Are you low-key freaking out about omicron? Yeah, me too. Can't we catch a break?
Maybe.
Step one to preventing new, scarier mutant strains is to reduce the number of infected people, which require a mix of ventilation, masking, distancing, and, of course, vaccinations.
These days, the "vaccine controversy" is primarily about vaccine-hesitancy and vaccine denial - that is, about people who can get the vaccine but choose not to.
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But if you cast your mind way, way, *way* back to last spring, you'll remember that the big issue was vaccine equity - the maneuvering by the rich world to keep vaccines from the Global South until we'd all gotten our jabs.
This was and is a scandal. As a humanitarian matter, it's a frank admission that the lives of people in poor countries are less important than the lives of people in rich countries.
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But even if you have the kind of howling void in your ethics that can wave that away, it's also an epidemiological disaster.
Because vaccines don't offer perfect protection, even vaccinated people are at risk of breakthrough infection. The more exposure, the higher the risk. Leaving the 125 poorest countries in the world - 2.5 billion people - unvaccinated until 2023 or 2024 creates a huge pool of infected people who might infect you.
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Dividing the world into vaccine haves and have-nots is like dividing a swimming pool so it has a "pissing end" and a "no pissing" end. We're still all in the same pool. Humanity has a shared epidemiological destiny.
But vaccinated people who get infected generally experience milder symptoms. I have a double-vaxed relative who got a breakthrough infection whose only symptom was loss of smell, and four days later he got his smell back and was testing negative on lateral-flow tests again.
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So maybe if all you care about is your own skin, it's okay to deprive the Global South of vaccines? Not so fast. Remember omicron? At the root of a viral infection is a flurry of reproductive activity, in which a virus hijacks your own cells to make copies of itself. Some of those copies will be imperfect, leading to mutations.
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Most of those mutations are inconsequential. Some make the virus less dangerous. Some make it more dangerous - better at spreading, better at bypassing vaccine protection, better at making us sicker.
The decision to impose Vaccine Apartheid on the Global South is a decision to turn 2.5 billion of our fellow humans into potential incubators for mutant strains, as their undefended bodies are colonized by covid and hijacked to produce trillions of copies of the covid virus.
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Even if the chances of a harmful mutation are small, these infections present an incomprehensibly vast number of lottery tickets that the virus gets for free, and eventually, it will win a jackpot.
Last spring, a talking point about why we didn't need to worry about this started to circulate: we don't need to worry about harmful mutations because viruses tend to "gentle" themselves over time.
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A strain that kills its host too quickly, or immobilizes them with severe symptoms, will lose out to less harmful strains that get more reproductive opportunities because their hosts can spread them farther and wider.
This is certainly true of some pathogens, but it's by no means a universal law, not even over very long timescales: rabies hasn't gotten gentler through the millennia. And it's even less true over short timescales: HIV is just as dangerous today as it was in the 1980s.
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What's more, the story of self-gentling viruses omits a key detail about how more deadly strains die off: by killing everyone who contracts them so quickly and decisively that the sick can't drag themselves to a new population before expiring. Other pathogens like the Black Death "gentled" themselves by wiping out significant pluralities of the populations of whole nations, over and over again, for *centuries*.
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Despite this, the story that blocking vaccine access to 2.5 billion poor people didn’t pose a risk to vaccinated people was repeated. Sometimes, this was clearly motivated reasoning (“I’d rather believe in self-gentling vaccines than public goods”). Sometimes it was plain old wishful thinking.
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Not everyone who told this tale was talking out of their hat — I heard from a molecular biologist with lots of experience in tracking viral mutation who thought that the specific characteristics of the covid molecule made harmful mutation very, very unlikely.
Maybe he was right. But very, very unlikely outcomes to processes that we allow to unfold trillions and trillions of times are still a real risk (hi, omicron!).
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The public subsidized the covid vaccines at many junctures through their development. But the rapacious pharma giants who produced them spun a narrative that attributed vaccine development to the miracle of private enterprise. This let them defend the idea of blocking global access to vaccine-making patents and associated materials.
https://pluralistic.net/2021/05/16/entrepreneurial-state/#patient-zero-money
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This story was bolstered by more lies, including the claim that it would simply take too long to build new mRNA vaccine factories (privately, Moderna admitted that new factories could be scratch-built in 3–4 months):
https://apnews.com/article/drug-companies-called-share-vaccine-info-22d92afbc3ea9ed519be007f8887bcf6
Even more important to the narrative were the racist lies about the incompetence of brown people in poor countries and their inability to make vaccines of their own (the world’s largest vaccine factories are in the poor world).
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Big Pharma was absolutely shameless here, using New Cold War rhetoric about China “stealing American IP” to stampede the White House and Congress into backing its move to keep the Global South from making its own vaccines:
https://pluralistic.net/2021/05/15/how-to-rob-a-bank/#roll-the-dice
The belief that poor people are incapable of making vaccines goes hand-in-hand with a doctrinal worship of “market forces” as the only way to resolve hard policy questions.
