Those on the pandemic's frontlines -- health and care workers, including nurses -- risk their lives every day to treat their patients. They face high risk of infection with Covid-19; the World Health Organization (WHO) estimated in May, almost certainly a substantial underestimate, that a stunning 115,000 or more had already died from Covid-19. By July, the death toll was estimated at 200 each and every day since the pandemic began.
The WHO has declared 2021 the International Year of Health and Care Workers, but to celebrate them as heroes is an empty, meaningless gesture if we continue to fail to protect them.
In February, a year into the pandemic, a National Nurses United survey found that, even in the United States, 81% of nurses were forced to reuse personal protective equipment (PPE). Appropriate high-quality PPE remains in short supply, is non-standardized and overpriced, and is poorly designed for use in many low- and middle-income countries (LMICs).
Vaccinating people as quickly as possible is vital to ending the Covid-19 pandemic. However, vaccine supply is still limited in most countries, with production expected to lag for many months or even years. The global vaccination effort has thus far been shockingly and reprehensibly inequitable. LMICs have gotten the short end of the needle, and nowhere is this injustice more pronounced than in Africa.
As vaccination supply continues to ramp up globally and we continue to push for both more equitable distribution of existing vaccines and increased production, LMICs will need to prioritize who gets the vaccine first in order to maximize lifesaving potential. Limited vaccine supply forces the majority of countries to continue to be strategic with unacceptably scarce vaccines.
Vaccinating all health and care workers globally is both a moral and practical imperative; prioritizing these workers makes all of us safer. Yet based on a WHO estimate of 140 nations in July, only one in eight health and care workers across the world had been vaccinated, with most of those who have been vaccinated working in high-income countries.
The global total of health workers depends on definitions -- for example, whether lay community health workers are included -- with estimates ranging from 50-135 million, including approximately 28 million nurses.
Failure to vaccinate health and care workers against coronavirus threatens the entire world's population with increased, but preventable, sickness and death -- not just from Covid-19, but also from conditions routinely treated by pediatric and maternal health services, disease prevention programs, and standard vaccinations.
In Africa in particular, where health and care workers are in particularly short supply, the disruption of programs that provide vaccines for children and treatment of HIV, malaria, tuberculosis, pneumonia, and other life-threatening conditions may kill millions of people and harm millions of others with preventable illnesses that can cause lifetime disability. These breakdowns in care can set health progress back for decades.
At the annual World Health Assembly in May 2021, WHO Member States recognized that necessary steps must be taken to protect health and care workers at all levels, including through equitable access to vaccines. To fully vaccinate every one of the world's health and care workers with two vaccine doses would require at most 270 million doses -- less than one week's worth of global vaccine production.
To prioritize vaccinating health care workers, we must:
Increase equitable distribution of vaccine. Wealthy countries have stockpiled and reserved vaccines -- with more than 75% of all vaccines administered in just 10 countries as of May -- leaving poorer countries with a tiny share of supply. Forty-five percent of vaccine doses have gone to 16% of the world's population. Low-income countries have received as little as 0.3% of global vaccine supply.
Ramp up global vaccine manufacturing. We need more local manufacturers, more open intellectual property, more technology transfer and creation of vaccine manufacturing hubs that can facilitate both technology transfer and a rapid increase in manufacturing. The mRNA vaccines in particular, development of which was largely funded by taxpayers in the United States and Europe, must be opened for a massive increase in manufacturing beyond individual companies. We cannot allow manufacturing companies to prioritize maximizing vaccine sales over equitable vaccine delivery, which is the moral equivalent of profiteering during the global war against Covid-19 and it's continuing to cost millions of lives. Pfizer's CEO Albert Bourla responded by calling the allegations "unfair."
In the midst of our ongoing global pandemic, these lifesaving vaccines must be considered a global public good. And the way for Moderna and Pfizer to act accordingly, as good corporate citizens, is to rapidly scale up transfer of technology and know-how to increase vaccine production beyond what they and their associates have been able, despite great effort, to do. Otherwise, we're gambling with millions of lives and global stability.
Track data on access and coverage among health care workers. Earlier this year, Resolve to Save Lives and its partners published Protecting Health Care Workers: A Need for Urgent Action, highlighting specific actions that should be taken to improve health care worker safety. One of the report's recommendations was to improve data collection and accountability, including mortality and morbidity data, to better understand the risks faced by health care workers.
The data available reveals that, as of September 26, about six billion doses of vaccine have been distributed. If the world's leaders had prioritized health and care workers in all countries, regardless of income level, all could have been fully vaccinated by now. In Africa, for example, only 2.4 million health workers in 38 countries have received at least one dose of vaccine, but more than 30 million have not had a single shot, let alone two. This is an injustice which must be urgently addressed.
Across the world, health care workers continue to face daily death and devastation. Now it's our turn to protect those who protect us daily, whether they work to heal humanity in rich nations or in poor ones. We must vaccinate all the world's health and care workers and we must do this now -- for their sakes and for the sake of the patients they care for. There is sufficient vaccine to do so. What are we waiting for?
Strive Masiyiwa is founder and Executive Chairman of Econet Group. An African technology entrepreneur and philanthropist, he currently serves as an African Union Special Envoy for COVID and on the AU's Africa Vaccine Acquisition Task Team (AVATT). Dr. Tom Frieden, director of the CDC from 2009-2017, oversaw responses to the H1N1 influenza, Ebola and Zika epidemics, is President and CEO of Resolve to Save Lives, an initiative of Vital Strategies and Senior Fellow for Global Health at the Council on Foreign Relations. The views expressed in this commentary belong to the authors.