COVID-19 isn’t over. Variants are proof.

As mask mandates lifted in April, many celebrated—some of them, mid-flight. Others watched in horror.

For some, the moment marked a long-awaited return to “normal.” But for others, including millions of people living with chronic illnesses and millions more who have yet to receive a single dose of a vaccine, the moment was a stark reminder of the disparities that have persisted three years into the pandemic.

Since vaccines first became available, the U.S. and other wealthy nations bought up the world’s supply. The Biden administration refused to take necessary steps to scale vaccine supply to meet global demand, such as building new factories and compelling the sharing of vaccine technology, despite calls from Partners In Health and others in the People’s Vaccine movement to do so.

Now, that inaction has cost millions of lives. And it’s created a breeding ground for variants.

There remain many unknowns about these variants—for instance, how “mild” they are, or how long currently available vaccines will protect against severe illness. But for public health experts, including those at PIH, the message is clear: COVID-19 isn’t going away. It’s just getting smarter.

“I don’t think that the pandemic is over,” says Dr. KJ Seung, senior health and policy advisor at PIH and co-leader of endTB. “I think that we’re going to have successive waves of death and sickness because of multiple variants. Some may not be as bad as what we’ve had in the past, but some could be worse.”

A Missed Opportunity

As variants like Omicron BA.2 threaten to weaken the impact of the vaccines, U.S. drug-makers are scrambling to update their shots to protect against severe illness. An annual shot, like the flu vaccine, may be needed, says Seung. And that’s where the conversation is focused in wealthy nations.

A third of the world’s population hasn’t received a single dose of any COVID-19 vaccine. Millions more lack access to three doses of a mRNA vaccine—currently considered the gold standard COVID-19 vaccination series in the U.S.

“In terms of vaccine equity, it’s a major problem,” says Seung, whose career has focused on fighting infectious diseases like tuberculosis. “We can’t even get first doses into most of the world. So now if people need annual vaccines or annual boosters on top of that, we’re going to have a really difficult time meeting demand.”

Public health experts are watching another troubling trend: Variants like Omicron BA.2 are spreading even in populations with 70% vaccination and booster coverage, showing that the virus, unchecked in its spread, is evolving in ways that can evade the vaccines' protections.

“We have billions of people who are infected with this virus. And when we just have that huge ocean of virus going around, the likelihood of mutations goes up exponentially,” says Seung. “You just don’t know what sort of variants are going to come out of that.”

Much of that suffering could have been prevented, experts say, had the U.S. allowed its vaccines to be mass produced and distributed to the world’s population, as PIH has called for since 2020.

“Vaccines were so effective against the earlier strains that we might have prevented the Omicron variant had we vaccinated the world fast enough with our most effective vaccines,” says Garrett Wilkinson, government relations and policy officer with PIH’s Advocacy team. “We really missed that opportunity.”

As Big Pharma Profits, Thousands Die

Instead, the U.S. government failed to act. That inaction has only continued.

Even as Omicron cases tick upwards, the U.S. has dialed down its COVID-19 response. The U.S. Congress recently cut $5 billion in proposed funding for the global COVID-19 response, though it kept funding for domestic efforts.

These setbacks have led public health experts and advocates to grapple with the reality of a world where vaccine protection has been secured for the world’s wealthy—at the expense of the world’s poor—even as that protection itself has begun to wane.

“We lost,” says Wilkinson. “Just as we warned could happen, our vaccines that we poured tens of billions of dollars into developing and producing now don’t work as well as we thought they would, because we waited too long to vaccinate the world and let new variants emerge.”

Without any U.S. government intervention in the interest of public health, pharmaceutical companies continue to refuse to share vaccine technology or scale vaccine production to meet global needs, even as thousands die every day from COVID-19. Pfizer stands to make $101.3 billion this year, in large part due to its COVID vaccine—an unheard-of level of revenue in the pharmaceutical industry.

“With the mRNA vaccines, big pharma is really trying to keep a monopoly situation as long as possible,” says Seung. “That’s clearly not going to work at this point. We thought people were fully vaccinated at two doses. Now they’re talking about four. This doesn’t even get into variant-specific boosters.”

It’s unclear what the next chapter of global COVID-19 advocacy will involve. But one thing is certain: vaccinating wealthy nations and leaving the rest of the world behind has come with consequences.

“Although COVID-19 vaccination still prevents hospitalizations and saves lives, our vaccines no longer work as well against Omicron as they did against previous variants,” says Wilkinson. “That’s precisely because of a failure of global solidarity.”