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Dec. 2, 2021

Faculty voice: Dealing with COVID-19 'survivor's guilt'

Maji Hailemariam Debena is a public health reasearcher and assistant professor in the Department of Gynecology and Reproductive Biology in the College of Human Medicine. The following faculty voice is an op-ed repurposed from AllAfrica.

My life as an African researcher gives me a unique grasp of the issue of health inequality. I was born in a small rural town in Ethiopia, and am currently working in Flint, Michigan, a city that has gained international renown as a source of lead contaminated water that was ignored by public officials.

And if that doesn't convince you of my expertise, I also spent six months of this past year working from my parent's house in Hawassa, Ethiopia, fighting to get access to COVID-19 vaccines for me and my family with very little success.

But less than an hour after my plane landed at Dulles Airport in August, I got to choose between two vaccines for my first dose at a drugstore. I might even be eligible for a booster soon. Working between Africa and the U.S. lets me experience both worlds in their rawness, and I navigate a kaleidoscope of emotions. My two strikingly different realities force me to live in the shadow of survivor's guilt, and I'll remain here until I know that people everywhere have access to a life-saving vaccine.

So far, Ethiopia has vaccinated about 2% of its more than 118 million citizens. When I returned last February, Ethiopia received its first delivery of 2.2 million doses of Covid-19 vaccine through the COVAX program. The country prioritized health care workers, followed by high-risk populations. My dad and a few other people I know were eligible under the high-risk category. It took almost three months for him to get his second dose. And my mother says she's "willing to wait," which makes my heart sink. Since that first shipment, the country received more vaccine donations from the "global north" but most doses go to people in big cities. Seventy-eight percent of Ethiopians live in rural areas.

My father-in-law in South Africa died of COVID in June while waiting for his shots. He passed away a week before his appointment for his first shot, at the age of 72. It is baffling to me to see 5-year-olds in high-income countries get vaccinated while the elderly like my father-in-law die in Africa while waiting to receive the vaccine. But its not just the kids getting vaccinated before the elderly that disturbs me. Different pharmacies are now reporting the number of COVID vaccines they had to discard. In the past six months alone, over 15 million COVID vaccine doses have been discarded in the US.

Meanwhile, my second dose of vaccine allowed me to attend in-person meetings and classroom settings. I can go to public events and stores that require vaccination. I can feel less worried about getting severely ill if I contract COVID. This is an extreme privilege for me, but it is also reminds me of how empty the talk about decolonizing knowledge and global vaccine access is. In the absence of true global solidarity, the concept of global health remains elusive. For low-income countries, inability to afford and difficulty to ship the vaccines produced elsewhere means more preventable deaths thus far.

I feel enormous pride knowing that I did my part to end this pandemic. However, when I think about all those people who deserved the vaccine before me, like my mother, I'm conflicted. Envisioning the hundreds of millions of elderly and vulnerable Africans who might benefit, I feel guilty for surviving the virus, guilty for being here, and guilty for having this privilege to get the vaccine this easy.

Now that booster shots are about to be made widely available for Americans, I fear that the gap between vaccine "haves" and "have nots" will grow even wider. After all, some Americans have already gone for extra doses without waiting for the science to catch up, while others defiantly refuse to be vaccinated at all. When I saw a person wearing a T-shirt with the phrase, 'unvaccinated is the new sexy,' it deepened the stark contrast of my dual existence. Overall, 75% of the vaccines produced worldwide have gone to just 10 countries that have the leisure to play out these extreme power struggles about freedom of choice. All the other countries can only choose to wait or die.

Equity of access should not be just a public health campaign slogan. We will not address vaccine inequity until low-income countries have equal access to the vaccine, including producing it locally. I can't believe those in high-income countries still question the need for vaccine patent waivers, which would allow the production of vaccines by more pharmaceutical companies globally. There are commendable beginnings in India and South Africa, but the road ahead remains too intricate and extremely long.

I will continue to write about this inequity, not just to alleviate my "survivor's guilt." but because I am a public health researcher rooted in both worlds and what I see is unacceptable. In the spirit of global solidarity, high-income countries must relax restrictions on vaccine productions. Low-income countries must be offered temporary patent waivers to produce vaccines locally. Stop making low-income countries dumping grounds for soon-to-expire donations of unused vaccines from elsewhere.

I long to see a day where when it comes to global health crises, my two realities become one, and geography isn't an automatic death sentence.

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