Let's talk: The future of vaccines

Selam Gebrekidan:    

Hello, everyone. Welcome, and thank you for joining us for this episode of the webinar in our spring series called Let's Talk Vaccines. I'm Selam Gebrekidan, and I'm an investigative reporter within New York Times, and I'm based in London. Some of you may know Doctors Without Borders, by French-named Médecins Sans Frontière, or MSF, and throughout this webinar we'll be using MSF. And to get to the main topic of our webinar today, we're going to be talking about the current and future to COVID-19 vaccines. What do we mean by equitable access? Some of us may have personal stories about this, for example, I'm based in London. In the UK where 38 or so percent of the population already has had at least a first shot of the COVID-19 vaccine. Our audience members today are probably in the United States, where again, many people have been vaccinated. But my family is still in Ethiopia and they don't have really prospects of getting vaccinated before 2023 or 2024.

So right now, a lot of the world's richest countries have accumulated many of the vaccines. They have secured the vast majority of the supply, whereas we're seeing health systems near collapse, so much death and human suffering in places like Brazil and in India. And across much of the world, frontline health workers who do need to be vaccinated are not getting vaccines. So today we'll be talking about that. Before we continue, I have a few housekeeping items to take care of. This discussion will last for about 45 minutes, so we'll be keeping our discussion brief and quick moving. Wherever you're joining us from today, you can submit your questions for our panelists. If you're watching on Livestream, YouTube Live, Facebook Live, or Twitch, you can send questions in the comments or chat section and our team members will send them to me, and we'll be selecting questions more relevant to the topic of discussion today. There will also be live captions for this event. You can view them on a separate URL, or you can watch on YouTube where you can click on the CC button on the player to turn them on.

All right, so just to introduce the panelists who are joining today, Kate Elder is the senior vaccines policy advisor for MSF Access Campaign. Mona Imad is joining us from Lebanon. She's the project coordinator for MSF COVID response in the country. Zain Rizvi is a law and policy researcher at Public Citizen, with a focus on pharmaceutical innovation and access to medicines. All right, so Kate, I will start with you. I mean, over the last year, we've seen some incredible advances that have given us COVID-19 vaccines, and many of us did not believe that that would have been possible in such a short period of time. And yet access seems to be still a big problem for much of the world. Can you kind of walk us through what has happened over the last year, since this pandemic really became the focus of most of our lives across the world?

Kate Elder:     

Yeah. Thanks, Selam. And thanks for inviting me today. Nice to have everybody tuning in. I think it is, what you just said, it's definitely incredible to just reflect on where we were a year ago around when the pandemic was starting and where we are now in April 2021. Obviously, a year ago, people were very hopeful that we would have vaccines, and we have had them in extraordinarily record times. In terms of the scientific achievement and accomplishment, I think it's completely unprecedented. So acknowledging that and thanking all of the scientists who work diligently to create these vaccines, which are really everybody's hopeful tool for coming out of this pandemic and getting back to the things that we miss so much.

But what we've seen since I guess about five months ago now, when the first vaccines were approved, is we've just seen this incredibly drastic divide of inequity, just mounting by the day. You started speaking about it at the top of our call, Selam, that here in the United States, where many of our viewers probably are and where I'm sitting, we have almost achieved 30% of the adult population, of the eligible population, having received both doses of their vaccines. So almost 30%, a third of our population, is fully vaccinated, whereby in many developing countries, low income countries, they haven't even been able to vaccinate ... I mean, less than 1% of their population. I think it's around ... the WHO tells us about 0.3% of the population now.

So we have 235 million doses that have been administered in the United States, and we only have about 50 million doses that have been shipped worldwide by this mechanism called COVAX, the COVAX facility being the globally agreed upon mechanism that countries are buying into to try and deliver this equity. So the challenge is right now, we just see this inequity growing exponentially by the day, which I think is very visible because people can see what's happening around the world in real time.

