The statistics in this article were current as of 5/3/21
As we move further into the second year of the COVID-19 pandemic and the international push for immunization, there is finally some hope that the spread of the virus will be contained in the near future. So far SARS-CoV-2 has infected over 150 million people worldwide and caused over 3 million deaths. Domestically, we have sustained over 32 million infections and over 575,000 deaths. Despite these harrowing statistics, the last days of 2020 saw the approval of the first vaccines designed to confer immunity to COVID-19. Thanks to the historic efforts of tens of thousands of researchers across multiple disciplines and an army of clinical trial volunteers, there are now 14 different vaccines approved for use around the world and dozens more in development.
The efficiency with which these vaccines have been developed and tested cannot be overstated. The complete genome of SARS-CoV-2 was published on January 10, 2020. Less than a year later, on December 11, Pfizer’s mRNA-based vaccine was approved for emergency use by the FDA. This is undoubtedly one of the most significant accomplishments of the biomedical research community in recent memory, as well as a timely intervention given the unprecedented scale of loss throughout the country during the winter wave of the pandemic.
The effort to develop the vaccines has involved partnerships between public and private institutions, academic and industrial researchers, and taxpayer and philanthropist funding. For example, Penn’s own Drs. Drew Weissman and Norbert Pardi contributed fundamental groundwork to the field of mRNA vaccines. As the US builds up its supply of inoculations, there is a growing sense of optimism that a majority of the public – or at least those individuals that are most susceptible to severe COVID – will be immunized in the near future. In particular, expansion of vaccine eligibility to all adults in the country is a welcome sign that we are beginning to turn a corner.
Distribution of the newly approved vaccines presents a whole new set of challenges locally and internationally. Nationwide, over 96 million people or just under 30% of the population have been fully vaccinated. Despite a brief reduction in average vaccination rates after a peak in early April, over 2 million people are receiving shots most days. This has led to an expectation that the majority of people in the US will be inoculated against SARS-CoV-2 within the year. With this timeline in mind, Penn and many other institutions are hoping to return to in-person activities next fall.
While the federal government has handled the purchasing of vaccines, individual states are in charge of distributing shots to their citizens. This has thus far led to a mosaic of immunization rates throughout the country, with some states delivering vaccines to as much as 35% of their population, whereas others lag behind with 15 to 20% coverage. Pennsylvania sits in the middle of the pack, with roughly 31% of residents fully vaccinated and a campaign proceeding at a rate just slightly above the nationwide average (update statistics for publication). Unfortunately, vaccination within Philadelphia county is proceeding at a slower rate than that of the state as a whole, and, at the neighborhood level, inequalities in access to the vaccine are readily apparent. Despite having suffered the most from the pandemic, zip codes in northeast, west, and southwest Philadelphia have received fewer vaccinations than more affluent areas of Center City or the suburbs (update if necessary). A recent study by WHYY found that several suburbs are receiving vaccines from the city at rates as much as four times faster than several city neighborhoods. The zip codes that are lagging behind tend to be made up mainly of black or latinx residents, whereas those enjoying higher rates of vaccination are predominately white. In a stark demonstration of this reality, the Inquirer recently reported that Rite Aids throughout the city are giving doses to 21 white residents for every black resident served. These shortcomings are particularly egregious in the context of the increased mortality suffered by Black and Indigenous Americans throughout the pandemic thus far.
Stratification of access to vaccines along racial and class boundaries is not unique to the US. While the US and EU have successfully procured enough jabs for most or all of their citizens, the vast majority of countries are not so lucky. In fact, one model suggests that many developing nations will have to wait until 2023 to access the life-saving inoculations. Considering the rapid spread of more transmissible variants as well as the growing consensus among researchers that SARS-CoV-2 will become an endemic virus and continue to circulate in areas with high susceptibility for years to come, it is likely that areas with low vaccination rates will continue to suffer at disproportionate rates.
In an effort to address this dangerous inequity various groups have organized initiatives to broaden access to the vaccines. In Philadelphia, the Black Doctor’s Covid Consortium began testing residents in underserved areas of the city and has since transitioned to hosting walk up vaccine clinics open only to residents from neighborhoods that have had reduced access thus far. Penn Medicine has also formed a partnership with Mercy Catholic Medical Center and various community organizations and administered several successful vaccinations clinics throughout West and Southwest Philadelphia. At the international level, dozens of low- and middle-income countries as well as WHO Director-General Tedros Adhanom Ghebreyesus have asked the World Trade Organization to temporarily waive intellectual property rights on approved vaccines to facilitate increased production and distribution around the world. Talks have stalled thus far but this will certainly remain a polarizing geopolitical issue.
The race to bring COVID vaccines to clinic involved an incredible degree of collaboration between different institutions and countries. A similar degree of cooperation will be necessary if we hope to bring the pandemic under control in an equitable fashion. With cases currently on the rise all over the world, including catastrophic levels of infection in India, there is a risk that some of the benefits of the vaccine rollout may be squandered. In order to truly capitalize on the incredible work done to produce these vaccines, we need to prioritize accessibility to the greatest extent possible.