Can an “old school” vaccine address global inequities in Covid-19 vaccination?
When the COVID-19 pandemic began invading the world in late 2019, Peter Hotez and Maria Elena Bottazzi set out to create a low-cost vaccine that would help inoculate populations in low- and middle-income countries. The scientists, with their prior experience of developing inexpensive vaccines for the world’s poor, had anticipated that the global rollout of Covid-19 jabs would be marked with several inequities. They wanted to create a patent-free vaccine to bridge this gap, but the U.S. government did not seem impressed, forcing the researchers to turn to private philanthropies for funds.
Hotez and Bottazzi, both scientists at the Texas Children’s Hospital Center for Vaccine Development at Baylor College of Medicine, raised about $9 million in private funds. Meanwhile, the U.S. government’s contribution stood at $400,000.
“That was a very tough time early on in the pandemic, you know, trying to do the work and raise the money for it at the same time,” says Hotez, who was nominated in February for a Nobel Peace Prize with Bottazzi for their COVID-19 vaccine. He adds that at the beginning of the pandemic, governments emphasized speed, innovation and rapidly immunizing populations in North America and Europe with little consideration for poorer countries. “We knew this [vaccine] was going to be the answer to global vaccine inequality, but I just wish the policymakers had felt the same,” says Hotez.
Over the past two years, the world has witnessed 488 million COVID-19 infections and over 61 million deaths. Over 11 billion vaccine doses have been administered worldwide; however, the global rollout of COVID-19 vaccines is marked with alarming socio-economic inequities. For instance, 72 percent of the population in high-income countries has received at least one dose of the vaccine, whereas the number stands at 15 percent in low-income countries.
This inequity is worsening vulnerabilities across the world, says Lawrence Young, a virologist and co-lead of the Warwick Health Global Research Priority at the UK-based University of Warwick. “As long as the virus continues to spread and replicate, particularly in populations who are under-vaccinated, it will throw up new variants and these will remain a continual threat even to those countries with high rates of vaccination,” says Young, “Therefore, it is in all our interests to ensure that vaccines are distributed equitably across the world.”
“When your house is on fire, you don't call the patent attorney,” says Hotez. “We wanted to be the fire department.”
The vaccine developed by Hotez and Bottazzi recently received emergency use authorisation in India, which plans to manufacture 100 million doses every month. Dubbed ‘Corbevax’ by its Indian maker, Biological E Limited, the vaccine is now being administered in India to children aged 12-14. The patent-free arrangement means that other low- and middle-income countries could also produce and distribute the vaccine locally.
“When your house is on fire, you don't call the patent attorney, you call the fire department,” says Hotez, commenting on the intellectual property rights waiver. “We wanted to be the fire department.”
The Inequity
Vaccine equity simply means that all people, irrespective of their location, should have equal access to vaccines. However, data suggests that the global COVID-19 vaccine rollout has favoured those in richer countries. For instance, high-income countries like the UAE, Portugal, Chile, Singapore, Australia, Malta, Hong Kong and Canada have partially vaccinated over 85 percent of their populations. This percentage in poorer countries, meanwhile, is abysmally low – 2.1 percent in Yemen, 4.6 in South Sudan, 5 in Cameroon, 9.9 in Burkina Faso, 10 in Nigeria, 12 in Somalia, 12 in Congo, 13 in Afghanistan and 21 in Ethiopia.
In late 2019, scientists Peter Hotez and Maria Elena Bottazzi set out to create a low-cost vaccine that would help inoculate populations in low- and middle-income countries. In February, they were nominated for a Nobel Peace Prize.
Texas Children's Hospital
The COVID-19 vaccination coverage is particularly low in African countries, and according to Shabir Madhi, a vaccinologist at the University of the Witwatersrand, Johannesburg and co-director of African Local Initiative for Vaccinology Expertise, vaccine access and inequity remains a challenge in Africa. Madhi adds that a lack of vaccine access has affected the pandemic’s trajectory on the continent, but a majority of its people have now developed immunity through natural infection. “This has come at a high cost of loss of lives,” he says.
COVID-19 vaccines mean a significant financial burden for poorer countries, which spend an average of $41 per capita annually on health, while the average cost of every COVID-19 vaccine dose ranges between $2 and $40 in addition to a distribution cost of $3.70 per person for two doses. In December last year, the World Health Organisation (WHO) set a goal of immunizing 70 percent of the population of all countries by mid-2022. This, however, means that low-income countries would have to increase their health expenditure by an average of 56.6 percent to cover the cost, as opposed to 0.8 per cent in high-income countries.