Why did this happen? I think we're all responsible for it and our governments are responsible for it. Why did it happen? Well, we had a run on vaccines before they were even available, right? So we had declarations of global solidarity last year in April, when WHO launched an initiative to try and bring this commitment to global solidarity, that we were all in this and committing to future medical tools, whether they be vaccines or diagnostics or medicines as being "global public good." We heard a lot of talk from global leaders around a people's vaccine. And then at the same time, the government that had the money, the government that had the resources, went on and just did a buying spree for vaccines that weren't even available yet. So there is finite quantities of vaccine and that's the challenge, right? These are mutually exclusive. National hoarding is mutually exclusive to equitable distribution of vaccines, but it's in our common good to share these tools. So we're in a pretty serious situation right now.

Selam Gebrekidan:

Thanks for that. We're going to come back to some of the points that you raised there, because I think they're extremely important. But we're moving on with this now, Mona, you are based in Lebanon and you're doing ... you're not just helping the government in terms of vaccinations, you're helping the testing and diagnostics. Can you tell us more about MSF's work in Lebanon and what your role has been in that?

Mona Imad:   

Yeah. So in terms of ... well, we have been supporting the Lebanese Ministry of Public Health since the last year actually, since the onset of the pandemic. And through our medical response team and mobile medical team, I would say, we have been supporting them and diagnosing ... contact tracing and diagnostic tests across the country who are deploying teams around wherever it's needed.

So this has been going on since last year, and since I would say more than a month ago, we have been solicited by the Lebanese Ministry of Public Health to support them actually in implementing the vaccination scheme. And this has been going on for more than five weeks. And up to now, we have been able to vaccinate more, I would say, around 4,000 people. And our support is on people who have difficulty in accessing the vaccines. Namely, we are focusing on elderly people in nursing homes and healthcare workers that work for them within the facilities.

And of course this request came from the authorities, and it reflects the credibility and reliability of MSF as a main partner in implementing such schemes and helping them scale up the response and vaccination process, especially to these people, vulnerable people who are at high risk of contracting the disease.

Selam Gebrekidan:

Thanks for that. I appreciate it. And Zain, you work at Public Citizen and we've had multiple conversations before about equitable access. I know how strongly you feel about this. What of the recent developments have made you think that equitable access is ... do you think that equitable access is even more important now with what we're seeing in places like India and Brazil?

Zain Rizvi:      

Yeah. Thanks, Selam, and thanks, MSF for inviting me today. So just a brief background, Public Citizen's consumer advocacy organization, based in Washington, DC, we work on many different consumer areas. And I work in the global access medicines team. And so right from the beginning of the pandemic, we've been kind of tracking government's response to the pandemic and in particular looking at vaccine development. And it's been astonishing to see, I would say, the hypocrisy really between rich countries talking about equitable access in the grandest of terms, and then taking minimal steps, if any, to actually live up to those commitments.

And so when Kate talks about this astonishing speed with which we were able to develop these vaccines, there were huge, huge sums of public money involved. In fact, we created a tracker looking at just how much one US government agency called BARDA, which is Biomedical Advanced Research Development Authority. They put in like $16 billion, right? So these manufacturers got a huge infusion of public money.

And yet we see now that access is anything but equitable, and it is just heartbreaking. We see India burning, and yet the world has fully yet to realize just what the magnitude of the need is. And I think that's what's really concerning, because there are well-intentioned initiatives like COVAX, for example, that want to vaccinate the world that are desperate for doses and dollars in domestic production capabilities. And yet even COVAX aim to vaccinate between 20 and 30% of the world by the end of 2021.

And so one way to look at COVAX is that the US has already vaccinated more people than developing countries can expect to vaccinate by the end of this year. And so what does that mean? Think about India right now. Think about Brazil. And it's not just India. It's spreading in South Asia, and so my family is originally from Pakistan, and Pakistan recorded the most pandemic deaths yesterday. And there is a special injustice now that we know people are still dying from this pandemic, even though we know that there are existing vaccines that are available that could have protected them had they had the opportunity to get vaccinated in the first place.

