Tobias Kahler, Germany boss of the Bill and Melinda Gates Foundation, draws an interim conclusion about the vaccination campaign against Covid-19. He explains which global steps are necessary next and also gives an outlook on how the foundation can envision the response to future pandemics.
Berlin newspaper: Mr Kahler, when we spoke a year ago you pointed out the need for global herd immunity and said that when we have achieved immunity in around 60 percent of the population, the pandemic will be over. How do you see it today?
Tobias Kahler: There is certainly agreement on one conclusion: science has delivered results in record time. That was not to be expected at this speed and is a huge success. However, we have to realize that there are new, significantly more contagious variants of the coronavirus. We must therefore assume that the proportion of immunized people must be significantly higher.
The head of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, recently bought the rich Länder denounced because they want to provide healthy people with booster vaccinations, wäduring the ärmeren LäChange the vaccination rate is extremely low. How do you rate this imbalance?
Basically, it is a good prerequisite that safe and suitable vaccines are available at all – and, more recently, effective drugs as well. However, massive injustice persists in the distribution of these vaccines and drugs. It cannot live up to our moral standards that the absolute majority of vaccines go to rich countries. Some of them have secured two to three times the vaccination doses that would actually be needed for booster vaccinations. This is a blatant injustice and can result in more contagious and heavier virus variants forming and spreading worldwide, including in Germany.
What Schlüsse do you draw from it?
The situation clearly shows us the global injustice in health care around the world. The pandemic has exacerbated existing inequalities here: For example, after decades of decline, the global spread of malnutrition is increasing again. And child mortality rates remain very high in many low-income countries. In sub-Saharan Africa around seven percent of girls and boys die before their fifth birthday. With regard to Covid-19, our goal must therefore be: It is imperative that the most vulnerable people in the world be protected as quickly as possible.
Booster vaccination is being discussed in Germany, and young and healthy people also want to be vaccinated a third time. Pfizer boss Albert Bourla recently stated in an interviewärt that he assumes there will be refreshments every year dürfte. How should this be done fairly, and how do you deal with new variants?
We expect that Sars-CoV-2 will mainly occur endemically in the future, but nobody can say today exactly how the virus will develop. However, it is very likely that the producers – as with the flu – will be able to react regularly to any changes in the virus with further development of the vaccines. Research on the next generation of Covid-19 vaccines is already in full swing.
The arm LäHowever, this does not help to change…
There is really a big problem right now: Germany has promised to donate 100 million vaccine doses to low-income countries by the end of the year. So far, only 20 million of these have been delivered. Federal Minister of Health Jens Spahn has now announced that part of the remaining donations will be postponed to January and February of the coming year in order to avoid bottlenecks in the booster vaccinations with Biontech in this country.
Can not be delivered because all Germans want to be vaccinated?
The situation is somewhat more complex both in Germany and in other European countries. In some countries, millions of cans are still in a sort of dump and are not given to poorer countries. These vaccines are available in addition to those that are vaccinated as boosters in their own populations. However, governments run the risk that a significant proportion of the cans may have to be destroyed once their expiration date has passed. In addition, there are still legal problems with the distribution of vaccines to other countries.
Photo: Katharina Kritzler
Tobias Kahler
Germany head of the Bill and Melinda Gates Foundation. He previously worked for the Australian NGO ONE. He studied politics, international relations and economics at the University of North Carolina at Chapel Hill, the Free University of Berlin and the London School of Economics.
Which?
Various questions have to be clarified between the vaccine manufacturers, the Covax global vaccination initiative and the countries involved. This concerns, among other things, the question of whether and under what conditions the EU may sell vaccines to third countries. Approval from the manufacturer is required for this, for example due to liability issues. Therefore, new contracts have to be signed for the distribution of vaccination doses, which slows down the process.
Why is the destruction of millions of vaccine doses threatened?
The time pressure is enormous: the countries that are to receive vaccines by donation have to prove that they are actually able to inoculate the cans after delivery. In order to be able to plan this specifically, the recipient countries need reliable commitments about deliveries. Because distribution and logistics are a major challenge in the fragile structures of many countries. Covax and the global vaccination alliance Gavi are very well positioned worldwide and know the conditions in the individual countries best. But they too need a secure basis and a certain degree of predictability.
In addition to these legal and logistical questions, there is also the question of a certain vaccination egoism in individual Lächange a role?
We understand, of course, that the individual countries want to provide the best possible care for their own populations. But there are some rich countries that have secured higher quotas at the expense of less financially strong countries in bilateral agreements with manufacturers – and that long before the first vaccines against Covid-19 received emergency approvals. In addition, states like India imposed export restrictions when the number of cases in their own population rose sharply. Many of the cans produced there were actually supposed to be delivered to poorer countries via Covax. Of course, if we remember the pictures, the situation in India was dire. Therefore, the behavior is also understandable.
What long-term consequences does the Gates Foundation draw from the pandemic? How should theäconditions ächange?
First of all, we are convinced that vaccination is the best solution against pandemics. This means that the vaccines that are now available must be further developed. MRNA technology is an incredible success story. With it, novel vaccines could be used very quickly. Moderna developed the first vaccine candidate in just 48 hours. There will be vaccines based on mRNA not only against Covid-19, but also against many other infectious diseases, such as HIV or malaria. All over the world, production capacities are already being built up in order to be able to distribute quickly and fairly globally. Biontech is already planning to build a factory in Africa. Second, it is important to create a worldwide monitoring system in order to be able to detect new virus variants in real time and contain them in good time. There should also be a permanent, worldwide test system and a task force that are always active and quickly ready for use. In addition, global genome sequencing capacities need to be further expanded in order to respond quickly to major outbreaks. The third point is the need for global government coordination so that everyone can act in unity and determination around the world.
How can you imagine global monitoring?
Monitoring is already going much better today than at the beginning of the pandemic. The WHO is currently building a hub for pandemic and epidemic data collection in Berlin. For this purpose, data of all kinds should be made usable in order to see how pathogens spread. This applies to forecasting as well as tracking and goes hand in hand with the use of artificial intelligence. Incidentally, Germany has taken on a pioneering role here with the SORMAS e-health software, which was developed by the Helmholtz Center for Infection Research in 2014 for the fight against Ebola. Overall, of course, success will depend on the extent to which WHO member states allow the exchange of information.
The tests are all from China at the moment – wäIsn’t it a location aspect to have the tests manufactured in Germany, for example?
In a pandemic, a certain diversification in the supply chains certainly always helps, especially since Qiagen, for example, also offers diagnostics made in Germany. The tests from China worked well; they became available in large quantities in a short period of time.
What role do drugs play in corona treatment?
Fortunately, molnupiravir is the first drug that has a very good effect. The drug can reduce the death rate by 50 percent, so this is really a breakthrough. That is why the Gates Foundation is making the equivalent of more than 100 million euros available so that this therapy can also be made available to people in poor countries.
Are vaccinations becoming more important than medication?
Vaccinations are clearly more effective. We receive protection from infectivity. Even if the vaccination protection wears off over time, it does not go away. When people are vaccinated, immunity increases and fewer people get sick. That is the most efficient method.
Will we get the corona vaccinations?
Personally, I assume that we will have to continue to be vaccinated in the next few years.
The interview was conducted by Michael Maier.