Reflecting on the factors that have driven global inequity in COVID-19 vaccine distribution, Andrea Taylor, assistant director of programs at the Duke Global Health Innovation Center, says that wealthy nations took the risk of investing heavily in the development and scaling up of COVID-19 vaccines – at a time when there was little evidence to show that vaccines would work. This reserved a place for these nations at the front of the queue when doses started rolling off production lines. Lower-income countries, meanwhile, could not afford such investments.
“Now, however, global supply is not the issue,” says Taylor. “We are making plenty of doses to meet global need. The main problem is infrastructure to get the vaccine where it is most needed in a predictable and timely way and to ensure that countries have all the support they need to store, transport, and use the vaccine once it is received.”
Taufique Joarder, vice-chairperson of Bangladesh's Public Health Foundation, sees the need for more trials and data before Corbevax is made available to the general population.
In addition to global inequities in vaccination coverage, there are inequities within nations. Taufique Joarder, vice-chairperson of Bangladesh’s Public Health Foundation, points to the situation in his country, where vaccination coverage in rural and economically disadvantaged communities has suffered owing to weak vaccine-promotion initiatives and the difficulty many people face in registering online for jabs.
Joarder also cites the example of the COVID-19 immunization drive for children aged 12 years and above. “[Children] are given the Pfizer vaccine, which requires an ultralow temperature for storage. This is almost impossible to administer in many parts of the country, especially the rural areas. So, a large proportion of the children are being left out of vaccination,” says Joarder, adding that Corbevax, which is cheaper and requires regular temperature refrigeration “can be an excellent alternative to Pfizer for vaccinating rural children.”
Corbevax vs. mRNA Vaccines
As opposed to most other COVID-19 vaccines, which use the new Messenger RNA (mRNA) vaccine technology, Corbevax is an “old school” vaccine, says Hotez. The vaccine is made through microbial fermentation in yeast, similar to the process used to produce the recombinant hepatitis B vaccine, which has been administered to children in several countries for decades. Hence, says Hotez, the technology to produce Corbevax at large scales is already in place in countries like Vietnam, Bangladesh, India, Indonesia, Brazil, Argentina, among many others.
“So if you want to rapidly develop and produce and empower low- and middle-income countries, this is the technology to do it,” he says.
“Global access to high-quality vaccines will require serious investment in other types of COVID-19 vaccines," says Andrea Taylor.
The COVID-19 vaccines created by Pfizer-BioNTech and Moderna marked the first time that mRNA vaccine technology was approved for use. However, scientists like Young feel that there is “a need to be pragmatic and not seduced by new technologies when older, tried and tested approaches can also be effective.” Taylor, meanwhile, says that although mRNA vaccines have dominated the COVID-19 vaccine market in the U.S., “there is no clear grounding for this preference in the data we have so far.” She adds that there is also growing evidence that the immunity from these shots may not hold up as well over time as that of vaccines using different platforms.
“The mRNA vaccines are well suited to wealthy countries with sufficient ultra-cold storage and transportation infrastructure, but these vaccines are divas and do not travel well in the rest of the world,” says Taylor. “Global access to high-quality vaccines will require serious investment in other types of COVID-19 vaccines, such as the protein subunit platform used by Novavax and Corbevax. These require only standard refrigeration, can be manufactured using existing facilities all over the world, and are easy to transport.”
Joarder adds that Corbevax is cheaper due to the developers’ waived intellectual rights. It could also be used as a booster vaccine in Bangladesh, where only five per cent of the population has currently received booster doses. “If this vaccine is proved effective for heterologous boosting, [meaning] it works well and is well tolerated as a booster with other vaccines that are available in Bangladesh, this can be useful,” says Joarder.
According to Hotez, Corbevax can play several important roles - as a standalone adult or paediatric vaccine, and as a booster for other vaccines. Studies are underway to determine Corbevax’s effectiveness in these regards, he says.
Need for More Data
Biological E conducted two clinical trials involving 3000 subjects in India, and found Corbevax to be “safe and immunogenic,” with 90 percent effectiveness in preventing symptomatic infections from the original strain of COVID-19 and over 80 percent effectiveness against the Delta variant. The vaccine is currently in use in India, and according to Hotez, it’s in the pipeline at different stages in Indonesia, Bangladesh and Botswana.
