Is America not prepared for Covid mass immunisation?


People 65 and older wait outside the Hattie Holmes Senior Wellness Centre in Washington, Jan. 12, 2021, to get a coronavirus vaccine.
Image Credit: AP

Covid-19 exposed all the flaws of both national and international governance. The US, which had hoped to give at least 20 million people their first coronavirus shots by the end of last year, has so far managed a little over half that. States, hampered by poor federal-level support, have struggled with basics like who goes first, and both excessively stringent and excessively broad stances have caused problems.

The pandemic was identified as a threat well before 2020 but, for most of us, the reality was unimaginable in its eventual scale, and certainly in the devastating cascade of social and economic problems it created. When it comes to inoculations, though, we knew this day would come eventually.

It is true that these are very early days. Providing public goods at scale is, after all, the very essence of a government’s function. More importantly, the basics we need to get right now — from being agile to following science and combating misinformation — will underpin our fight against every subsequent global challenge, not least a changing climate.

Securing vaccines

Of course, as with everything in this pandemic, measuring vaccination success isn’t straightforward. We could do worse, though, than start by weighing up how countries did in securing vaccines, distributing doses and communicating effectively to build trust.

Supply is immediately problematic as a gauge of government success on its own. We can of course count the volume of doses countries secured and there were high-profile blunders, as with the United States passing on the chance to buy extra Pfizer doses last summer.

But wins here are predicated on wealth and sharp elbows as much as they are on administrative capacity and quality of governance. Israel, for example, paid a hefty premium for its vaccines, something not all Covid-battered budgets allow, and was able to throw data into the deal too, thanks to an unusually personalised and digitised health system.

Then there’s speed of delivery — actually getting the shots and rolling them out. Again, though, this isn’t just about good governance. Certainly, Israel is a standout when considering doses delivered per capita, having delivered more than 2 million doses for a population of just over 9 million.

So too are the United Arab Emirates, and even Britain. But speed here has been largely dictated by circumstance — it’s a race against an out-of-control outbreak. Israel has had over 535,000 cases, almost 6% of its population. Britain registered almost 56,000 new cases on Friday, one of the worst rates globally. In both, the fate of politicians depends on it.

Go slower approach

By contrast, the “go slower” approach taken by some Asian countries isn’t exactly failure. Even if a decision to “sit back” is open to question during an economically devastating pandemic where millions have already been inoculated elsewhere.

So what’s a better test of how governments have actually done, irrespective of pre-existing wealth and Covid-19 status?

One, did they make room for ethically tricky discussions. This was already necessary last year, when lockdowns forced the damage to economies to be weighed against the risk to human lives, but, as Donald Low, professor of practice in public policy at Hong Kong University of Science and Technology, put it to me, there is precious little space for ethics when conversations focus on cost-benefit analysis.

Hence much of the floundering in debates where there is no perfect answer, like whether to bet on the probable protection of one dose or the near-certainty of two, or whether to vaccinate the elderly before schoolteachers.

Deliberations on doses, for example, could have started earlier, says Keiji Fukuda, director and clinical professor at the University of Hong Kong’s School of Public Health, though he adds final decisions were not possible far in advance without a sense of the immune response to the first dose of specific vaccines, manufacturing capacity and the speed at which infection is spreading, which only come with the outbreak.

Finally, the least forgivable oversight of all: Did governments educate and communicate to get citizens rolling up their sleeves and avoid the greatest collective action failure of our time? That’s not about inoculating the president on live television as Indonesia did, but explaining the science, the testing process, the risks and rewards.

Most people, after all, are not hard-bitten vaccine sceptics. The one lesson we should have learnt from 2020 is that no one is safe until everyone is.

Clara Ferreira Marques is a noted opinion columnist covering social and governance issues

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