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  • Talia Goodman

No one wants a new normal, but the presence of COVID-19 requires a new normal. Vaccines appear to be the first step in returning the world to its former state. Globally, 6.6 billion doses have been administered, and 23.17 million are distributed each day. As of October 14, 2021, over 187 million Americans, or 56.6% of the total U.S. population, have been vaccinated against COVID-19 [1]. The United Arab Emirates leads the world in vaccine rates, with 94.83% of their population being vaccinated, and Tanzania lies at the bottom of the list with only 0.97%. Countries like the UAE and the United States give the appearance of progress towards normalcy, but the majority of the world does not have access to the same resources. Only 2.5% of people in low-income countries have received at least one dose [2]. Inequity in vaccine distribution makes the idea of vaccine passports, certifications of vaccination that reduce public health restrictions for their bearers, unfair.

Governments argue that the purpose of vaccine passports is to allow people to travel, attend large gatherings, access public venues, and return to work without compromising personal safety and public health [3]. Vaccine passports make sense for international travel because all foreign visitors being inoculated against COVID-19 would help to keep both the country in question and the tourists safe. However, practical and ethical challenges prevent domestic vaccine passports from being implemented.

Nations that do not offer vaccination to all of their citizens but then introduce a vaccine passport for domestic use would be unfairly discriminating against chunks of society. It would only entrench inequities that favor citizens of high- and upper-middle-income nations. Aside from those who lack access to vaccines, some people remain unvaccinated on medical, religious, and philosophical grounds. While many people in other countries would get the vaccine if it were available to them, here are some statistics from Forbes about the Americans who refuse the vaccine: 18% of 18-29-year-olds, 18% of men, 40% of Republicans, 44% of white evangelical protestants, 20% of Fox News viewers, and 22% of people with less than a college degree [4]. ​​While not ideal, vaccine passports could incentivize members of the public that are unvaccinated by choice to not only get the vaccine, but return for a second dose.

In some countries, travelers must be vaccinated against Yellow Fever and receive a card as a vaccine passport if they want to enter the country. No card, no travel. If connecting our vaccine card to a QR code can help protect the public and get us on the way back to some normalcy, isn’t it at least worth trying?


References

[1] Carlsen, A., Huang, P., Levitt, Z., & Wood, D. (2021, October 14). How is the COVID-19 vaccination campaign going in your state? NPR. Retrieved October 14, 2021, from https://www.npr.org/sections/health-shots/2021/01/28/960901166/how-is-the-covid-19-vaccination-campaign-going-in-your-state.

[2] Ritchie, H., Mathieu, E., Rodés-Guirao, L., Appel, C., Giattino, C., Ortiz-Ospina, E., Hasell, J., Macdonald, B., Beltekian, D., & Roser, M. (2020, March 5). Coronavirus (COVID-19) vaccinations - statistics and research. Our World in Data. Retrieved October 14, 2021, from https://ourworldindata.org/covid-vaccinations.

[3] Osama, T., Razai, M. S., & Majeed, A. (2021, April 1). Covid-19 vaccine passports: Access, equity, and Ethics. The BMJ. Retrieved October 14, 2021, from https://www.bmj.com/content/373/bmj.n861#ref-1.

[4] Hart, R. (2021, September 5). By the numbers: Who's refusing Covid vaccinations-and why. Forbes. Retrieved October 14, 2021, from https://www.forbes.com/sites/roberthart/2021/09/05/by-the-numbers-whos-refusing-covid-vaccinations-and-why/?sh=63d03bdc52ea.



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  • Camille Krejdovsky

Over the past several months, life in the US has begun to resemble some form of post-COVID normalcy. With air travel rebounding, sporting venues reopening, and concerts on the horizon, life is beginning to look a lot more like pre-January 2020 times. The current COVID-19 vaccines have facilitated this, allowing many to go about their daily lives with a greater sense of security, knowing that their risk of severe illness is lowered. In some instances, the white paper vaccine card has become a sort of ticket to freedom, with many leisure venues requiring it for entry.