However, Corbevax is yet to receive emergency use approval from the WHO. Experts such as Joarder see the need for more trials and data before it is made available to the general population. He says that while the WHO’s emergency approval is essential for global scale-up of the vaccine, we need data to determine age-stratified efficacy of the vaccine and whether it can be used for heterologous boosting with other vaccines. “According to the most recent data, the 100 percent circulating variant in Bangladesh is Omicron. We need to know how effective is Corbevax against the Omicron variant,” says Joarder.
Shabir Madhi, a vaccinologist at the University of the Witwatersrand, Johannesburg and co-director of the African Local Initiative for Vaccinology Expertise, says that a majority of people in Africa have now developed immunity through natural infection. “This has come at a high cost of loss of lives."
Shivan Parusnath
Others, meanwhile, believe that availing vaccines to poorer countries is not enough to resolve the inequity. Young, the Warwick virologist, says that the global vaccination rollout has also suffered from a degree of vaccine hesitancy, echoing similar observations by President Biden and Pfizer’s CEO. The problem can be blamed on poor communication about the benefits of vaccination. “The Corbevax vaccine [helps with the issues of] patent protection, vaccine storage and distribution, but governments need to ensure that their people are clearly informed.” Notably, however, some research has found higher vaccine willingness in lower-income countries than in the U.S.
Young also emphasized the importance of establishing local vaccination stations to improve access. For some countries, meanwhile, it may be too late. Speaking about the African continent, Madhi says that Corbevax has arrived following the peak of the crisis and won’t reverse the suffering and death that has transpired because of vaccine hoarding by high-income countries.
“The same goes for all the sudden donations from countries such as France - pretty much of little to no value when the pandemic is at its tail end,” says Madhi. “This, unfortunately, is a repeat of the swine flu pandemic in 2009, when vaccines only became available to Africa after the pandemic had very much subsided.”
Researchers probe extreme gene therapy for severe alcoholism
Story by Freethink
A single shot — a gene therapy injected into the brain — dramatically reduced alcohol consumption in monkeys that previously drank heavily. If the therapy is safe and effective in people, it might one day be a permanent treatment for alcoholism for people with no other options.
The challenge: Alcohol use disorder (AUD) means a person has trouble controlling their alcohol consumption, even when it is negatively affecting their life, job, or health.
In the U.S., more than 10 percent of people over the age of 12 are estimated to have AUD, and while medications, counseling, or sheer willpower can help some stop drinking, staying sober can be a huge struggle — an estimated 40-60 percent of people relapse at least once.
A team of U.S. researchers suspected that an in-development gene therapy for Parkinson’s disease might work as a dopamine-replenishing treatment for alcoholism, too.
According to the CDC, more than 140,000 Americans are dying each year from alcohol-related causes, and the rate of deaths has been rising for years, especially during the pandemic.
The idea: For occasional drinkers, alcohol causes the brain to release more dopamine, a chemical that makes you feel good. Chronic alcohol use, however, causes the brain to produce, and process, less dopamine, and this persistent dopamine deficit has been linked to alcohol relapse.
There is currently no way to reverse the changes in the brain brought about by AUD, but a team of U.S. researchers suspected that an in-development gene therapy for Parkinson’s disease might work as a dopamine-replenishing treatment for alcoholism, too.
To find out, they tested it in heavy-drinking monkeys — and the animals’ alcohol consumption dropped by 90% over the course of a year.
How it works: The treatment centers on the protein GDNF (“glial cell line-derived neurotrophic factor”), which supports the survival of certain neurons, including ones linked to dopamine.
For the new study, a harmless virus was used to deliver the gene that codes for GDNF into the brains of four monkeys that, when they had the option, drank heavily — the amount of ethanol-infused water they consumed would be equivalent to a person having nine drinks per day.
“We targeted the cell bodies that produce dopamine with this gene to increase dopamine synthesis, thereby replenishing or restoring what chronic drinking has taken away,” said co-lead researcher Kathleen Grant.
To serve as controls, another four heavy-drinking monkeys underwent the same procedure, but with a saline solution delivered instead of the gene therapy.
The results: All of the monkeys had their access to alcohol removed for two months following the surgery. When it was then reintroduced for four weeks, the heavy drinkers consumed 50 percent less compared to the control group.
When the researchers examined the monkeys’ brains at the end of the study, they were able to confirm that dopamine levels had been replenished in the treated animals, but remained low in the controls.
The researchers then took the alcohol away for another four weeks, before giving it back for four. They repeated this cycle for a year, and by the end of it, the treated monkeys’ consumption had fallen by more than 90 percent compared to the controls.
