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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again everyone. If we needed more proof that COVID-19 is a global disease, India's devastating caseload is impacting multiple countries in Africa. COVAX, the global vaccine sharing initiative would have distributed around 65 million doses to African nations through this month. According to the news site Quartz, they were all set to be manufactured by the Serum Institute of India.

For example, Nigeria was set to receive the greatest number of doses through the COVAX program around 14 million, but that has now been stalled as India focuses all vaccine production efforts for its own citizens for the time being, given the enormity of the crisis there.

Here are a few other global vaccination stories that caught our eye. Chile rivals the United States for leading the Western Hemisphere when it comes to vaccinations per capita. 41% of the population there has at least one dose, but they've relied on a Chinese vaccine, which has reportedly proven less effective and new cases are surging.

The Eastern European country of Serbia has procured 15 million vaccines for a population of just 7 million people according to the new site DW. Up until recently, Serbia has even been giving out free doses to tourists, about 30,000 tourists in total it's reported, though that program recently ended. Joining me now to talk about the vaccine rollouts around the world is Emily Rauhala, Foreign Affairs reporter at the Washington Post. Emily, welcome to WNYC. Thanks for doing this.

Emily Rauhala: Thanks for having me.

Brian: Listeners, we'll open up the phones right away for immigrants from anywhere or anyone else with connections to different countries all over the world. How is the COVID-19 vaccine rollout going in your home country or the country or otherwise connected to? 646-435-7280. Maybe you just want to say the country's case numbers or talking about COVID politics there. The US isn't the only country where COVID politics have gotten crazy.

What are your friends and family members back home telling you about what government officials are or are not doing or saying in order to stem the pandemic or maybe to deny it? We know those people here who think election fraud was real and COVID was fake, right? That's the thing. Is anything like that happening somewhere else that you know? How are your family members, or friends, or whoever navigating finding a vaccine? How are they ramping up their own personal safety measures?

Has the latest resurgence changed people's opinion on their elected officials or anything else you want to add to help us report the global COVID story, vaccines or other angles? 646-435-7280. That's 646-435-7280 with Emily Rauhala from the Washington Post.

Emily, you recently reported 48% of all vaccine doses administered so far have gone to just 16% of the world's population in what the World Bank considers high-income countries. As you reported recently, it's not just that richer countries procured their doses earlier, it's that they ‘locked up 53% of the near-term vaccine supply’. Can you give us some examples of how that fact is actually playing out for people of other countries?

Emily: Sure. The vast inequity in the global vaccine rollout story really started as soon as it looked like there might be some good vaccines. Last summer, we had some of the wealthiest countries in the world basically cutting deals directly with vaccine makers before these vaccines were even approved or tested, and pre-buying or securing vast amounts of doses.

What that has meant is that as these vaccines did come online, as they were tested as they proved safe, and a lot of the vaccine news has been really great in that respect, only a small handful of countries had any access to those early doses. Those are countries like Canada, the United States, Israel, Britain, and most countries in the world, representing the vast majority of the world's population are really only starting now to vaccinate.

Brian: As I noted in the intro, the global COVAX program has been hit hard by India's surge in cases. Can you talk about India’s Serum Institute a bit? What vaccine were they're making and how many doses were they supposed to make and distribute to where by now?

Emily: Sure. COVAX is a WHO backed plan. The idea was, let's pool our resources. Instead of every country fighting for a vaccine, let's pull resources, we're going to bulk purchase vaccine from drug makers, and then we're going to divide it equitably, so that, for instance, healthcare workers in every country get vaccine before people who are low risk.

The vaccine really at the heart of this effort, at least the early part of this effort in Q1, Q2 of this year was AstraZeneca. A large share of AstraZeneca for COVAX was going to be made at the Serum Institute in India, a big player in the vaccine world. What's happened is that this already slow rollout to low and middle income countries has been vastly delayed, put on hold because of what's happening in India. The Serum Institute is struggling to meet local demand in the middle of a really horrible crisis, and that's made it even harder to get vaccines anywhere else.

Brian: You cite research from Duke University's Global Health Innovation Center that estimates that 92% of the world's poorest countries won't reach a vaccination rate of 60% of their populations until 2023 or later. Do you want to name-- There's a lot of countries that fall into that category, but any in particular that you think are worthy of mention, maybe because the virus is spreading there in particular ways or anything else?