Selam Gebrekidan:

Well, I think that as journalists we encounter is when people think about equitable access. Some people would suggest donations, charity-tied donations, from rich countries to lower-income countries, whenever rich countries have protected their population, right? And some people talk about, "No, we should be sharing technology with manufacturers that are capable of producing this vaccine for themselves." And that's more relevant in places like India, where there's a lot of manufacturing capacity. What, what does equitable access mean to you, Kate, in this respect? That is it a lot of options that are available to the world? Is it largely going to be based on the goodwill and donations of people?

Kate Elder:     

I think, just picking up on what Zain said with the very laudable objectives of the COVAX facility. I mean, we, as a global community wanted to do better. I think that's the bit that's so jarring about this.

We knew what we needed to do in order to do better. And yet we stuck with the status quo. And I hope that everybody shares the outrage that I know many of us on this call feel right now with knowing that the status quo wasn't going to deliver equity, if we didn't do something significantly different and change the way we make medical innovation available to people. Everybody saw this coming from a mile away that we would be in this sort of situation. It's the age old adage of the haves versus the have-nots, if you will.           

And when there are tight controls on who gets to produce these medical innovations, whether it's vaccines or diagnostics, and there's tight controls on that, and we don't do it differently, and we leave it up to corporate interests that have a very, very clear objective, right? I mean, their objective is to deliver for their shareholders, right? That's just the cold hard truth is that corporations make medicines to make money and to reimburse their shareholders, not to be too dramatic. But I think everybody's quite aware of that. So if we weren't going to significantly change the way we were producing these vaccines, and we were of course, going to be in this situation where there was limited control and a small group of businesses that were able to decide who they sell to first at what price and in which quantities they produce these vaccines.           

What we needed to do is we needed a multi-pronged approach to making the pie bigger, not to beat this euphemism of just making the pie bigger, right? So we have capable manufacturers in many places of the world. We know that technology transfer partnerships, mentoring companies, sharing the technology, sharing the know-how can equip other companies to make vaccines.    

We know there's intellectual property barriers that prevent other capable manufacturers from making them. But what we needed to do is we needed to get together a plan to force the companies that have the technology. Again, as Zain said, technology that was developed with our taxpayer dollars. We need to force them to share it with other capable manufacturers, whether it's in South America, South Africa, Southern Africa, India, where we see a lot of vaccines being made. And we need to lift all of those barriers as expeditiously as possible, take away the barriers so that the people who can make these vaccines can make them. But we haven't seen that happen, right? So we need governments that paid for these vaccines to push those companies, Pfizer, Moderna, Johnson & Johnson, AstraZeneca to use all that capable manufacturing capacity around the world, making the pie bigger.

Selam Gebrekidan:    

And Mona, maybe you can tell us a little bit more about how this has played out in your region, particularly. We've seen some coverage of Israel's very successful vaccination campaign and has that left other people, for example, people in the Gaza Strip behind. And MSF does some work on that so, can you give us an update on what's going on over there?

Mona Imad:   

I'll gladly give you an idea about the Lebanese context. I mean the Lebanese context as a developing country, we're on the other side of the table, we're on the receiving end of the table. And I agree with Kate. I mean, we're doing fine so far. It has been set out as the priority for the Lebanese government to expand the vaccination scheme. Mostly to curb the collapse of the health structure that has been taken by surprise as it has been globally, I would say.

So, yes, we are on the other side of the table. And I can say that we are at the mercy of suppliers. It has been good so far, but we could definitely expect surprises, and this would definitely influence the national campaign and the objective set out by the government and all the health actors basically fight to this pandemic.

