Now on bbc news its time to hardtalk. Welcome to hardtalk, im stephen sackur. The roll out of covid 19 vaccines has boosted hopes the virus can be tamed, but it will have to be a worldwide effort if its to be effective, and right now the signs are not so good. While tens of millions have already been vaccinated in the rich west, the worlds poor are facing a very long wait the phrase Vaccine Apartheid has already been coined. My guest is the chief scientist at the world health organization, dr Soumya Swaminathan. Is Vaccine Inequity undermining the fight against covid . Dr Soumya Swaminathan in geneva, welcome to hardtalk. Hello, stephen. Thank you for having me. Its a pleasure to have you on the show. Lets start with an overview. Is there any reason to believe that we are getting on top of this Global Pandemic . Well, one year ago, the Director General of the who announced that this covid 19 was a Public Health emergency of international concern. That was on 30 january, 2020. And he said that there was a window of opportunity that countries had, that we all had, to get on top of the virus and to stop it from becoming a huge pandemic. One year later, were in a situation where we have crossed 100 million cases, more than 2. 2 Million People have died, and these are just recorded deaths there are probably many more uncounted deaths and deaths due to collateral effects, impact on Health Systems. But at the same time, we have new tools that we didnt have a year ago. Most importantly, we have vaccines, but we also have a lot of diagnostics and some therapeutics, some drugs. And if we use them wisely and equitably, we have another window of opportunity now to get ahead of this virus. At this point, it looks like the virus is winning because its transmitting, its growing explosively in many parts of the world, its mutating, its changing to adapt itself, to be able to transmit itself better from person to person. But i think, you know, its been unprecedented, the speed at which people have come together, scientists particularly, and have developed the new tools. Right now, its a question of how we use those tools fairly, equitably, based on moral, ethical, and scientific principles to get ahead. So a lot depends on what we do in the coming weeks and months. But if you say that right now the virus is winning, it suggests to me that we are not using the tools we have developed wisely. Yes, ithink, you know, very early on we started learning about how this virus spreads and we also know that you have to do a combination of things to stop this virus from spreading from person to person. So, for example, you have to put in place measures that, you know, physically distance people, you have to avoid people gathering together in crowds, Everyone Needs to wear a mask whenever they are in contact with people where they cannot maintain physical distancing. Universal masking, the models show, can do more to reduce mortality in the short term than even vaccines. We need to, of course, maintain hygiene and wash our hands. We need to be in places that are well ventilated, avoid crowded and closed settings. And then the governments need to put in place systems for Early Detection of cases so that you can isolate them, and this isolation needs to be supported, because many people dont have the capacity, you know, to be able to isolate themselves they may not even have a separate Room In The House where they live. So supportive isolation, quarantining of contacts, tracking and tracing contacts. So, essential Public Health measures, which, by the way, have worked in many countries that have adopted them. Yeah, we know of those measures and, frankly, weve known about them for many months. The difference, and what many people hope will be the game changer, is the roll out of a host of different vaccines now. But in mid january, your boss, dr tedros, the chief of the who, spoke of, quote, A Catastrophic Moral Failure in the way vaccines were being distributed. He pointed out that 39 million doses had already been administered when he spoke in the high Income Countries, whereas he said just 25 not 25,000 or 25 million, but 25 individual doses had been delivered in sub saharan africa. Now, if that was a moral failure of catastrophic proportions a couple of weeks ago, has anything been done to rectify it . Yes, and thats what weve been working on for the last several months. You know, from history, we know that theres always been delays between access to products in high income and low Income Countries. If you take hiv, it took more than a decade, 12 million africans had died, before anti retroviral treatments were made available to them. And now, of course, many of them are living long lives. Its the same thing happened with him by the time vaccines were made available to the developing countries, the pandemic was over. Luckily, it was not a pandemic that actually caused high mortality and so we got away with it. And this is why in april of 2020, the who got together with several countries, with foundations and with other Global Health agencies, gavi and cepi particularly for vaccines, to launch the Act Accelerator and the covax pillar. So there are pillars that focus on drugs, diagnostics and vaccines, but the covax pillar, which is gavi, cepi, the coalition for epidemic preparedness innovation, and who jointly addressing the issue, both of accelerating the development of vaccines and promoting that and facilitating that, but even more importantly, ensuring equitable access. And the covax facility. Yeah, but its not working. Its not working, dr swaminathan. I mean, the Covax