But while life here seems to be inching back to normal, the global situation looks much different. As of October 15th, 2021, just 7.5% of those living on the African Continent had received at least one vaccination dose. In countries such as Haiti and Tanzania, those numbers look much bleaker, coming in at less than 0.6% of their populations. The disparities are clear: lower-middle-income countries are struggling to provide their citizens with first doses while wealthier countries such as the US and several European nations have begun to offer optional 3rd doses, or booster shots. The factors leading to these striking differences in access are complex, revealing longstanding inequalities and the failure to include lower-middle-income countries in emerging technology. While there was a plan in place to create more equitable global vaccine access, called COVAX, it ultimately has fallen short of its goals due to wealthier nations forming side deals with vaccine manufacturers and buying up vaccine supply before it was even produced.

In addition to the ethical issues that the inequality in access raises, global vaccine distribution is mandated by our collective desire to enter the post-COVID era. As pockets of COVID-19 infections are allowed to persist, new variants will arise, eventually making their way around the world. According to Dr. Krishna Udayakumar, Director of the Duke Global Health Innovation Center, it’s only a matter of time until one of these variants will render our current vaccines ineffective, leading us “back to square one”. If ethical concerns alone won’t push us to make the needed changes, necessity will.

While the need for equality is easy to recognize, the path towards it is complicated and difficult. The novelty of the vaccine technology and its storage requirements have further exacerbated the issue, making it so that not all of the excess vaccine that wealthier nations have possession of can be shipped abroad due to expiration concerns. But even if it were possible to ship surplus abroad, this would be a temporary fix that circumvents the root of the issue. Development of manufacturing and distribution capacity is what is really necessary in these countries, along with potential further innovations in vaccine technology. While the former has proved difficult due to the hesitancy of the pharmaceutical industry to relinquish control of their patents (which dictate who can produce the vaccine), the latter is already underway. Researchers have identified the issues in distribution and are proposing creative solutions, such as a self-administered vaccine patch that is not as temperature sensitive as the original formulations. Another exciting possibility is the pan-coronavirus vaccine being worked on by researchers at the Duke Human Vaccine Institute, which would provide protection against a large range of coronaviruses, with the potential to protect against new variants as well as future outbreaks. Innovations such as these, in combination with expansion of manufacturing rights and investment in local manufacturing capacity will be a challenging, but ultimately essential step in the march towards the global return to normalcy. The silver lining is that the interconnectedness of this pandemic has forced attention towards the health inequalities that exist around the world and is pushing us to address them through innovation that will hopefully create solutions viable beyond the context of the current public health crisis.


References

  1. Josh Holder, “Tracking Coronavirus Vaccinations Around the World,” New York Times, October 15, 2021, https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html.

  2. IBID.

  3. Jamie Ducharme, “COVAX Was a Great Idea, But Is Now 500 Million Doses Short of Its Vaccine Distribution Goals. What Exactly Went Wrong?”, September 9, 2021, https://time.com/6096172/covax-vaccines-what-went-wrong/.

  4. Krishna Udayakumar, “COVID Booster Shots Are Coming. But Most Of The World Hasn’t Gotten Its First Vaccine”, interview by Scott Simon, Weekend Edition Saturday, NPR, August 28, 2021, https://www.npr.org/2021/08/28/1031965166/covid-booster-shots-are-coming-but-most-of-the-world-hasnt-gotten-its-first-vacc.

  5. IBID.

  6. Amy Maxmen, “The Fight to Manufacture COVID Vaccines in Lower-Income Countries”, Nature News, September 15 2021, https://www.nature.com/articles/d41586-021-02383-z.

  7. O’Shea, Prausnitz, Rouphael, “Dissolvable Microneedle Patches to Enable Increased Access to Vaccines against SARS-CoV-2 and Future Pandemic Outbreaks”,Vaccines (Basel), April 1 2021, doi: 10.3390/vaccines9040320.