Selam Gebrekidan:    

Right before we move on. I want to take a look at the results from social media quiz that Doctors Without Borders or MSF, ran on Instagram earlier this week. I suspect that Kate has given a way to answer already earlier, but I'm going to read the question now. And for those of you watching, feel free to type your answer in the chat as well.           

Now, what percentage of COVID-19 vaccines administered worldwide have gone to low-income countries 5%, 1%, or 0.3%? So I'm sorry. All right. So the results from the poll about 17% guessed A, which is 5% of low-income countries, 38% guessed B, and 46%, and in fact the majority, guessed the correct answer, which is C, 0.3%.           

And we're getting a few questions from our audience, which I will try to bring in, now. We have Nina on Instagram who asked, "Why can't more countries start producing their own vaccines?" I think Zain would be happy to take that.

Zain Rizvi:      

Yeah, sure. So that's the question, right? What prevents countries from making vaccines? And I think one thing to take a step back and understand is that the way medicines are produced the kind of global system we have involves something called TRIPS, which is an agreement at the World Trade Organization that basically governs how intellectual property is dealt with. It sets minimum standards. And under TRIPS there, it created a system, what it was called intellectual property. And the reason I kind of do bunny ears for that is because this whole idea of IP is a pretty novel concept. It's actually very different from actual property. But the idea here is that you get monopolies over medical inventions. And as a result, companies are able to control decisions about these medical technology. So they get to a determined supply, they get to determine price, they get to determine additional suppliers.

And so you've seen this play out as largely companies are deciding who they partner with companies are deciding how much they scale up rather than any government-led initiative to share technology, to share the vaccine recipe, to help ramp up global production. One of the kind of most egregious aspects of the global response has been that we know there are existing manufacturers out there who want to be able to produce COVID-19 vaccines. Who've asked the manufacturers, "Can you share your technology so we can help start helping ramp up production?" And those manufacturers, despite receiving billions of dollars of public funding have either ignored those requests or denied those requests. And so it just underscores the need for really governments to step up and particularly the Biden Administration, because the US government is the largest funder of coronavirus research and development in the world.

And so the US government has enormous leverage here to try and push the companies to share the technology, to work with manufacturers around the world, and to launch really a global manufacturing program that would help set up regional hubs. So you could get manufacturing done all around the world quickly to meet the global need.

Public Citizen estimates that such a program could cost $25 billion and it could help produce eight billion doses of the NIH Moderna vaccine within about a year's time. And so think about what '22 could look like in the absence of this program and think about what 2022 could look like if there was serious engagement from the highest levels of governments around the world to really end this pandemic once and for all.

Selam Gebrekidan:    

And Kate, can you tell us what you're seeing in terms of what Zain proposed as one of the solutions would be governments taking concrete action. Do you believe that the European Union, the Biden Administration, the US, and other countries that have, through public funds financed a lot of the new technologies that have given us COVID-19 vaccines. Are they moving in the right direction in terms of ensuring equitable access? And if not, are they going to be threatened by the new variants that are popping up in new places?

Kate Elder:     

I think everybody... I'm no scientist, but yet I still know that it's in our interests, those of us sitting here in the United States, around the world to make sure that these vaccines are delivered equitably, right? Everybody's reading daily about the rise of variants and the prevalence in certain countries and the effect of these vaccines, the efficacy of these vaccines on the variants, it should terrify everybody, it's terrified me.           

So you don't need to be a scientist to realize the scientific imperative of sharing vaccines equitably. If we're not going to do it for the right reasons, right? The moral and ethical reasons, at least we would do it, for a self-serving objective, right? But seemingly it hasn't pushed governments enough yet to take steps as expeditiously as possible as Zain has clearly outlined we need to take, which is making the pie bigger.           

So I think we can look at a couple of different examples of initiatives that are happening around the world and how governments are behaving. I mean, one is the process that's happening at the World Trade Organization related to intellectual property rights, as Zain just talked about this, TRIPS. And it is not a surprise to see which governments have been stonewalling that process from moving forward. I don't think anybody thinks that a successful process would equal a windfall of vaccines, but it's still a very important enabling factor to move us forward.          

