Just how far can kindness travel?

Opinion: Can New Zealanders care about people in low-income countries when we have our own pressing social problems? Nikki Turner speaks to UNICEF Aotearoa.

Professor Nikki Turner. Photo: supplied

Doctor Nikki Turner is a fast talker. She has a lot to cram into a 20-minute interview – inequality, vaccine nationalism, Joe Biden’s US vaccine summit, the Pfizer vaccine for five-year-olds, and why COVAX is a must, not a nice-to-have.

“There’s a bit much work on at the moment,” says Turner. “But that’s okay. It’s better to be over-employed than under-employed, isn’t it?”

Turner works in a general practice clinic just 2km from a now quieter Wellington International airport. She says the pandemic is having a significant impact and is seeing increased anxiety, fear and poverty.

“One of my patients is from a family of two adults, a grandmother and five kids. They’re all living in two bedrooms with heavy mold on the walls. Lockdown in a house like this is very difficult for them.”

Turner, like many medical professionals, is stretched. Her team are giving vaccinations and clinical advice in cars and providing consults on back porches. They’re racing against the clock to protect communities and offer reassurance.

Covid-19 is a universal crisis but it begs the question – are Kiwis capable of caring about people in low-income countries when we have pressing social problems in our own backyard?

On Wednesday, US President Joe Biden hosted a virtual Covid-19 summit and announced that the US would share an additional 500 million doses of the Pfizer-BioNTech vaccine. Biden urged world leaders to vaccinate 70 percent of populations by this time next year. Vaccine doses need to be shared but currently only 20 percent of people in low- and lower-middle-income countries have received a first dose of vaccine compared to 80 percent in high- and upper-middle-income countries.

This week, UN Secretary-General António Guterres gave a stark warning. “The world must wake up. We are on the edge of an abyss – and moving in the wrong direction. Our world has never been more threatened. Or more divided.” After awarding the world an ‘F’ in ethics, he too is urging vaccines to be equitably shared.

Is anyone listening? Turner is irritated that global leaders weren’t focused on the urgency right from the start.

“It’s taken this long to realise that you need world targets, not just country targets. Nationalism has been rife and now the rich countries can make targets because they’ve had a good crack at vaccination.”

Turner, just like Guterres, is holding humanity to account. “This is a long overdue cry. Western countries should be ashamed that it’s taken this long.”

But there are glimmers of hope.

The tiny Himalayan country of Bhutan is nestled between India and China. Nearly every adult in the country – more than 540,000 people – were vaccinated in just three weeks earlier this year. Bhutan received the majority of vaccines through the COVAX initiative, a global collaboration which aims to provide equitable access to Covid-19 vaccines. To date, 301 million doses have been shipped through COVAX to 142 countries.

As the largest single vaccine buyer in the world, UNICEF is working with manufacturers and partners on the procurement of Covid-19 vaccines and delivering these safely and quickly to participating countries, including eight Pacific Island countries so far.

In April 2021, the New Zealand Government pledged to share doses with COVAX. This country’s total contribution to COVAX AMC (the mechanism to fund vaccines for low- and lower-middle-income countries) is NZD$17 million. We’re giving back, although more doses are urgently needed.

“The world needs international organisations like UNICEF to recognise the inequalities and to try and support those who are missing out, those who don’t have a voice and are getting a much smaller share of the pie,” says Turner.

Biden’s insistence on 70 percent vaccination rates differs from the figure now circulating in Aotearoa. Ashley Bloomfield, Director-General of Health, said recently they were aiming for “at least 90 percent”. So, what number should the world be aiming for or are we just pulling numbers from a global bingo board?

Turner says there isn’t a magic figure that will stop Covid.

“The higher the vaccination coverage, the less people will die, and less people will end up in hospital. There are health services in even well-resourced countries like the US and in many other countries that are at breaking point. They just can’t cope. Although 70 percent may sound like a made-up figure, essentially you want the highest possible vaccination rates so we can protect individuals, protect communities and protect our health services.”

With more people vaccinated, there’s less chance for the virus to mutate and if another variant comes along which is significantly different to Delta, vaccines can be altered quickly to better combat the virus. It’s the power and speed of science.

“If a significant further mutation does occur, the Pfizer vaccine and the other major international vaccines can be changed rapidly. You change the recipe slightly and you can boost communities. That’s the backup plan.”

Vaccines protect high-income countries, low-income countries and everyone in between. But we have to act now, and the race is on. The pandemic is destroying countries, it’s destroying economies, it’s destroying the health services and it has an impact on everybody.

Including children.

This week, Pfizer announced that vaccinated children aged five to 11 showed evidence of protection against the virus. While the original clinical trials focused on the elderly and people with medical problems because they were most severely impacted by Covid-19, international science discussions had to include children.

“We know we cannot keep the virus out of New Zealand and even though the incidence of severe illness is much lower with children, there will be some that get sick.”

“At this stage, I don’t think there’s an answer as to whether we should be vaccinating all children under 12. We still need to keep looking at the data and the effect that the Delta variant and future variants have on our children.”

Traditional vaccine clinical trials on children are underway. One group is vaccinated and then compared with a placebo group, who have not been given the vaccine. Early clinical trials have shown that the immune response of these children is the equivalent to the immune response of teenagers.

Although the safety profile is currently looking good, the vaccine won’t be licensed for under 12-year-olds in Aotearoa until the New Zealand medicines safety authority Medsafe has scrutinised the data closely.

“You’re likely to see it go through the American approval process pretty fast in the next few weeks and they’ll make a decision at the FDA level on whether it is approved. Because our focus in New Zealand is on vaccinating children 12 years and up, it’s likely to be several months away.”

Well over 70 percent of eligible Kiwis have now had one dose. We’re extraordinarily lucky to live in a country where frontline workers aren’t forced to make the agonising decision of determining who to support and who to turn away when oxygen and beds are in short supply. It’s grossly inequitable that some countries can protect their populations more than others.

Nobody in the world has immunity to Covid-19 and vaccines don’t deliver themselves. UNICEF teams are delivering vaccines by plane, by foot, and across mountains – to remote communities in Bhutan and to our neighbours in the Pacific. We won’t stop until everyone is vaccinated against Covid-19, because we’re not safe until everyone is.

Although kindness needs to begin at home, it can also travel across the globe.