Emily: Sure. In terms of low-income countries, this is a predominantly in Africa, Democratic Republic of Congo, Madagascar, also Caribbean, Haiti. There's also some lower middle-income countries, with very large populations that are also vaccinating at an extremely slow rate. Whether it will be late 2022, or 2023, it's hard to predict now. We really don't have a sense of how much vaccine will be made between now and then.

If you look at countries like Brazil, like Pakistan, it's still a really, really long time before they have a significant portion of their population vaccinated, let alone something approaching herd immunity. We're really talking about years as opposed to months. I think really shapes how we need to think about pandemic and vaccination going forward.

Brian: We have some international calls coming in so let's take them. I don't think the show has ever had a call live from Nepal before, but here is Dr. Kharel calling from Nepal. Do I have that right, doctor? Hello and are you in Nepal at this moment?

Dr. Ramu Kharel: Hi, Brian. Yes, thank you for having me. I'm in Nepal, I'm in Kathmandu. As our guest has mentioned, one of the countries that's struggling is Nepal, from the Serum Institute's lack of ability to send vaccines across different countries.

Brian: What else would you like to report about the details on the ground? [crosstalk] Go ahead.

Dr. Kharel: I would like to say I am emergency medicine faculty at-- international fellow at Brown University. I was in the US when the peak was the highest in Rhode Island. I worked in Atlanta also and now I happen to be in Nepal, and the peak here, we're seeing the replication rate of the virus is one of the highest in the world. It was at 2.13 a few days ago. This is a very small country with a population the size of Texas, so about 30 million people with ventilators that are less than 1,000 and less than 1,500 beds. We have only 4% of our population vaccinated with only one dose. I am seeing here every day people calling me almost every 10 minutes, looking for ICU beds and we have none.

We have a campaign going here, Brian, that's pushing for our country US because we have a lot of Nepali people who live in the US as well, in New York, specifically, and we need some taxis here. I know there are people not taking vaccines in rich countries. I think the inequity that we just discussed with the prior guest is so real. I'm looking at it with my eyes and it breaks my heart. I hope that people in the US specifically can join our campaign Vaccines4Nepal also. I know we have a plan for India, but Nepal is a small country and I don't want it to be forgotten in that midst.

Brian: I'm glad you call them mentioned that. Who would have to make the decision to get vaccines over there in the way that you want?

Dr. Kharel: Brian, we have a campaign here- -COVID Alliance for Nepal and we have written an open letter to US ambassador to Nepal. Looks like it will have to go through the executive branch so secretary of state and ultimately, Kamala Harris or Joe Biden. But the decisions are for India was made at the executive level and I hope that-- There are so many Nepali people there in the United States, Brian, and I hope that they can use some of this public platform to push some of these extra vaccines to come here as well.

We're predicting that we might have as much as 200,000 cases a day in the upcoming months if this goes on. Right now, I'm here doing emergency medicine research and I am in a lockdown. We are all in a lockdown but the neighboring districts in India are getting, and you'll not believe this, the positivity rate for testing here is almost 75% in some places and nationally it's 45% people come positive every day. I think it's the executive branch and I hope they can make that push a little bit. Hashtag for this #Vaccine4Nepal.

Brian: Dr. Kharel, good luck there and thank you for raising people's awareness about the situation in Nepal. Thank you for your call.

Dr. Kharel: Thank you so much.

Brian: Next, we're going to go to Tian in Johannesburg, South Africa. Tian you're WNYC, hello from New York.

Tian: Hi there. I just wanted to say that as Africans, we took part in clinical trials to get this vaccine. Our tax money went towards the research as well and yet we look at our TVs and we see our friends from the global north taking vaccines selfies, but yet we're told we have to wait for a vaccine until 2023. There's so much talk about COVAX. We can't depend on COVAX. It’s underfunded, it's unaccountable, it can't get us vaccine equity. That must be done mainly by our governments.

Our countries in the global north will vaccinate, they will shut borders and Africa yet again, will become the continent of a pandemic. We'll be known that the continent of COVID. The call is for countries who are standing the way of access like the US, like the EU, like the UK, like Norway to support the waiver. Pharmaceutical companies can then share the know-how so we can get on with making our own vaccines and not be beholden to charity. That's not how we going to end this pandemic.