Secondly, Zain just mentioned other initiatives like the World Health Organization has launched this technology transfer hub specifically focused on the mRNA vaccines, vaccines that Moderna, Pfizer, BioEnTech are making. And they're asking for these companies, "Please come join in good faith, bring your technology, engage in a process with other capable  manufacturers”. Have we seen Pfizer or Moderna quickly step up since that initiative was launched a couple of weeks ago to say, "Yes, we're in. We're going to share our technology"? No, we haven't. And we call on them. We call on Pfizer, we call on Moderna, we call on BioEnTech to bring your A game. Bring your A game to the world so we can all get out of this pandemic. So that's sort of another indicator of this.         

The area where, I think, we're starting to see some progress is sort of this charity model, right? We've heard the US government, just a couple of days ago, announced that we will shift doses of AstraZeneca to the rest of the world, and that's a good step in the right direction. That is one of the most basic steps that we could take, using vaccine that's just sitting in warehouses here in the United States and sharing it with the world. We've heard similar announcements from the French government. We've heard New Zealand in terms of donating doses. And those doses are absolutely needed, so we call on these governments that give those doses urgently now.           

But that is certainly a charity model. That is not changing the way we are equipping governments to be able to support themselves and their populations, too. So I'm hopeful. You have to be hopeful and stay optimistic. I wish that this progress was starting sooner. It's never too late, but we do need to see a lot of pressure from governments on industry. Again, reminding them we paid for these technologies, and now we're calling it in for the rest of the world.

Selam Gebrekidan:    

And Mona, you can really help us with this. I'm speaking to you from London. Zain and Kate are in the US. But our reality is quite different from, I imagine, places like Lebanon or where my family is right now, in Addis Ababa. Here, basically, we're just in the UK. We're just counting down the days until our particular age group is going to be eligible for vaccines. In the US, many of my friends are already vaccinated. How do you view this from where you are? What does it feel like to see people posting pictures of their vaccination cards on social media and talking about what they will do or what they've done because they're vaccinated and protected? And maybe you have already been vaccinated and maybe not in where you are. I just want to know what it feels like, this divide.

Mona Imad:   

Yeah. No, it definitely gives a feeling of security in places like Lebanon and the rest of the world when it's not necessarily the case and seeing the government attempting to prioritize it as for the population and making it a point to do that, so it's definitely a relief for the people.           

For now, we're focusing. I don't know if you've asked me this question. For now, we're focusing on the elderly population. We are focusing on people, as I said before, with difficulty in accessing the vaccines, and of course, in line with the priority population set out by the WHO, and mostly, in a way, to help the... Let's say to prevent any collapsed of the health structure in place.           

And from that, we have been advocating and pushing the Ministry of Public Health for us, as NSF, to expand our support of other population group, also under the idea or the umbrella of equal access for all, and we would be expanding our support to refugees inside the refugee camps, and the migrant workers, and also, to a certain extent, people with disabilities. So hopefully, we're going in that direction.

Selam Gebrekidan:  

So it's optimistic?

Mona Imad:   

Yeah, yeah.

Selam Gebrekidan:  

All right. And I'm going to post the question that's been submitted by a number of our viewers right now and from the livestream. Kim and Olivia are wondering, what can private citizens do to push governments to reduce patent barriers on COVID-19 vaccines? Zain, do you want to take that?

Zain Rizvi:      

Sure. So there's a lot right now. There's a lot. I think individual folks often underestimate the power that they have, but there's a lot that they could do. I think there are... There's a glaring gap, right? I think it's obvious to everyone. At least in the US, from where I'm sitting, there is no plan right now, right? There's no plan to get global access for vaccines. And so that should be remedied, and that should be remedied immediately. And so, I would encourage everyone to get in touch with the representatives to urge the need for global access, to support an ambitious global manufacturing program that helps the world set up regional hubs to mass produce these vaccines, that gets the US to share the vaccine recipes that it has helped fund, and of course, to support the TRIPS waiver instead of locking it.           

