While many parts of the world beg for the vaccine, in the United States, health officials are begging for people to take it.

Supply outstrips demand to the point that pharmacists have been instructed to break the seal on multi-dose vials, even if only one dose ends up being used. In Wisconsin, this results in an average of over 2,000 vaccine doses being wasted daily, according to data from Wisconsin’s Department of Health Services collected between Aug. 29 and Sept. 4.

Though University Health Services does not regularly calculate statistics on dose wastage, they also follow a policy of leaving no willing community member unvaccinated, senior clinical nurse specialist Tami Morin said in an email to The Badger Herald. The clinic has administered 260 doses per week over the past four weeks.

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“UHS follows the guidance of the Wisconsin Department of Health Services, which is to have no wasted opportunities for vaccination,” Morin said. “This means that if we need to open a vial to ensure one person can be vaccinated we will do it.”

This reflects plummeting demand domestically. Wisconsin hit a peak of over 420,000 doses administered in a week back in April. Dosage numbers for the last week of September were less than a tenth of that.

Concurrently, a majority of the world’s population has yet to receive a single vaccine dose. Vaccine distribution has left entire continents behind, even when COVID-19 has not. As of October, the World Health Organization estimated just 4.4% of Africans were vaccinated.

Prominent health authorities have been warning of this since the pandemic began. In May, WHO Director-General Tedros Adhanom Ghebreyesus said that “vaccine apartheid” had become a reality.

Wealthy nations were able to cut to the front of the vaccine line by paying higher prices, said Dr. James Conway, the associate director of University of Wisconsin’s Global Health Institute. The timeliness of vaccine delivery demonstrates the prioritization of wealthier nations.

COVAX, a joint venture that aims to provide 92 of the world’s poorest nations their vaccines free of charge, has binding vaccine commitments with manufacturers just like the U.S. and the European Union do. But, wealthier nations have seen their commitments fulfilled much faster than COVAX, Conway said.

“Money talks,” Conway said. “The Western countries have committed to pretty high prices, to make sure that they were first in line. Covax signed contractual agreements that they also should be getting a decent amount of vaccine, but my understanding is that they signed on for a lower price.”

While the U.S. and other wealthy nations have succeeded in dosing most of their populations, COVAX has repeatedly had to scale back its distribution goals. Initially, its goal was to have two billion doses administered by the end of 2021 — a marker that current forecasts predict will only be met by the end of the first quarter of 2022.

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The topic of vaccine inequity has repeatedly emerged in conversations regarding booster shots, which countries including Germany, Israel and the U.S. have begun offering to certain eligible populations. Germany in particular was criticized for using its vaccine supply on boosters even as it falls short on its donation commitments.

Speaking on vaccine boosters, WHO Emergencies Chief Dr. Michael Ryan said the situation was akin to handing out life jackets to people who already have them while letting others drown.

When asked whether race plays a role in how the lives of those from other countries are valued, UW medical history professor Richard Keller said “it certainly does.”

“It’s the countries with resources that are the ones that have the best vaccine distribution and production, and it’s the countries without resources that have the worst production and distribution,” Keller said. “I think it’s the job of better resourced countries to assist countries with fewer resources.”

For associate professor of population health sciences Ajay Sethi, the unequal distribution is reminiscent of the inaccessibility of antiretrovirals in the Global South for much of the HIV/AIDS pandemic.

While the drugs were unaffordable in much of the world, patent laws prevented African companies from making generic versions.

“I know that I saw very similar sort of delays in getting important therapeutics to the world in the context of HIV medication,” Sethi said. “In some cases, companies overseas just began reverse engineering and producing those medications and disregarding the patent laws, simply because this was an issue of human rights and ethics.”

Intellectual property in the context of vaccines and other COVID-19 therapeutics has become a hotbed for controversy. The Brookings Institute, a centrist-liberal think tank based in Washington D.C., recently came out in favor of waiving intellectual property protections for COVID-19 pharmaceuticals.

In a piece published in June, the think-tank wrote that the main function of intellectual property law is restricting the dissemination of ideas in the short term to create innovation in the long term. By preventing the theft of innovation by competitors and guaranteeing short-term monopolies of successful invention, intellectual property law aims to motivate innovation.

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But during a public health crisis, society cannot afford to wait for innovation in the long term, The Brookings Institute argued. Governments funding vaccine development and purchasing already create sufficient economic incentives for innovation.

After pressure from activists, in May the Biden administration decided to back a World Trade Organization proposal allowing other countries to design and manufacture COVID-19 vaccines without fear of patent litigation. Switzerland, Japan and Germany are among countries still opposed to the proposal, which requires unanimous approval.

Also in opposition, the pharmaceutical industry came out strongly against the Biden administration’s decision, arguing that it would strain supply chains, lead to counterfeit vaccines and undermine American innovation in biomedical discovery.

Advocates for the proposal contend the U.S. has a vested interest in vaccinating the world. UW professor of pathobiological sciences Thomas Friedrich said unvaccinated populations anywhere, at home or abroad, are a threat to vaccinated populations everywhere.

Unvaccinated individuals are stepping stones that give the virus chances to mutate and bounce to vaccinated populations. In most cases, the SARS-CoV-2 virus will bounce around unvaccinated people and be unable to infect vaccinated hosts, but the more unvaccinated individuals there are, the more opportunity the virus has to mutate and attempt jumps into vaccinated populations, Friedrich explained.

The Delta variant threatens the entire world, but it emerged in a population with no widespread vaccination, Friedrich said.

To its credit, the Biden administration has committed 1.1 billion doses to be donated. Still, the U.S. and other wealthy countries need to do more, Friedrich said.

“I think the issue is a billion doses for a vaccine that requires two doses is a drop in the bucket,” Friedrich said. “We need 15, 16, 20 billion doses to vaccinate the world.”

Officially, the death toll for COVID-19 is over 5 million, according to Johns Hopkins pandemic dashboard. The true death toll may be far higher.

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The Economist’s excess death calculation estimates 16 million people have died as a result of the pandemic so far. Even a small delay in vaccinating the world could result in catastrophic loss of human life.

“You could argue that every death that’s occurring due to COVID-19 is unnecessary, or preventable, given that we have vaccines,” Sethi said. “There certainly are going to be scientists and modelers estimating how many millions of deaths around the world could be prevented. Very similar estimates were done showing that by not providing the world antiretroviral therapy for HIV, millions of lives were lost.”