"I want to wait and watch."

This is a peculiar response I receive from my friends and some family members in the United States when I ask them about their thoughts on COVID-19 vaccination. This is a peculiar response for a couple of reasons: COVID-19 vaccines are exceptionally effective, are now readily available and are the best way to end the pandemic and return to normalcy.

This skeptical response is reflective of broader trends in the United States: An NPR/Marist poll this spring revealed that up to one-fourth of the national population would decline to get vaccinated even when offered.

This is also a very American response in a country where the proportion of fully vaccinated people is now roughly 45%.

Two vastly different vaccine rollouts

The vaccine rollout at the global level has markedly different dynamics. As of June 16, almost 80% of the global population has not received a COVID-19 vaccine. In low-resource countries, the vaccination rate is less than 1%. These statistics match with the lived experiences of my family and friends in India and other countries where coronavirus infection continues to cause immense suffering.

The response in these places is more somber.

"I just want a chance at vaccination." That's what I'm hearing from my friends and family in countries where vaccines are not readily available.

In these countries, older people long to spend time with their grandkids, college students want to go back to school and those who earn their living on a daily-wage basis want to support their families without the risk of infection or hospitalization. None of them can safely engage in these activities.

These trends reveal two distinct patterns, and one is happening at the expense of the other. The trends of vaccine hesitancy and refusal in the U.S. are a sign of extreme privilege. This privilege is exhibited by those who continue to reject vaccinations even though COVID-19 vaccines — and the support, such as free child care for parents and caregivers to get vaccinated — are now readily available.

Hoarding resources and expertise

There's another trend at play, one that I find equally disturbing: vaccine nationalism. Rich countries are hoarding vaccines and unwilling to share the resources and the technological expertise needed for other countries to manufacture vaccines.

From a global health perspective, I fully endorse initiatives to encourage vaccination in the United States. But I believe it is a cause of deep moral concern that rich countries are giving priority to vaccinating low-risk populations in their own countries, such as teenagers, rather than sharing the excess supply with countries battling the infection surge. It's simply not fair.

For example, Africa is home to more than 1 billion people, and yet is one of the regions where fewer than 1% have been fully vaccinated. High-risk groups, including front-line health care workers, often do not have an option to get vaccinated. And several nations in the continent have not received any supplies at all.

These actions have long-term health policy implications as COVID-19 vaccines are also necessary to preserve the health of the limited number of care providers who are risking their lives to treat patients in these countries. In India, more than 500 doctors have already lost their lives and thousands have been infected while battling COVID-19. In the last two to three months, every time I called Kashmir — the place where I grew up — I was either speaking with someone who was infected or had a family member who was sick.

An immigrant's perspective

As an immigrant in the U.S., I am in the uniquely painful position of witnessing two sides of this story: friends and family here who are unwilling to get vaccines and loved ones in other countries who are unable to get vaccines. Whenever I discuss the refusal of getting vaccinated in the U.S. with people in other countries, they are often baffled that American policymakers need to provide monetary incentives to convince people to get vaccinated against the coronavirus, while in their countries, people are desperately seeking any way to get out of this pandemic.

Besides, access to vaccines is not the only issue internationally. Conflict-afflicted areas, including the Palestinian territories, Kashmir and Somalia, have fragile sociopolitical environments where vaccine delivery strategies are further strained as a result of security restrictions. And vaccine misinformation is ubiquitous.

This month, President Biden has announced the donation of hundreds of millions of COVID-19 vaccine doses to low-resource countries. While this move is a step in the right direction, it's nowhere close to enough. Analysts estimate that it would take more than 10 billion doses to enable return to normalcy at the global level. Vaccine manufacturing capacity has been limited to 1.73 billion doses until now.

What the lofty announcements often miss is that without boosting local manufacturing of vaccines through sharing of raw materials and enabling technology transfer, such donations will continue to be inadequate. With the delta variant now observed in 74 countries, and no consensus on how to vaccinate a majority of the global population, vaccine unavailability could lead to increased spread of the virus that could lead to more mutations in the virus.

Rich — and oblivious — countries

This ongoing COVID-19 vaccine distribution crisis has revealed the core drivers of inequity in global health: People in rich countries do not recognize the universality of health care problems and often see infectious disease outbreaks as problems for "other people in other countries." The major lesson of the pandemic — that infections do not respect national boundaries — is yet to be heeded.

So for the people who say, "I want to watch and wait," I would like to remind them that their vacillations are reckless and cruel. They upend the sacrifices we have all made together to end the pandemic. By not doing your part to reduce the risks, you increase the risks for all of us. And that's a very peculiar response to this catastrophic pandemic.

Dr. Junaid Nabi is a health systems researcher working at the intersection of health care reform and innovation. As an Emerging Leaders Fellow with the UNA-USA in spring 2020, he led the development of educational collaborations on COVID-19 response. He is a New Voices Senior Fellow at the Aspen Institute and serves on the Working Group on Regulatory Considerations for Digital Health and Innovation at the World Health Organization. Twitter: @JunaidNabiMD.

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Tags: COVID-19  vaccine hesitancy  pandemic  vaccination