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This is Bill Gates’s bread-and-butter, and his Gates Foundation led the charge to keep vaccine production in private, for-profit hands.
https://pluralistic.net/2021/04/13/public-interest-pharma/#gates-foundation
Gates’s work started with convincing the Oxford team to renege on its promise to put its publicly funded vaccine in the public domain. Instead, they gave exclusive rights to Astrazeneca:
https://khn.org/news/rather-than-give-away-its-covid-vaccine-oxford-makes-a-deal-with-drugmaker/
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Then Gates and the Gates Foundation lobbied hard against a WTO TRIPS Waiver that would let poor countries seize the means of (vaccine) production and make their own jabs. This wasn’t the Foundation’s first rodeo: they were also on the vanguard of the campaign to keep generic AIDS drugs out of South Africa at the peak of the country’s health emergency.
https://newrepublic.com/article/162000/bill-gates-impeded-global-access-covid-vaccines
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Pharma has deep pockets and can buy some pretty impressive spokevillains. Howard Dean (once a lion of progressive politics and now on Big Pharma’s payroll) pushed the racist brown-people-too-stupid-to-make-vaccines lie, too:
https://pluralistic.net/2021/04/08/howard-dino/#the-scream
Despite all this, the Biden administration — to its everlasting credit — backed the idea of a WTO waiver:
https://pluralistic.net/2021/05/10/comrade-ustr/#vaccine-diplomacy
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But even without the US trade rep’s help, Big Pharma managed to stall the WTO waiver, and now we have omicron.
https://twitter.com/WallachLori/status/1464344665851899906
But the Global South has not sat idly by while the north prioritized pharma shareholders’ dividends over the continuation of our species. Cuba has one of the world’s most advanced biotech industries, and it went into high gear as soon as covid emerged, producing five viable vaccine candidates:
https://pluralistic.net/2021/03/31/vaccine-for-the-global-south/#Soberana-Abdala
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“#WTO should hold an emergency online Gen Council mtg Monday to adopt #TRIPSwaiver after WTO Ministerial #MC12 just postponed by worrying new #covid19 variant caused in part thx to WTO IP barriers limiting vaccine/meds supplies needed to end pandemic https://t.co/JwN6Ub2YAf”
Today, the Cuba vaccine program — publicly owned, cooperative, and managed for the public good — is paying off handsomely. 100% of Cubans have had at least one dose, and 78% are fully vaccinated. Only 2.8% of the population of the world’s other low-income countries are vaccinated.
https://jacobinmag.com/2021/11/cuban-covid-vaccine-pandemic-biotech-research
The country has “reopened its borders on November 15 to tourism, roughly a tenth of its economy, and has reopened schools.”
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Thanks to its public biotech sector and its government’s deep commitment to public health, Cuba is now the only low-income country to have made its own COVID vaccine. It’s already helped millions of Cubans, and it’s poised to help millions more around the world.
Cuba is also scaling up its vaccine production and getting ready to vaccinate the rest of the world in a south-south technnology transfer. Vietnam (39% vaccinated) is getting 5m doses — 1m of them a donation from the people of Cuba to the people of Vietnam. Iran and Nigeria have inked deals to build their own vaccine factories to make Cuban vaccines.
Two of Cuba’s five vaccines are now in production. The other three are still in trials. One, a nasal spray, is in Phase II trials.
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The Cuban vaccines aren’t mRNA-based; rather, they’re conventional protein vaccines, which has many advantages. They don’t need elaborate cold-chains, and we know a lot more about how safe they are for kids to take.
As Branko Marcetic writes in Jacobin, Cuba’s decision to build out a domestic biotech industry started when Reagan announced cruel new sanctions while the country was undergoing a brutal dengue fever outbreak.
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It was a good call: today, 70% of the medicine Cubans take are made on the island and the country exports hundreds of millions of vaccine doses every year.
The country’s biotech sector has received recognition from the rich world, including, incredibly, from WIPO, a UN agency that is entirely beholden to multinational corporate interests. WIPO has given Cuba ten gold medals for its biotech products, including the world’s first meningitis B vaccine.
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The country was the first to eliminate mother-to-child HIV and syphilis transmission.
Cuba’s vaccine miracle almost didn’t happen, though: the ongoing blockade created a massive syringe shortage (solidarity donations from individuals abroad, including the US, saved its butt).
We don’t know yet how the vaccines — both Big Pharma’s and Cuba’s — will perform against omicron.
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But until we get the whole world — including poor people in poor countries — vaccinated, we will remain at risk from new strains.
Remember, the path to a “gentler” covid runs through mountains of dead people who are immobilized or killed so quickly that they never get the chance to spread the less-gentle strains. We can’t afford that, and we don’t have to.
Pass a WTO waiver now!
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Cory Doctorow
ilja 
jay 🌺
Meena
Quinn [she/her]