  8. Eric Ferreri, “Researchers Discuss New Vaccine That Could Prevent Future Pandemics”, Duke Today, May 17 2021, https://today.duke.edu/2021/05/researchers-discuss-new-vaccine-could-prevent-future-pandemics.

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  • Riya Mohan

The COVID pandemic has brought many changes to the way we live our lives. One of the biggest advances has been destigmatizing mental health issues in a way that couldn’t be achieved in decades past. However, studies show that high levels of stigma towards mental health care continue to persist in minority communities. Culturally sensitive care, or the ability of systems to provide care to patients with diverse backgrounds, will create a sustainable solution to this disparity and can be achieved by including more diversity within the medical health spaces and by utilizing updated pedagogy at multiple levels of the medical community.

Diversity has been a focus of reform within the medical community for decades. Almost twenty years ago, the Pew Health Professions Commission called for more minority individuals to be included within the Allied Health space, or the community of professionals who assist with diagnostic, technical, therapeutic, and supportive services of medicine. However, these changes must occur systematically across Medicine, Nursing, and Public Health in order to achieve long-term equity and ensure cultural sensitivity. The need for diversity is apparent in recent data from the AAMC’s Projections of Physician Supply and Demand that shows severe imbalances within the medical community. As of 2019, 68% of doctors were White and 23% of doctors were Asian, but only 7.3% and 6.5% were Black and Hispanic, respectively. A diverse group of healthcare providers ensures that innovative and inclusive care is implemented at every level of medical decision-making. Furthermore, in terms of mental health care, greater diversity promotes cultural contact that enables care providers to better understand the social contexts driving prejudice towards mental health issues. Only after a care provider understands these issues can they help address these fears and provide sensitive, individualized care.



To continue decreasing stigma towards mental health in minority communities, the social and cultural issues of healthcare must be included in medical training. This education could take place during medical school or residency as part of the required curriculum, or by making cultural training a requirement for health care providers to renew medical licenses, obtain hospital privileges, or complete yearly training. Though this would require a greater amount of effort on the part of administrators and health institutions to expand currently existing cultural training programs, it is a necessary step that ensures that the health community is kept up to date about health disparities. Cultural sensitivity cannot exist without adequate awareness and education as cognizance establishes greater trust and collaboration between care providers and patients. Trust and collaboration are needed, especially in the realm of mental health care, in order to provide the highest quality of care to the patient and reduce stigma.

Cultural cognizance, through greater diversity within health spaces and updated pedagogy to reflect the social issues prevalent in medicine, is vital to decreasing mental health stigma in minority communities. An effective medical workforce must reflect the diversity of its patients and the breadth of issues within the health community. Mental health is no exception.


References

  1. Mental health: a report of the Surgeon General. [Rockville, Md.: Dept. of Health and Human Services, U.S. Public Health Service ; Pittsburgh, PA: For sale by the Supt. of Docs, 1999] Web.. Retrieved from the Library of Congress, <lccn.loc.gov/2002495357>.

  2. "Critical Challenges: Revitalizing the Health Professions for The.” Critical Challenges: Revitalizing the Health Professions for the Twenty-First Century | Healthforce Center at UCSf, 1 Dec. 1995, healthforce.ucsf.edu/publications/critical-challenges-revitalizing-health-professions-twenty-first-century.

  3. “Critical Challenges: Revitalizing the Health Professions for The.” Critical Challenges: Revitalizing the Health Professions for the Twenty-First Century | Healthforce Center at UCSf, 1 Dec. 1995, healthforce.ucsf.edu/publications/critical-challenges-revitalizing-health-professions-twenty-first-century.

  4. Kripalani, Sunil, et al. “A Prescription for Cultural Competence in Medical Education.” Journal of General Internal Medicine, Blackwell Science Inc, Oct. 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC1831630/.



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DMEJ

   Duke Medical Ethics Journal