Programme says that, if its lucky, it may get 3 of people in the poorest countries vaccinated by the end of the first half of this year just 3 . We already, in the uk, have a figure of around 15 of the uk population vaccinated. In israel, theyre up at 33 34 of their people vaccinated. This idea that there is a fundamental inequity between the rich world and the poor, it is profound and its utterly damaging to any notion that the world is acting together to conquer coronavirus. Yes. I mean, you know, we knew that there would be a gap between supply and demand, particularly in the first months of the year. First of all, i think we should acknowledge the fact that we got to a registered vaccine 314 days after the public announcement of the whole Genome Sequence of the sars cov 2 virus that in itself is completely unexpected, so, you know, our expectations have also become higher. Secondly, the early vaccines had 95 efficacy, again, something that nobody expected our expectations of all vaccines are higher. We currently have over 200 vaccines, you know, 63 of them in clinical development, so theres a good pipeline of products, manufacturing capacity is being ramped up as we speak and so in the months to come, we are going to see hundreds of millions of doses of vaccines flowing into countries. The covax facility has just sent out an indicative Allocation List to all the 190 countries that are members of the covax telling them what they can expect to get in the first few months of the year. Its going to start small, but its going to be distributed, you know, based on some fair allocation principles. I asked you specifically what the who. In february. But what does the who feel that it can do to hasten a more equitable distribution . For example, one of your colleagues in the who, margaret harris, sent this message to the people and government of the united kingdom. She said, once you have completed the vaccination of your vulnerable groups that is care workers, Health Workers, people aged over 70 she said, once you have done that, the message given to your population in the uk should be � you can wait� , and you should then focus on ensuring equitable Global Distribution of vaccine that you currently have, because that would, she says, clearly be the moral thing to do. So is the who message to people in britain that once the most vulnerable have been vaccinated, they should accept that then vaccines should be sent to the poorer parts of the world to protect the most vulnerable in those parts of the world . Yes, exactly. I mean, i think when we made this plan of a fair allocation and equitable distribution, we knew therell be limited supplies, and so we started prioritising the groups who should get it first. I mean, one group are clearly the Health Workers and Front Line Workers. You know, weve seen they were disproportionately affected by this pandemic. They need to be protected so they can take care of the sick and Health Systems dont collapse and then come, of course, the elderly and others who are at high risk of infection and death. Now, this constitutes about 15 20 of a countrys population. You know, it varies, but its in that range. And the 3 you mentioned earlier are the health and Front Line Workers in most countries. We are saying, lets protect these people Around The World first before we start scaling to beyond these Priority Groups and vaccinating, you know, healthier adults. I mean, that is the endgame, is to vaccinate enough people in the population so you develop the Population Immunity to break the chain of transmission so the virus then, you know, theres no longer a pandemic. But we need to reduce deaths, we need to prevent preventable deaths, and that we need to do now as soon as possible, and that can only be done if we are vaccinating these Vulnerable People all over the world. But do you recognise the profound political difficulty that comes with your message . Because you are saying to taxpayers whose taxes have been used to procure hundreds of millions of doses of vaccine for the uk government or the us, or the canadian or other rich world governments, no, youre not going to get the vaccine, your government is now going to send all of the excess vaccine that it currently has procured to poorer parts of the world to vaccinate them. Do you think thats really, seriously, going to fly in the rich world . Are citizens going to accept your argument . Well, i think there are several things that we can do, countries can do and manufacturers can do. The first is that a lot of the vaccines have been developed through, you know, public funds, including from Philanthropic Organisations and private public partnerships, and these require that there should be some equitable access provisions built in when this happens. Its true that many of the high Income Countries have really invested heavily in the development of vaccines, and this has been done over many years, the platforms have been built over many years. One thing we can do is to expand manufacturing, and companies that have successful vaccines can and should partner with others that have the capacity to manufacture, have spare manufacturing capacity in different parts of the world, and we try to use as much of that thats available in the world to really ramp up the production. And the third thing is the messaging. Of course, there is a message of Global Solidarity here. Its a message of humanity. You know, a life in every country is worth the same. But ill be honest with you. While were not asking any country not to protect. Yes, forgive the interruption. I have to be honest, what