When historians write about the Covid-19 pandemic, they will certainly highlight the essential research behind safe and effective vaccines, the remarkable pace of vaccine development, and the sacrifices made by clinicians and clinical trial participants. They will also write about the gross neglect of global partners when designing a worldwide public health strategy, which has been plagued by vaccine inequity, nationalism, and fear.
The latest misguided response by the U.S. government bans incoming travel from a number of southern African countries — some which have no known cases of Covid-19 caused by the Omicron variant — but not from European ones where the variant has already been detected. Moreover, the ban does not apply to U.S. nationals flying into the U.S., who need show only proof of a negative Covid-19 test.
This is not public health as much as it is political theater that dismisses scientific evidence of how to effectively mitigate viral spread. This occurred in 2020 when President Trump quickly imposed travel restrictions on China, but took weeks longer to do so against Italy and European countries where SARS-CoV-2 had spread widely — and those countries probably accounted for more transmission in the U.S. overall.
As global health physicians, we have witnessed such shortcomings before, namely during the HIV and Ebola epidemics. In both, vulnerable people were viewed as vectors of disease and ended up as victims of blame, to the detriment of containing viral spread. This eroded trust and amplified stigma, which also made the viruses harder to trace and treat. People were less inclined to be tested, less likely to disclose their positive status, and less likely to connect to health care providers to seek timely treatment.
In 2001, the then-head of the U.S. Agency for International Development, Andrew Natsios, opposed providing lifesaving antiretroviral therapy to people living with HIV in South Africa, despite the widespread availability of these lifesaving drugs in the U.S., insisting that the health care infrastructure in South Africa was not advanced enough. Africans “don’t know what Western time is,” he infamously said, and so would be unable to take medications on schedule.
This apathy toward people in Africa was labeled by some as a crime against humanity. Yet it led to years of delay in getting effective lifesaving treatment to countries on the African continent.
The spread of the West African Ebola epidemic of 2014 to Europe and the U.S. prompted a much more serious response against an outbreak in the Democratic Republic of the Congo four years later, even though there had been many previous Ebola outbreaks in the DRC. The key difference was that wealthy countries felt threatened in 2018. If helping other countries during global health crises depends on U.S. leaders feeling the American public is threatened, the responses will be far too late.
A devastating result of the U.S. response to Covid-19 is that it threatens global solidarity — leaders in South Africa, where the Omicron variant was first detected, are rightfully feeling unfairly targeted — and the travel bans could make other countries more hesitant to come forward as quickly when detecting the next serious viral mutant.
Scientists in South Africa reported the Omicron variant to the World Health Organization on Nov. 24; it was designated as a variant of concern to the global community two days later. The scientists who identified the variant should be applauded, but instead all South Africans are being punished under the guise of U.S. security. Travel bans will not be effective at preventing new cases after they have already spread widely, and it is highly likely that many more Omicron cases are already present around the globe. The few cases detected in the U.S. are almost certainly the tip of the iceberg, since the country has yet to truly scale up its genomic sequencing. With asymptomatic spread and high transmissibility, particularly through small aerosol particles, it is virtually impossible to keep our new variants.
The U.S. seems to invoke an isolationist ideology each time a global pandemic hits. The government has tried to use self-preserving strategies like offering booster shots to healthy citizens and stockpiling vaccine doses — to the detriment of the American public given that such efforts detract attention and commitment from providing doses to unvaccinated people elsewhere, both logistically and symbolically. According to WHO Director-General Tedros Adhanom Ghebreyesus, in mid-November six times as many booster doses were being administered daily around the world than primary doses in low-income countries. So it should come as little surprise that new variants are emerging as quickly as they are.
Instead of addressing the conditions that promote the emergence of new variants and epidemic surges in the first place, such as donating billions of doses to countries that are largely unvaccinated, bolstering primary health care systems, improving local supply chains, and building vaccine manufacturing plants in low-resource countries, the U.S. and other high-income nations preemptively set up a system that ensured inequity in vaccines from its inception. Wealthy countries stockpiled vaccine doses through advance market commitments well beyond what was needed for their populations and failed to mandate technology transfers that would predictably be needed well before vaccination campaigns began.
But America’s collective challenge extends far beyond vaccine equity.
Stopping a pandemic hinges on how the U.S. fundamentally views and treats its global allies. Controlling the spread of any variant is the responsibility of all countries. The U.S. government is treating countries in southern Africa as security threats instead of as allies in need of assistance. The message this sends is clear: The U.S. will protect its own at the expense of others. What U.S. leaders fail to understand is that this strategy will also fail to protect Americans.
While many strategies that can be used effectively to control the spread of SARS-CoV-2, including wearing face coverings, widespread vaccination, testing, and good ventilation, American politicians must recognize that their approach to the pandemic fundamentally lacks solidarity with non-Western countries. How the U.S. responds to Omicron is an opportunity to do better. If leaders fail to ground their response in global health equity — the provision of lifesaving scientific advances to every person regardless of where they live or what they can pay — the pandemic response is at risk of further failure for all people when the opposite is needed.
Ingrid Katz is the associate faculty director of the Harvard Global Health Institute and an associate physician in internal medicine at Brigham and Women’s Hospital in Boston. Abraar Karan is an infectious disease physician and global health researcher at Stanford University.
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