So those are kind of the immediate concrete steps. If you want to get more immediate, if you live in Washington, D.C., we're actually holding a socially distance rally next week on May 5th, which is a Wednesday, at the mall, and we are demanding, frankly, that the US government start to act globally now because we are seeing just horrific images of people around the world of the continued spread of the pandemic. And so you can check out freethevaccine.org for more details. May 5th, in front of the mall, please come out

Selam Gebrekidan:    

Because this is an important question, Kate, I'm going to pose this to you as well. What can private citizens do to remove these barriers to access the COVID-19 vaccines?

Kate Elder:     

I think it's been extraordinary to see how civil society and how people have rallied around this inequity. Everybody knows that we're hearing stories from Mona in Lebanon. We're hearing of your family in Addis Ababa, Selam. We hear Zain's family in Pakistan. We all have somebody that's just a text away, right? And we are hearing, firsthand, their experience. I think people are really motivated to help, and civil society has been beating a drum collectively, which is incredibly impressive.           

So in addition to think global, act local, as Zain already said, contacting your representatives. There are partnerships. There is The People's Vaccine. I want to give a thumbs up and an endorsement of People's Vaccine. People can go onto peoplesvaccine.org. to see all of these activities that are happening. There are petitions happening everywhere. There are rallies, as Zain has already said. And they're using your voice or your virtual voice via your social media. So go into peoplesvaccine.org. Many of our organizations, public citizens sign up for what they're doing. They're doing great actions. MSF as well. Please sign up so we can keep you updated on what we're doing from the MSF Access Campaign in terms of these actions as well. But there's many ways to get involved.

Selam Gebrekidan:    

Right. There's some more very great questions, maybe, at the moment. There's one from Nick on livestream. In addition to the actual vaccine, are there still other components of the supply chain that are in critically short supply, for example, what's happening with needles, syringes, cold storage?

Zain Rizvi:      

I can take that.

Selam Gebrekidan:           

Zain, I'm coming back to you, yeah.

Zain Rizvi:      

Yeah, sure. So yes, there are shortages. We have seen manufacturer's report that there are shortages, in fact, of some raw materials now needed to make vaccines and some equipment. Part of what's going on is that some countries have enacted de facto export bans or export bans on some of these key materials. And so we've started to see some release of these materials, but much more needs to be done.       

And I think it really speaks to the need for really concerted government action, because right now, what's going on, in fact, is a lot of the pharmaceutical companies, in fact, they're seeing that there's these supply shortages on the horizon, and so what they're doing is they're placing these massive orders, and then they end up hoarding more materials than they need because they're worried that they won't be able to get the materials in time for the vaccine production itself. And so, it's creating huge distortions and inefficiencies.           

And really, it speaks to the need for governments to step up, to coordinate, to make the investments required to ramp up raw material production, to allocate it effectively and equitably, and to really make sure that we defeat this virus. One thing that's remarkable to remember here is that it was only about a year ago when everyone told us we were in this together. And then what happened, right? What happened? That clearly did not end up occurring. And so I think, really, we need a global solution that requires governments to really step up to vaccinate the world.

Selam Gebrekidan:    

Kate, I have a question for you from Elizabeth on the livestream. You've spoken earlier about how many of the other countries have basically cornered the market for the vaccines. And Elizabeth asks, is there a reason why governments weren't given a minute on how many vaccines they could secure in order to make sure that it was distributed equally?