“Drinking went down to almost zero,” said Grant. “For months on end, these animals would choose to drink water and just avoid drinking alcohol altogether. They decreased their drinking to the point that it was so low we didn’t record a blood-alcohol level.”
When the researchers examined the monkeys’ brains at the end of the study, they were able to confirm that dopamine levels had been replenished in the treated animals, but remained low in the controls.
Looking ahead: Dopamine is involved in a lot more than addiction, so more research is needed to not only see if the results translate to people but whether the gene therapy leads to any unwanted changes to mood or behavior.
Because the therapy requires invasive brain surgery and is likely irreversible, it’s unlikely to ever become a common treatment for alcoholism — but it could one day be the only thing standing between people with severe AUD and death.
“[The treatment] would be most appropriate for people who have already shown that all our normal therapeutic approaches do not work for them,” said Grant. “They are likely to create severe harm or kill themselves or others due to their drinking.”
This article originally appeared on Freethink, home of the brightest minds and biggest ideas of all time.
Massive benefits of AI come with environmental and human costs. Can AI itself be part of the solution?
The recent explosion of generative artificial intelligence tools like ChatGPT and Dall-E enabled anyone with internet access to harness AI’s power for enhanced productivity, creativity, and problem-solving. With their ever-improving capabilities and expanding user base, these tools proved useful across disciplines, from the creative to the scientific.
But beneath the technological wonders of human-like conversation and creative expression lies a dirty secret—an alarming environmental and human cost. AI has an immense carbon footprint. Systems like ChatGPT take months to train in high-powered data centers, which demand huge amounts of electricity, much of which is still generated with fossil fuels, as well as water for cooling. “One of the reasons why Open AI needs investments [to the tune of] $10 billion from Microsoft is because they need to pay for all of that computation,” says Kentaro Toyama, a computer scientist at the University of Michigan. There’s also an ecological toll from mining rare minerals required for hardware and infrastructure. This environmental exploitation pollutes land, triggers natural disasters and causes large-scale human displacement. Finally, for data labeling needed to train and correct AI algorithms, the Big Data industry employs cheap and exploitative labor, often from the Global South.
Generative AI tools are based on large language models (LLMs), with most well-known being various versions of GPT. LLMs can perform natural language processing, including translating, summarizing and answering questions. They use artificial neural networks, called deep learning or machine learning. Inspired by the human brain, neural networks are made of millions of artificial neurons. “The basic principles of neural networks were known even in the 1950s and 1960s,” Toyama says, “but it’s only now, with the tremendous amount of compute power that we have, as well as huge amounts of data, that it’s become possible to train generative AI models.”
Though there aren’t any official figures about the power consumption or emissions from data centers, experts estimate that they use one percent of global electricity—more than entire countries.
In recent months, much attention has gone to the transformative benefits of these technologies. But it’s important to consider that these remarkable advances may come at a price.
AI’s carbon footprint
In their latest annual report, 2023 Landscape: Confronting Tech Power, the AI Now Institute, an independent policy research entity focusing on the concentration of power in the tech industry, says: “The constant push for scale in artificial intelligence has led Big Tech firms to develop hugely energy-intensive computational models that optimize for ‘accuracy’—through increasingly large datasets and computationally intensive model training—over more efficient and sustainable alternatives.”
Though there aren’t any official figures about the power consumption or emissions from data centers, experts estimate that they use one percent of global electricity—more than entire countries. In 2019, Emma Strubell, then a graduate researcher at the University of Massachusetts Amherst, estimated that training a single LLM resulted in over 280,000 kg in CO2 emissions—an equivalent of driving almost 1.2 million km in a gas-powered car. A couple of years later, David Patterson, a computer scientist from the University of California Berkeley, and colleagues, estimated GPT-3’s carbon footprint at over 550,000 kg of CO2 In 2022, the tech company Hugging Face, estimated the carbon footprint of its own language model, BLOOM, as 25,000 kg in CO2 emissions. (BLOOM’s footprint is lower because Hugging Face uses renewable energy, but it doubled when other life-cycle processes like hardware manufacturing and use were added.)
Luckily, despite the growing size and numbers of data centers, their increasing energy demands and emissions have not kept pace proportionately—thanks to renewable energy sources and energy-efficient hardware.
But emissions don’t tell the full story.
AI’s hidden human cost
“If historical colonialism annexed territories, their resources, and the bodies that worked on them, data colonialism’s power grab is both simpler and deeper: the capture and control of human life itself through appropriating the data that can be extracted from it for profit.” So write Nick Couldry and Ulises Mejias, authors of the book The Costs of Connection.