we see, particularly in europe and in the rich world, isnt so much solidarity. We see vaccine nationalism. Weve seen a big fight between the eu and astrazeneca about supplies of the Oxford Astrazeneca vaccine, which ended up with the eu threatening to block all exportation of vaccine made in the eu to destinations outside the eu because they said it wasnt prepared to see vaccine leave the eu when they werent getting the supplies that they claimed theyd already ordered and paid for. So in this context of vaccine nationalism, which, frankly, appears to be spreading Around The World, what hope do you have for this sentiment of Global Solidarity . Well, you know, were linked in so many ways that itll be impossible, really, if countries start closing their borders and so on, because if you look at supply chains, vaccines are not all made and manufactured and packaged in one place. You know, they move across borders. The raw material is made in some part of the world, its shipped across, and the finish happens somewhere else. And then, you know, its packaged and distributed. So countries need to cooperate for this. And i think this is where we really need to come together. And its notjust the moral and ethical argument. You know, theres also an economic argument to countries helping each other. If you have islands in the world that are well protected, where the entire population is protected, and the rest of the world, the pandemic is raging, new variants are emerging, the virus continues to multiply and spread. And weve seen that these variants cross borders. They dont respect borders, and theyre going to come back and infect people all over again, apart from the fact that lots of people are also dying unnecessarily in these countries that dont have access. And a recent Economic Analysis done by the International Chamber of commerce showed that if we do not distribute vaccines equitably, the world could be looking at a loss of Something Like 9. 2 trillion in 2021, and half of that would be borne by the high Income Countries. Youre the Chief Scientific Officer for the who, dr swaminathan. Just a quick word on a lot of noise and discussion about the efficacy of different vaccines, because, again, Public Confidence and public trust is really important here. President macron in france, in the middle of this spat with astrazeneca, he then turned his attention to efficacy and he looked at the Oxford Astrazeneca vaccine and he said, im not even sure it works for the over 655. He says it may be quasi ineffective. When you hear political leaders wading into the science debate like that and airing opinions which seem to be more informed by, shall i say, politics than science, are you concerned what its doing to public trust . Yes, i mean, ithink, you know, we know that vaccines. Traditionally, there are challenges in vaccine acceptance, more in some countries than in other parts of the world. Its really important that we focus on the science and the data and the evidence and that we let the institutions that have the responsibility to examine that data, the regulatory agencies and countries and the other bodies that have been set up to do that, make these pronouncements. And then we trust that these agencies, including the who, which has the sage, which is the independent expert group that gives Policy Guidance on immunisation, and then we have our regulatory and prequalification teams. They, of course, work with regulators Around The World. But once the pq team has prequalified a vaccine, we can trust that its efficacious, safe and that its been manufactured to some quality standards. So i think this is not a question of an individual� s view. Its really a question of what the data show. And to me so far, all the results that weve seen some of them are through Press Releases and some of them are through publications are very encouraging. Forgive the interruption. We can have safe and efficacious vaccines. Right. Forgive the interruption again, but would you say, as you look Around The World because we shouldnt just focus on the west here but as you look at the Sinopharm Chinese vaccine, you look at sputnik v, the russian vaccine, some in europe now saying, you know what . Well sign deals to get these vaccines, because theyre easierfor us to procure than some of the ones made in europe and in the west. Are you saying the who is entirely happy and confident that all of these different vaccines are both safe and efficacious . So, what i said was, once we have examined the data and the Committee Says that this vaccine can be put on the Emergency Use List or can be prequalified and the sage gives Policy Guidance on a vaccine, that means that we are satisfied with the data weve seen. Currently, weve only put on the emergency listing the pfizer vaccine. But we are working with 12 other manufacturers, including the russians, the chinese, the indian and so on, to look at the data. And im confident that in the weeks to come, we will be putting on that list more vaccines. Im not saying that the vaccines out there are going to be useful. With respect, dont you need to hurry up . I mean, the uk authorised its first vaccine for use in early december. Here we are at the beginning of february and youre saying that youve still only managed to entirely certify one vaccine and that it may be weeks before you certify some of the others. Whats holding you back . So, this is a really good point, and we really encourage manufacturers, even those who are at an early stage, to come to us with their data, because the earlier we can see the data, the earlier we can get prepared. The a