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Working towards global health equity by combatting misinformation, avoiding vaccine nationalism, and strengthening self-reliance
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The Salzburg Global Health and Health Care Innovation program "Better Preparedness for the Next Pandemic: Developing Vaccine Access Models with Low- and Middle-Income Countries" convened nearly thirty Fellows, including healthcare practitioners, policymakers, researchers, and representatives from health ministries in several African countries. They engaged in crucial discussions on access to suitable and affordable vaccines in low- and middle-income countries (LMICs), and several key points emerged related to misinformation, vaccine nationalism, and self-reliance.
In a discussion moderated by Lisa Adams, Associate Dean for Global Health and Director of Dartmouth’s Center for Health Equity, Salzburg Global Fellows sought to answer: “How can ‘infodemic’ – misinformation and vaccine hesitancy – be better managed, and what are the implications for procurement?” Drawing from their experiences of the COVID-19 pandemic, Fellows mentioned the ineffectiveness of a top-down approach that tells the public what they should know, rather than listening to their needs and concerns. “If facts were enough to motivate people, we would have solved all of the healthcare problems,” noted a Fellow.
Another challenge is the speed of misinformation on social media, unfortunately targeting not only the wider public, but also healthcare workers, letting their own fears and misconceptions cloud their judgements. The group talked about a “multi-pronged approach” involving not just politicians or healthcare workers. “It really comes down to the issue of trust, and whom you trust or listen to. Is it our politicians, our healthcare leaders, is it religious leaders or our star athletes, who will be the spokesperson to mobilize the community?”, reflected a Fellow.
Fellows suggested involving people who interact with the community on a more personal level, such as social workers or primary care practitioners, also pre-pandemic. When addressing procurement, Fellows touched on the need to factor in vaccine hesitancy. In their experience, there was a significant mismatch between the supply of the COVID-19 vaccine and its demand. A possible solution shared amongst the group was to survey the public to determine acceptance of vaccines to forecast demand, rather than using the number of individuals eligible for them.
When trying to summarize the issue, they came back to trust. “We need to map where trust is; who is trusted and who are the influencers spreading misinformation? There is a displacement of trust and if you start with that, you can start to make change.”
In the aftermath of the COVID-19 pandemic, the imperative to confront vaccine nationalism has become evident. Disparities in vaccine access highlight the need for collective action to safeguard global health. As storytelling contributes to vaccine nationalism, countries should shift their perspectives to view vaccine access as a global matter rather than relying on nationalist narratives.
Patrick Amoth, Director General for Health in Kenya’s Ministry of Health, commented, “We are talking about a global problem that has no boundaries. If we do not protect all of us, then even you will not be protected… How do we change that narrative and ensure that we as a global community are tied together in this?” The group reached a consensus that “solving for vaccine nationalism is solving for a collective action problem”.
Fellows suggested several ideas that can serve as an antidote. The first proposal is an “intercontinental buddy system”, a term coined by the group to refer to countries partnering bilaterally across continents that have common needs but distributed risk. Countries like Brazil and Kenya are already cooperating in a similar framework, and this kind of bilateral partnership could be expanded into global cooperation. The second suggestion is a clearing house in the Africa CDC for countries to better manage the vaccine donations they are given. There would be great value in sharing cross-country data through the Africa CDC platform so that surplus vaccines can be shared with neighbors based on need.
The group suggested that countries start with cooperation through organized regional or economic blocks, especially in Africa. By implementing strategies like these that foster global solidarity in addressing public health challenges, countries can pave the way for a more equitable and resilient future for all.
“Self-reliance is about empowerment, not exclusion.” This was the defining idea contributed by a Fellow during a discussion seeking to answer: “How far can local manufacturing and research be developed in Africa, and what would
its impacts be?” Fellows focused on the challenges behind these questions.
They highlighted that the conversation around African self-reliance needs to evolve beyond considering vaccines as a finished product. It needs to strengthen numerous components, such as diagnostics, pharmaceuticals, and education to foster self-reliance. It also needs to consider all aspects of vaccine development, such as the pharmaceutical ecosystem, the research and development sector, the market, and the political environment.
One of the solutions that Fellows considered is increased coordination in procurement and regional manufacturing. As every country cannot build vaccine centers for every disease, it would be ideal to have specialized centers for specialized diseases. Biotech startups need to be supported, as they can bear the increased risks accompanying vaccine development. Universities are also often neglected spaces of tertiary education which must be supported to develop a talent pool for the research and development sector.
A unique vaccine financing model that can keep up with changes in demand and supply was suggested by Fellows. They proposed a combination of a subscription and variable model, where vaccine centers are paid a subscription cost to support their operations, with additional costs levied in cases of increased demand. Additionally, local and specialized manufacturing must be incentivized, which would also increase supply chain resilience.
Fellows emphasized that African self-reliance in vaccine manufacturing is not about excluding the rest of the world, as 100% self-reliance is neither feasible nor desirable. Instead, African countries seek to be more independant in a health emergency and to better prepare for the next potential pandemic.