âToo many lives have been lost. Families, communities and nations have been devastated. â¦ Our marathon effort was a success, but the last mile is perhaps the hardest route.
It was UN Secretary General Ban Ki-moon in April 2015 speaking to world leaders about the Ebola crisis in West Africa. As President Biden and his team called on heads of state and industry leaders at a COVID-19 summit this week to make new commitments to end the latest pandemic, they all seemed to be forgetting about the The very problem Ban pointed out six years ago: the last mile.
The context of the two gatherings was quite different. In 2015, the question of how to strengthen health systems came to the fore during an outbreak of hemorrhagic fever in a few countries that was fatal but short-lived. This week the world is facing an active epidemic of respiratory disease which, after raging for nearly two years, still kills more than 65,000 people per week.
Progress against the disease is limited in large part because only 2% of people in the developing world have been vaccinated against COVID-19. At the same time, the rest of our health systems have been fundamentally disrupted. UNICEF and the World Health Organization have reported that routine immunization disruptions saw 23 million children miss standard immunizations in 2020-2021, the highest in a decade.
All of this means that most of our work to resolve this pandemic is ahead of us. There is certainly an urgent need to act on the commitments of billions of doses, on therapies and oxygen to help save lives, and on the mechanisms to be put in place at the global level to support better future preparation. But a crucial element is missing from the goals of this week’s summit: How are we actually going to immunize, save lives and improve preparedness to reach the billions of people who are not well connected to effective health systems?
Regarding global vaccinations, the current campaign priorities are to send 2.4 billion doses to developing countries by the end of 2021 to vaccinate 40% of the world. Every day, global partners try to give hope with photos of vaccine doses on airport tarmacs. Yet, to date, 70% of all vaccinations have been administered by just five countries.
COVAX, the organization coordinating the global COVID vaccination campaign, had to cut its vaccination plans by 30% in September. WHO said more than a third of African countries have significant gaps in the capacity to deliver vaccines at the district level due to faulty “last mile” delivery systems, just as the secretary-general has said. cited in the fight against Ebola in 2015.
More strikingly, we don’t have the syringes to vaccinate the world. Current estimates are that we will be missing at least 5 billion needles during the course of the COVID vaccination campaign. In 1999, a joint WHO, UNICEF and United Nations Population Fund policy called on all partners to fund ânot only vaccines, but the safe administration of vaccinesâ.
It is worrying that most of the current donations to countries are sent without needles. Experts have estimated that if this syringe shortage is not addressed, we could see 2-3 million deaths from infections caused by syringe reuse.
There is also a need to refocus the world on the goal of âsaving livesâ now. Solutions to date have focused on the upstream purchase of products rather than the people providing care and immunizing on the front line. If efforts to speed up access to oxygen and personal protective equipment are to have any effect, massive efforts must be made now to train and deploy our frontline health workers. This should include finding ways to more fully involve community health workers in immunization efforts, while medical staff support care for COVID-19.
Efforts to rebuild disrupted systems are only just beginning. Discussions began at the World Health Assembly last spring and will continue after this summit. By far the most controversial topic is how to increase manufacturing. Again, we focus on ‘first mile’ issues and ignore downstream questions about how countries can actually deal with the end of the vaccine supply chain, namely filling, finishing and dispensing. distributing vaccines safely to their populations, even the most difficult to reach.
In March 2015, we all made commitments that we believe would help create a world where an Ebola outbreak could not happen again. We have failed as a global community in part because we forgot the most important part, the last mile. Let us not let the commitments of this summit do the same.
David Heymann is Professor of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine. Ashish Jha is the Dean of Brown University School of Public Health. Edward Kelley is the director of global health for ApiJect Systems Corp., which focuses on injectable drugs.