As the world continues to find its way through the COVID-19 pandemic, vaccine nationalism and subsequent inequities have become central themes. 

While many of the world’s wealthier nations have either vaccinated a considerable portion of their populations or secured enough vaccine doses to do so, many poorer countries are unable to boast similar vaccination coverage for their citizens. 

With cases rising in some countries (notably India) and the emergence of multiple faster spreading variants, much of the progress made so far can be erased if inequalities in vaccine distribution, funding and supply are not rectified as soon as possible.

But how do we accomplish this? Well, two of the International Monetary Fund’s (IMF) top economists have proposed a $50 billion solution — which was endorsed in a joint op-ed  by the heads of IMF, World Bank Group (WB), World Health Organization (WHO) and World Trade Organization (WTO) — that can potentially get up to 60% of the world’s population vaccinated by the first half of 2022, in line with the WHO’s recommendations.  

While this is an almighty ask — given that according to the IMF, the pandemic wiped about $18 trillion off the world’s balance sheet, it’s one that they propose will see returns of $9 trillion to the global economy, not to mention lives saved.

Global Citizen spoke with Ruchir Agarwal, senior economist at IMF and co-author of “A Proposal to End the COVID-19 Pandemic”, about the proposal and how its recommendations equates vaccine policy to economic policy as far as ending the pandemic is concerned:

How close or far away are we from ending the pandemic?

Ruchir Agarwal: As we all know, the impact of the pandemic has been very large on the health & human side. But I’ll speak about the economic side. One way to see what the pandemic has done to the global economy is to look at how IMF projections for the world’s GDP have changed before, and after the pandemic. 

If you compare those projections, you will see that the world output cumulative over four, five years has been roughly $18 trillion lower. In other words, that's the amount of resources lost to the pandemic.

That translates to food, housing, and other needs for people all over the world. So that's the economic burden. We know the health burden has been huge and of course new complications and variants like this surge that we've seen in India and before that in Latin America, Brazil and elsewhere. 

So that's a simplified overview of the impact in terms of where we are as far as fighting the virus and how it is affecting us. 

Now, what are we doing to fight that? One of the big, positive surprises of this pandemic has been the demonstration of the human will to work together, which has led to the record progress we've made on vaccine development. 

Typically, experts were estimating that a vaccine that's safe and effective to fight against the coronavirus may not be available for five, 10 years. There has been no experience in the past for developing such a vaccine, but we managed to get several vaccine candidates which are very powerful, safe and effective, within the first year of the pandemic. 

Now, while there's been huge progress on the scientific front, a big constraint has been how do we get those products into the arms of people around the world? Where we are at this juncture is a point of great inequality in terms of the fight against the virus. 

The advanced countries have moved very quickly in terms of vaccinations. In the U.S. over 50 percent of people have had at least one dose already. Whereas in much of the developing world, including in most African countries, the vaccine coverage remains less than two percent of the population. 

We show in our proposal that that kind of inequality is likely to persist.

What role does this vaccine inequality play in speeding up or slowing down the global fight to end the pandemic?

Agarwal: In the first year of the pandemic, the impact was felt everywhere in the world. And, if you look at it from various measures — casualties, for example — the richer, more advanced countries may have been affected relatively worse compared to poorer countries. 

Going forward from now into the future, this is likely to shift. As the high income countries get large portions of their populations vaccinated, they're going to have a much quicker economic recovery. Whereas the rest of the world that remains without access to vaccines and with relatively weak health systems to fight surges are going to be held back by the pandemic which means there's going to be a divergence in recoveries. 

What we are seeing is that vaccine coverage is likely to remain low if no action is taken, which will only exacerbate this inequality. Very importantly, we've seen that many things have gone wrong in the fight against the pandemic: new variants have emerged, problems with supply chains have delayed vaccine supplies, and so on.