Brian: Tian, thank you very much. Emily Rauhala foreign affairs correspondent for the Washington Post, do you want to comment on either of those first two callers?

Emily: Sure. I think both points are really important. The first is the reality that ongoing COVID emergencies elsewhere do not stay within an individual country. They are spreading. We've seen this with India and its neighbors. We've seen it in Brazil where a very high number of cases in Brazil has spread to its neighbors. I think that's really how we frame this as an issue. This is something that's going to affect everyone. They're not isolated cases.

On the second question, it raises a really important point about vaccine diplomacy and the choices that the Biden administration is facing. There are a lot of calls from around the world and from within the United States for the administration to do more and the question is what does that look like? Is it focused on, for instance, donating surplus doses? The US has secured arguably a lot more than it needs. Where are those doses going? Will they be donated through COVAX? Will they be donated bilaterally for instance, perhaps to somewhere like India? Or will there be some sort of other diplomatic maneuver?

Lastly, as last caller noted, there are a lot of calls, including from South Africa, from India, for the US to change the way it looks at patents and the way it shares technology to help boost the global supply so that the world isn't scrambling for a limited share of vaccine, but the world is making a lot more, very rapidly.

Brian: Banasha in Brooklyn. You're on WNYC. Hello Banasha.

Banasha: Hi, Brian. Thanks for taking my call. I'm myself, a graduate student here and I've been able to get vaccinated, but my father and a lot of my family members live in Iran and there really is no obvious prospect of getting vaccinated anytime soon for them. Just today, my 83-year-old grandmother was somehow able to get the first shot of the AstraZeneca, which was truly amazing news to receive. We're not even sure how it happened. I think they only started importing the AstraZeneca about a month ago. Aside from that, they are getting 10,000 doses of the Sputnik every few weeks, they're developing a vaccine with Cuba, but it's a country of 80 million and it's really not looking good.

Brian: Why do you think if you have an impression of why a country that is a significant country in the world by money and power standards, I think it's fair to say, Iran can't get more vaccine than that?

Banasha: When the vaccine rollout began in the rest of the world, I think there was a lot of talk of the sanctions playing a role in Iran’s inability to purchase vaccines. The government claimed that because of the sanctions, foreign banks are not allowed to do business with Iran and so even though they were willing to purchase the vaccines, they were not able to do so. I think that's probably the main thing.

Obviously, it is a powerful country, but developing a vaccine in this short amount of time is not an easy thing. They're trying to develop their own vaccines, but it's not clear if it's going to be any good.

Brian: Thank you, thank you so much for your call. Jude in Brooklyn, you're on WNYC. Hi Jude.

Jude: Yes. Hi Brian. Good morning. Can you hear me?

Brian: Good morning Jude. We got you, we hear you.

Jude: Okay. Thank you very much. I just wanted to say that in Nigeria, our people are getting vaccinated in big cities. Initially when it started, people were very skeptical because of the report of blood clots from United Kingdom. Then it was more of foreign expatriates that were getting vaccinated, the Chinese, the Indians, the Caucasians. Later on, Nigerians are turning up for it but the supply hasn't reached all the rural areas yet, only the big cities. Most of the young people I spoke with have been able to get vaccinated. At least they've got one dose, but like my parents, my dad is 80, my mom is 70, they are waiting, but they haven’t arrived their own location yet.

Brian: The story that we started with at the beginning of the segment, that Nigeria was supposed to get 14 million doses from the Serum Institute in India producing vaccines for export to developing countries. Now they're holding all those vaccines back most or all because of the burgeoning crisis in India, that's affecting Nigeria in particular.

Jude: For now, it hasn't, but I know it will get it because people are just getting into turn out now. Initially people weren't turning out. Now people are turning out and we haven't even reached all the states. My state was earmarked for 10,000 doses, and the state is about 3 million people, and the entire vaccine in Nigeria got is about 3.5 million doses. That's the entire Nigeria got for now.

Brian: What's the conversation they're like to the extent that you know about vaccine hesitancy versus vaccine enthusiasm?

Jude: A lot of people are hesitating to get it, even some medical I know health workers haven't received. Then when I asked them, they said they were scared because they heard story of blood clot but I told them, I was like, “The percentage of people who have blood clots is far lower than people who got the vaccine and we're fine.” But I realized that a lot of Nigerians are interested now in getting the vaccine. They're turning out more than the previous time but it's not all over yet, only much in the big cities.