Kate Elder:     

That's such a great question because, I think, this also goes to the heart of what Zain is saying in terms of, how do you institutionalize global solidarity? How do you take it from lofty declarations and codify it into something that the world has to adhere to? And we do have global treaties that sort of lay precedent for some of the ways that the world needs to work together when we face these catastrophic events that affect all of us. We also have treaties on how we share flu vaccines, pandemic flu vaccines that do try to codify that, what governments will share, what portion of supply they will share with the WHO.           

We didn't take those steps in COVID, and we probably should have. I think there's always this balance of time, right? Time to address the catastrophe and time to think multilaterally and actually sit at the table together, and put the pen to paper, and get the consensus so that everybody has it as good as possible, or at least, not so many people have it so devastatingly bad as we have right here. So we didn't take those steps at the beginning of COVID. We took very important political steps of declarations. WHO tried to convene governments together under what's called the ACT Accelerator, the Access to COVID-19 Tools Accelerator. But yes, that did not translate into this. So there was really no rules of the game, rules of engagement, at how governments were scrambling for these vaccines right now. And now we're paying the price. I think the question is, okay, what do we do next? We're in this situation right now, we got to make this catastrophe as better as possible, improve it right now for this acute period. But are we going to learn? Are we going to learn for the next time that we have such a world altering pandemic? And there's lots of discussions right now about a pandemic preparedness treaty that's happening at the global level. I think the question is, what will governments of the G7, the G20 do? Are we going to basically do the same thing next time? I hope they all realize that we need a real 180 to prevent this from happening again. But right now, yes, we don't have those sorts of rules for how many doses each country buy, and those that had the deepest pockets got the most vaccine.

Selam Gebrekidan:    

That's interesting. And as you say, we could have seen this coming from a mile away. And in some ways in our coverage of the issue of equitable access to COVID-19 vaccines, what became apparent is that there are a lot of parallels to be drawn between what's happening now during the COVID pandemic and what happened before with antiretroviral drugs for HIV/AIDS. And it's the sort of feeling the whole world's repeating the same mistakes again and again. And we're either all protected or we're not protected. I think that's the main takeaway. But part of that is also what people themselves feel about the vaccine, because there's a lot of vaccine hesitancy, and it comes in various forms from people who do not trust the vaccines at all, to people who think that maybe these discoveries have happened too fast. And I encounter quite a number of people in fact who say that they're not anti-vaxxers, but they don't trust the vaccine for a disease whose symptoms have not been established clearly. Mona, are you seeing similar vaccine hesitancy in Lebanon?

Mona Imad:   

Yeah. I would say that acceptance is much higher than the hesitancy, but still there is a, let's say hesitancy rate, particularly towards certain actual vaccines actually and what goes around on social media, in terms of repercussions of the vaccine intake, et cetera. So I guess there is a need to build up some kind of, I would say literacy and awareness around the subject. Yeah. This has been the case, yes. So I would give you an example. So people would trust Pfizer and would reject AstraZeneca for whatever has been circulating as side effects for a certain age group of population. Yeah.

Selam Gebrekidan:    

So even the hesitancy is specific to certain types of vaccines. And I wonder what part of that is because of the way that certain news items are reported and whether that increases hesitancy as well, especially with Johnson and Johnson and AstraZeneca, we get a lot of criticism for being alarmist as journalists. And maybe that's something that we do need to take into account in our coverage as well. And what about the US, Kate or Zain? Are there any specific measures that you're seeing taken against the vaccine hesitancy to ensure that everyone gets to compliance? And there's also a story in the New York Times recently about how certain people in the US are not going back for their second shots, or have run into some sort of hurdles and then have just sort of dropped off with that. Is that going to be a big problem, or is that a very small proportion of the population from what you've seen?