In many of the scenarios where we think about where things can go wrong in the future, the disproportionate impact will be in the low or lower middle income countries, including many of the countries that are in sub-Saharan Africa. 

To reduce this inequality, it is very important to improve access to vaccines and other life-saving health tools. Now, one important point that you raise is: “what does it mean for the rest of the world? Why should the rest of the world care?” Of course, the moral obligation is clear. 

The $50 billion investment from wealthy countries and multilateral development banks that we recommend to help end the pandemic sooner will very well pay for itself as a large chunk of that — estimated to be up to nine trillion dollars over several years — will also go to higher income countries. 

You recommend upfront financing and upfront vaccine donations rather than commitments.

Why is it important that all necessary financing is available immediately?

Agarwal: That's a great question. Donor countries have done a good job of putting money on the table to finance the ACT-Accelerator and COVAX, which is an initiative by WHO and its partners. If the money that has been made available today, was made available one year ago, the world would be in a very different place. 

We already know what upfront funding can do. Even the same amount of money one month later has much less power in helping end the pandemic. Our proposal looks at how we can vaccinate everyone everywhere in the world — not just in one part of the world — by the first half of next year, and we reverse engineer what's needed to achieve that. 

It is crystal clear that what you need is both the financing and the implementation actions: putting the contracts in place for additional capacity and putting the preparation in for vaccine delivery, to happen today because all of these things will take time. 

That is why we have a strong focus on the upfront funding, sharing of donations, income investing and upfront implementation of our plan to end the pandemic.

What can governments and policy makers in lower income countries do to access more vaccines and reduce the vaccine inequality gap for their populations?

Agarwal: We emphasize the importance of strengthening health systems, having sufficient supplies of oxygen and treatments. We also emphasize putting in place preparation for delivery of vaccines so that when vaccines become available, there is no further delay. From this perspective, having greater clarity on when vaccine doses will be available to each country can greatly help them in stepping up their vaccine delivery plans.

So that involves prioritization and the understanding of who we prioritize, how we reach the rural areas and also the importance of testing. There is also a big shift happening now on testing: tests are becoming relatively inexpensive, and rapid antigen tests are available, which can be used in workplaces to allow for more economic activity while keeping the health costs of the pandemic contained. Those are some of the things that we mentioned that country authorities can do. Also, ensuring adequate supply of oxygen, therapeutics, and PPE well ahead of future surges can help save lives. 

Another important thing is also to have their voices heard at the global stage by emphasizing the danger of inequality. Individuals have to have their voices heard at their government level and the governments have to have the policies heard at the global level, so that we can all work together to push hard on ending the pandemic as quickly as possible everywhere.

How do your solutions help the world end the pandemic?

Agarwal: We set out the goal of ending the pandemic by the first half of next year everywhere — not just in advanced countries, but in every country in the world. And we lay out three broad targets that can help achieve this. 

The three targets are:

1. First to vaccinate everyone in every country in the world — vaccinate 40% of the population in every country in the world by the end of 2021 and at least 60% by the first half of next year. So that's the first target. 

2. The second target is to prepare and insure for downside risks. So putting in place a plan and implementation to handle bad things that can happen. For example, problems in the supply chain that can reduce supply of vaccines to those who need it, or the need for booster doses can arise because of mutations of the virus. So actions to handle those kinds of downside risks in the future help to build insurance, and the third is;

3. In the interim period between now and the next 12 months where vaccine supply remains scarce, make efforts to mitigate the cost of the health and economic crisis by scaling up testing, availability of therapeutics, oxygen, and PPE, maintaining public health measures, and stepping up preparation for vaccine delivery.

What is the biggest takeaway for world leaders and Global Citizens?

Agarwal: The message is that ending the pandemic is a solvable problem. The cost required to end the pandemic is estimated to be around $50 billion. But the return to the global economy is up to $9 trillion and that does not even take into account the benefit of saving lives. However, the window of opportunity to realize these gains is closing and therefore we need coordinated global action now.