Brian: Jude, thank you so much. Call us again. One more James in Brooklyn connected to Haiti. Hi James.

James: Hey, good morning, Brian.

Brian: Thank you for calling us. What would you like to tell us?

James: Yes, I'm saying I live here in New York City and I'm vaccinated and my family's vaccinated. Most of us I've been vaccinated here, but Haiti so far, it's not been very low. They are lucky because if COVID would have done any impact on Haiti, it would have been devastated for the people, because vaccination campaign only the rich will have benefited from that.

Haiti, you can't even get proper-- go to a hospital for a simple fever. You get return home because you don't have any money to pay. So far so good. We say yesterday, I’m reading from NPR and they say only been 400 death rate in Haiti so far for the whole population. I do know we have a problem with statistic in that- -easy to for real count and given the fact that Haiti is a corrupt country, corrupt government, they would not have done any good job way to help the people vaccinated or for testing or anything like that. So far, I see Haiti is really lucky. I'm hoping to stay that way.

Brian: Why do you think COVID hasn't spread there as fast as many of the crises?

Jude: Okay. I'm going to tell you exactly. Since I was a child, we'd been seeing, [unintelligible 00:20:27] I heard that for any virus or any bacteria to kill a Haitian, you have to be in the side of a [unintelligible 00:20:38] or something like that. So far, I think we been around so much like bacteria, people be living into so much dust, dirty dust all those thing, s. I think the body becomes immune. I'm sorry, but I think that's true. Also, Haitian, they use a lot of lemon, they drink lemon almost every day. It might be one of the reasons I think they have survive.

Brian: James, thank you very much. Emily Rauhala, foreign affairs correspondent for the Washington Post without conferring too much medical authority on the idea that being exposed to a lot of dust and stuff early in life protects you from COVID or that drinking lemon does, what would you say with respect-- I have a question for you about one of those callers, but what's top of mind for you?

Emily: Sure. I haven't looked at the Haiti situation closely, but I will say this. I hoped cases stay low there, but what we are seeing as we enter this new phase of the pandemic is that countries that were not hit hard are getting hit. Just a few months ago, people were writing think pieces about how India had been spared, speculating that it might have something to do with early life exposure to Coronaviruses and this similar idea that people had already been exposed and then we see India get hit so hard.

I would just caution that we don't know when these big surges are coming to different countries, but they certainly appear to be happening almost everywhere and that's why vaccination is so important.

Brian: To the caller who was connected to Iran and was talking about other countries developing other vaccines than the ones we know of already, there are the Russian and the Chinese vaccines and you wrote in the post with supply tight, China and Russia have engaged in vaccine diplomacy. Can you talk a little bit about the rollout of those two vaccines on a global scale? I know part of the story from Serbia, as I understand it that has a lot of Chinese and Russian vaccine, there are questions about effectiveness. What about that whole dynamic around the world?

Emily: Yes, exactly. Both China and Russia have from the early days of the global vaccine rollout really treated their vaccines as a tool for foreign policy. That stood in stark contrast to the conversation in the United States, which was under President Trump explicitly America first and under the new administration, has been effectively America first. The administration has said very directly, “We're focused for now on vaccinating Americans.” There's been this gap, this empty space for diplomacy and China and Russia have stepped in.

Now the extent to which that has been effective from a public health and/or from a diplomatic perspective, it’s not clear yet. A lot of countries are blocked out of using say Pfizer because there's just not enough supply and so they're turning to the Chinese and Russian vaccines. The results from what we know, and there's not complete transparent data for those vaccines is not as strong as for say Pfizer, but that does not mean that they can't and won't have benefit for countries that are in desperate need.

I think a lot of countries are looking at their options and saying, “Well, maybe this isn't a perfect vaccine, but we need vaccine and we're going to use it.” It will be interesting to see what kind of both health and diplomatic consequences throughout to those decisions.

Brian: Emily Rauhala, foreign affairs correspondent for the Washington Post, thank you so much for joining us today-

Emily: My pleasure thank you.

Brian: -and for putting your eyes as broadly around the world as you do. Callers, thanks to you for calling from so many places and connected to so many places.

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