this end, we should continue to encourage all Americans to become vaccinated. However, in my opinion, it is also time to turn our attention to vaccinating the rest of the world. To help vaccinate the rest of the world against Covid-19 would not only powerfully demonstrate American compassion and leadership to end the human suffering and death caused by the virus – so called “vaccine diplomacy” – but also would help prevent a reintroduction of viral “variants” not responsive to present vaccines back into America. Indeed, only by taking leadership to vaccinate the rest of the world can America assure the end of Covid-19 in the homeland.

The weak point of any vaccine is a mutation in a virus or bacteria which renders the vaccine less effective or even useless. These mutations occur as a natural part of the evolving pandemic as the SARS-CoV-2 virus is transmitted through a population. Indeed, a number of such mutations or “variants” have already been identified. These mutations may allow the virus to be transmitted more easily or they may make the virus more lethal. Thankfully, to date all of the currently identified “variants” have proved susceptible to the currently available vaccines. 

The vaccines target the spike protein of the SARS-CoV-2 virus that causes the disease Covid-19, and stimulate production of antibodies that attach to the spike protein, and prevent it from attaching to and infecting cells in the body. Unfortunately, it is possible to envision a variant for which the spike protein is sufficiently different in structure that none of the available vaccines produce an antibody that could recognize and attach to it. Such a variant would then infect and sicken even vaccinated persons and potentially recreate the sickness and death seen with the original SARS-CoV-2 virus.

Significantly, preventing transmission of the virus through a population is the only known way to stop the development of variants. Other than the lifestyle-based risk mitigation strategies mentioned above, vaccination is the only way to quickly and effectively decrease transmission of the virus through a population. Thus, the more quickly herd immunity is achieved through vaccination, both in America and throughout the world, the lower the risk of variant formation, and the more likely the end of the pandemic. But time is of the essence and we should take advantage of the momentum that has been created.

The American scientific and pharmaceutical communities have achieved a near miracle in the unprecedented rapid development of multiple vaccines against SARS-CoV-2. Production of vaccine was begun even before studies proved the safety and efficacy of the vaccines. Since the completion of the first clinical trials, the production of vaccine has further increased to the point that all American adults interested in vaccination have been offered vaccination. Most recently the Centers for Disease Control and Prevention have approved the Pfizer vaccine for children 12 and older. As these children and young adults are vaccinated, production should continue to increase and be exported to the developing world as quickly as possible. The Astra-Zeneca vaccine which is not yet FDA approved for use in the United States, has already become the first vaccine to be shared with other countries, and production of all vaccines should be accelerated for export.

Such an expedited export of vaccine against SARS-CoV-2 to the developing world will help avert millions of deaths and mitigate much suffering. Such vaccine diplomacy demonstrates our common humanity, American compassion, and a willingness to share our abundance. Additionally, and perhaps more significantly, it demonstrates the superiority of both our economic system and our technology. Moreover, much like the Marshall Plan after World War II, during which the United States transferred the equivalent of 130 billion dollars to help rebuild war torn Europe, such American largess will stabilize the world economy, undermine the draw of Communism and Socialism in the developing world, and create goodwill far out of proportion to a similar number of dollars spent on traditional foreign aid.

In summary, lifestyle-based risk mitigation strategies for the spread of SARS-CoV-2 were recommended to keep the population healthy, pending development of a safe and effective vaccine. Now with the development and distribution of multiple safe and effective vaccines, the rate of transmission of the virus has slowed, and hospitalizations and deaths have been reduced. While we work to achieve herd immunity with the vaccination of the majority of our population, we must also turn our attention as well as our economic and scientific prowess to vaccinating the rest of the world. This so-called vaccine diplomacy demonstrates American compassion, and leadership as well as economic and technological excellence. 

In my opinion, only by vaccinating the rest of the world and thus halting the development of viral variants, can America fully assure the end of Covid-19 – and a return, finally, to some semblance of normality here at home.

Paul E. Lemanski, MD, MS, FACP is a board-certified internist practicing internal medicine and lifestyle medicine in Albany (centerforpreventivemedicine.com). Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.