Kate Elder:     

Yeah. I'll just start and Zain, jump in if you want. I think vaccine hesitancy is such a complex topic that we really can't... The topography of vaccine hesitancy is so diverse, and thankfully there's really impressive institutions like at the London School of Hygiene and technical... Sorry, I have my dog behind me making noises. London School of Hygiene and Tropical Medicine has the Center for Vaccine Confidence, which it's full-time job is studying hesitancy and why people are hesitant. So I would never want to try and be conclusive about why somebody is hesitant. My personal anecdote of course, is that I sit in Brooklyn and I have a small toddler. And before COVID many parents of small toddlers also didn't want to get other vaccines for their kids because they just have misconceptions that, well, my kid is not really exposed to that disease. So why would I give them this vaccine?           

I think right now we do see hesitancy, and WHO was anticipating this in a major way. So credit to WHO for already preparing as much as possible to lay the groundwork, work with local leaders, work with governments to stem hesitancy in countries. But we certainly have heard stories of where people think, well, COVID, isn't such a big deal in my country. Why do I need these vaccines? And then the next thing they do is they open up the newspaper and they read about AstraZeneca and possible blood clots, and the thing that just reinforces the decision. So I certainly wouldn't at all blame the media flaw. I'm not going to say that all your job is to report what you're seeing, but of course people have access to information and then they interpret it the way they interpret it.           

I think what just need to always do is of course anticipate, and couple with literacy, as Mona said. We have to get to thought leaders that hold sway and influence in their communities, and we have to do a better job of communicating to them. Sometimes as well the healthcare sector is maybe not the best place to communicate to populations around the importance of vaccination. Maybe it's a different influencer in the community too. So we have to basically just do our homework. I think WHO right now is trying to do a lot of work to stem vaccine hesitancy as well. I'm not sure what's happening Mona, in Lebanon. I'd love to hear about that too, but-

Mona Imad:   

Indeed, yeah. Indeed huge work on risk communication and community engagement actually around the subject. Yeah. We're happy to see that happening, given the fact that as you said, access to, I would say between brackets random information, that would not necessarily help people have like the best informed decision about whether to go get the vaccine or not. And especially again, when you are targeting a specific population group, like people at risk, I would say it's very important to apply these preventative measures in order to decrease the access or the demand on ICU and the health services, and in that case help prevent any collapse of structures. And again, I repeat collapse because the system in Lebanon has been really exhausted by what's happening, especially with the peak in figures and the death rates and the saturation inside the COVID wards. So again, it's a preventative measure that I would say is a right, not as a privilege, and yeah.

Selam Gebrekidan:    

We're approaching the end of time that we have, but Mona, I'd love to hear your thoughts, for example, on do you think that countries would be better prepared? Do you think that we have learned our lessons from this pandemic? Do you think that next time, which inevitably there will be a next time, we'll be able to weather it better?

Mona Imad:   

Who is this question too?

Selam Gebrekidan:    

You. Let's say Mona.

Mona Imad:   

That's indeed a difficult question. You took me by surprise. This is definitely one of a kind pandemic after many years of not having gone through such a thing. And many actors are involved in this, and most of all the pharmaceutical companies, which hold the key. So I think it's a matter of private sector and how to go about it in terms of global access to health and private sector and government. So, I would never know. Let's wait for the next pandemic maybe, and maybe then we can judge. But as you say, given the catastrophic impact on the globe, so I hope we could make the most of the lessons out of it.

Selam Gebrekidan:    

Right. Zain, do you think we've learned our lessons?

Zain Rizvi:      

I have an optimistic answer, which is that the folks watching this are going to get mobilized and act with us and we're going to win. And because we're going to win, we're going to be better prepared for this pandemic and also for the next pandemic. So I am optimistic.

Selam Gebrekidan:

Great. Kate?

Kate Elder:     

I'm with Zain. We have to have our optimism and we have to translate that optimism into concrete action. So I think we'll get there. I think there's a lot of people who are outraged and never want to repeat this again.

Selam Gebrekidan:    

Well, on that happy note, thank you everyone for joining us. And thank you Zain, Kate and Mona for your time today. It was a pleasure talking to you guys. Bye.

Mona Imad:   

Thank you.

Kate Elder:     

Bye.