Why this USAID official is calling global vaccine inequity a 'winnable fight' : Goats and Soda Jeremy Konyndyk, executive director of USAID's COVID task force, shares his perspective on the U.S.' efforts to donate and distribute vaccines to low-income nations.


Why this USAID official is optimistic the U.S. can get the world vaccinated

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The number of new COVID-19 infections is dropping across the country. States are dropping mask mandates. Almost two full years now into this pandemic, Americans are more than ready to get back to normal. And maybe we can.

But then you wonder, what about the next variant? We know the next one is coming so long as much of the world remains unvaccinated, which is still the case. Just over 61% of the world's population has gotten one shot of a COVID-19 vaccine. That number plummets to about 10% when you're talking low-income countries.

And this is where I'm going to bring in Jeremy Konyndyk. He's executive director of the COVID-19 Task Force for USAID, the U.S. Agency for International Development. Welcome back to ALL THINGS CONSIDERED.

JEREMY KONYNDYK: My pleasure. Thanks so much.

KELLY: So those numbers I just threw out, they suggest that we're not where we need to be. Progress isn't where it needs to be yet. But I've seen you say this is a winnable fight. Why?

KONYNDYK: Well, we have seen a lot of encouraging indications that with the right level of supply and the right kind of support, many, many countries can get their vaccination rates up towards the levels that we're seeing in the high-income and middle-income countries. So we've seen a progression over the past year. You know, the supply first went predominantly to high-income countries. We then saw rates begin to rise in the upper-middle and the lower-middle income countries. And as you said, the low-income countries have been lagging behind.

The supply issue now is mostly resolved. There is sufficient supply in the global system now to provide vaccine doses to any country that is able to use them. The challenge has been in a lot of low-income countries, they haven't had the resources and the technical support to do something that they haven't ever needed to do before, which is vaccinate their adult population to scale.

KELLY: Let me pause you there and just catch up to you. I want people to understand your stake here is - a key part of your role with USAID is coordinating with COVAX, the organization leading global vaccination efforts. And it's really interesting to hear you say the supply issue has mostly been resolved, but I gather there's still issues with distribution.

Like, you can get it to the right part of the world, you can get it to the right country, but these are vaccines, as we know, that have to be kept cold. They have a short shelf life. What is your outfit doing to try to address that part of the challenge?

KONYNDYK: We are attacking the in-country distribution challenge in a few ways. You know, there is a logistical and operational element to this. Do countries have the specialized freezers that they need? Do they have the internal transport infrastructure that they need? So we provide support with that. And working with partners like UNICEF, we have helped to install the specialized ultra-cold chain freezers for the Pfizer vaccine in numerous countries around the world. That's one piece of the equation.

You also need a different approach to vaccination than these countries are used to taking. So, you know, most low-income countries have very developed childhood immunization programs, but they haven't really needed to vaccinate their adult populations in large numbers. So we're helping to reach that population and make it accessible to that population.

KELLY: I mean, it's building an entire infrastructure for, as you say, countries where this just has not been part of daily life.

KONYNDYK: It really is. And then, of course, helping to build confidence in the vaccine. In most countries in the developing world, it's not as politicized as it is here, but it's still a challenge and it's still unfamiliar. And so we do outreach and rumor tracking and things like that to address some of the challenges and some of the misinformation that may be out there.

KELLY: Yeah. Speak to more - that issue of vaccine hesitancy, which, as you note, the U.S. certainly has not solved here at home. How does the global effort to try to combat it look different from what we know here?

KONYNDYK: So I think it's important to distinguish between hesitancy and accessibility. And what we have seen in the countries that we've been consulting with and since we stood up our initiative for global vaccine access in early December, we've been talking to many countries across Africa to understand what are the dynamics and the patterns that they're seeing with their population.

And one of the things that we keep hearing is that right now, the problem isn't so much that people are hesitant to get the vaccine. It's that it's not very accessible to them. So they may live in a rural area. You know, they may work on a schedule that makes it difficult for them to take time out of their day to go get the vaccine. If you're a daily wage laborer, it's very difficult to forgo a day's wages in order to go get vaccinated. So we need to do more to push the vaccine out to people like that in ways that are accessible where they live and how they live.

And you know, there is a hesitancy element. It's not so politicized, and we've supported programs like in Ivory Coast tracking in real time some of the misinformation that is floating around on social media and then feeding that into targeted outreach campaigns to specifically counteract some of the misinformation that's out there.

KELLY: And does it work? Can you measure it?

KONYNDYK: It's hard to measure any specific rebutting of a WhatsApp rumor or something like that, but what we have seen with support from the U.S. government, Ivory Coast was able to increase their national coverage rate from 22% to 36% in the course of a month.

KELLY: Right.

KONYNDYK: And we're seeing progress like that in many countries. In Uganda, the government has now vaccinated the majority of its adult population. So this is what gives us confidence that this is a winnable fight. We're seeing progress like that.

KELLY: You'll have seen the whole controversy over rich countries like the U.S. pushing for multiple shots for Americans, even as other nations don't have enough supply. Is it ethical to push for booster shots here when other countries haven't even gotten, you know, first-round doses out to their citizens? Am I hearing you right that that is not the conflict that it perhaps once was because the supply issue is easing?

KONYNDYK: That's right. That is really not a zero-sum trade-off by any means at this point.

KELLY: We should feel zero guilt about getting boosters if we harbored any. It's not going to poor kids in a country where they're not otherwise going to be able to get one.

KONYNDYK: Absolutely. You know, there is now sufficient supply in the pipeline for low-income countries that they can access the doses they need. The challenge at this point is the absorptive capacity, and that's where we're working to support and scale up countries to increase their uptake. But at this point in time, a dose - a booster someone gets in this country is not coming out of the arm of someone in the developing world.

KELLY: I want to end by asking about something I read when I was preparing to talk to you, which is that we, the world, needs to be preparing for an extended period of time, like years, where we're going to be at risk for more variants. That is so exhausting to think about. And I wonder how you're thinking about it, like a recalibration from a sprint against COVID to a marathon.

KONYNDYK: Definitely some kind of a marathon. And it is exhausting. I think this is why we are so focused and so committed on trying to accelerate vaccine uptake in every country. You know, we don't know where the next variant will come from. We don't know how the next variant will perform. But every 4 to 6 months, we have seen a new and more dangerous variant emerge.

And, you know, the one constant throughout all of that has been that the vaccines are very, very powerful at preventing severe illness and keeping people out of hospitals. And so it is really crucial. You know, this is a winnable fight. It's also a necessary fight for that reason. We really need to prevent severe disease and keep people out of hospitals and keep the death toll down. And the vaccines are still performing very well against that across all variants. And that's really the focus right now.

KELLY: Jeremy Konyndyk, executive director of the COVID-19 Task Force for the U.S. Agency for International Development, thanks so much.

KONYNDYK: Thanks. It's my pleasure.

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