The energy requirements, hardware manufacture and the cheap human labor behind AI systems disproportionately affect marginalized communities.
Technologies we use daily inexorably gather our data. “Human experience, potentially every layer and aspect of it, is becoming the target of profitable extraction,” Couldry and Meijas say. This feeds data capitalism, the economic model built on the extraction and commodification of data. While we are being dispossessed of our data, Big Tech commodifies it for their own benefit. This results in consolidation of power structures that reinforce existing race, gender, class and other inequalities.
“The political economy around tech and tech companies, and the development in advances in AI contribute to massive displacement and pollution, and significantly changes the built environment,” says technologist and activist Yeshi Milner, who founded Data For Black Lives (D4BL) to create measurable change in Black people’s lives using data. The energy requirements, hardware manufacture and the cheap human labor behind AI systems disproportionately affect marginalized communities.
AI’s recent explosive growth spiked the demand for manual, behind-the-scenes tasks, creating an industry described by Mary Gray and Siddharth Suri as “ghost work” in their book. This invisible human workforce that lies behind the “magic” of AI, is overworked and underpaid, and very often based in the Global South. For example, workers in Kenya who made less than $2 an hour, were the behind the mechanism that trained ChatGPT to properly talk about violence, hate speech and sexual abuse. And, according to an article in Analytics India Magazine, in some cases these workers may not have been paid at all, a case for wage theft. An exposé by the Washington Post describes “digital sweatshops” in the Philippines, where thousands of workers experience low wages, delays in payment, and wage theft by Remotasks, a platform owned by Scale AI, a $7 billion dollar American startup. Rights groups and labor researchers have flagged Scale AI as one company that flouts basic labor standards for workers abroad.
It is possible to draw a parallel with chattel slavery—the most significant economic event that continues to shape the modern world—to see the business structures that allow for the massive exploitation of people, Milner says. Back then, people got chocolate, sugar, cotton; today, they get generative AI tools. “What’s invisible through distance—because [tech companies] also control what we see—is the massive exploitation,” Milner says.
“At Data for Black Lives, we are less concerned with whether AI will become human…[W]e’re more concerned with the growing power of AI to decide who’s human and who’s not,” Milner says. As a decision-making force, AI becomes a “justifying factor for policies, practices, rules that not just reinforce, but are currently turning the clock back generations years on people’s civil and human rights.”
Ironically, AI plays an important role in mitigating its own harms—by plowing through mountains of data about weather changes, extreme weather events and human displacement.
Nuria Oliver, a computer scientist, and co-founder and vice-president of the European Laboratory of Learning and Intelligent Systems (ELLIS), says that instead of focusing on the hypothetical existential risks of today’s AI, we should talk about its real, tangible risks.
“Because AI is a transverse discipline that you can apply to any field [from education, journalism, medicine, to transportation and energy], it has a transformative power…and an exponential impact,” she says.
AI's accountability
“At the core of what we were arguing about data capitalism [is] a call to action to abolish Big Data,” says Milner. “Not to abolish data itself, but the power structures that concentrate [its] power in the hands of very few actors.”
A comprehensive AI Act currently negotiated in the European Parliament aims to rein Big Tech in. It plans to introduce a rating of AI tools based on the harms caused to humans, while being as technology-neutral as possible. That sets standards for safe, transparent, traceable, non-discriminatory, and environmentally friendly AI systems, overseen by people, not automation. The regulations also ask for transparency in the content used to train generative AIs, particularly with copyrighted data, and also disclosing that the content is AI-generated. “This European regulation is setting the example for other regions and countries in the world,” Oliver says. But, she adds, such transparencies are hard to achieve.
Google, for example, recently updated its privacy policy to say that anything on the public internet will be used as training data. “Obviously, technology companies have to respond to their economic interests, so their decisions are not necessarily going to be the best for society and for the environment,” Oliver says. “And that’s why we need strong research institutions and civil society institutions to push for actions.” ELLIS also advocates for data centers to be built in locations where the energy can be produced sustainably.
Ironically, AI plays an important role in mitigating its own harms—by plowing through mountains of data about weather changes, extreme weather events and human displacement. “The only way to make sense of this data is using machine learning methods,” Oliver says.
Milner believes that the best way to expose AI-caused systemic inequalities is through people's stories. “In these last five years, so much of our work [at D4BL] has been creating new datasets, new data tools, bringing the data to life. To show the harms but also to continue to reclaim it as a tool for social change and for political change.” This change, she adds, will depend on whose hands it is in.