The Escalation of Dengue Cases in Latin America: A Chance to Apply Lessons Learned from COVAX

Established on the principles of global equity and access to the COVID-19 vaccine, COVAX provides the international community with important lessons to respond to the unfolding dengue crisis in Latin America. As a global collaboration led by the World Health Organization (WHO), GAVI, the Coalition for Epidemic Preparedness Innovations (CEPI), and UNICEF, COVAX was a multilateral initiative involving the private sector, governments, and NGOs.

Viet Nam receives second shipment of 1,682,400 COVID-19 vaccine doses through COVAX Facility at Noi Bai International Airport. This delivery of the vaccines comes in addition to a first batch delivered in April 2021 and is part of the 4.1 million vaccine doses committed to Viet Nam, free of charge, by the COVAX Facility, the international partnership created to ensure global equitable access to COVID-19 vaccines. Source: UNICEF-Fotoarchiv

However, COVAX, despite its noble intentions, has failed to achieve its goal of providing “fair and equitable access” to the COVID-19 vaccine for every country. The stark reality of this failure is seen through the vaccine rate discrepancy in 2021 between high-income countries (HICs) and low-income countries (LICs). While HICs had a 75-80% vaccination rate, LICs had less than 10%, indicating stark disparities. Some possible reasons for the failure of COVAX include inadequate goal setting, lack of support from wealthier countries, betrayal from pharmaceutical companies, lack of secured funding, and limited engagement opportunities for Low- and Middle-Income Countries.

Despite the closure of COVAX, there is a silver lining. The lessons learned from this experience can guide us in building a better international cooperation strategy to combat global issues, including pandemic preparedness and response. These lessons include the importance of equity, the need for public health-centered solutions that prioritize vulnerable populations' needs, the expectation of hoarding, export restrictions, and nationalism during global pandemics, the designation and allocation of international emergency funding and resources, and the assurance of transparency. This is a call to action, a chance for us to improve.

As the Pan American Health Organization (PAHO) calls for a collective response to the grappling dengue crisis in the Americas, the lessons from COVAX can guide the multifaceted approach to prevent the next pandemic. Dengue, a mosquito-borne arboviral disease transmitted through the bites of female Aedes aegypti or Aedes albopictus mosquitoes, is a global health concern. The infection is caused by one or more serotypes: DENV 1, DENV 2, DENV 3, and DENV 4. The severity of the infection varies across regions and is influenced by the immune system, posing a significant challenge in areas of low socioeconomic status.

By the end of March 2024, approximately 4,820,955 suspected dengue cases were reported globally, a 260% increase compared to the same period in the previous year. Brazil, Argentina, Peru, Paraguay, and Colombia have the highest number of reported dengue cases in Latin America. The region continues to face a massive burden.

Since 1920, the Dengue vaccine has been under research, leading to great development. Originating from research at Saint Louis University, Dengvaxia® was developed in 1997. Dengvaxia authorization for use was approved in 2015 and licensed by Sanofi Pasteur. Dengvaxia® is one of the most effective dengue vaccines, with an efficacy above 80%. However, the CDC recommends that only children between 9 and 16 years old receive the vaccine, and they must have been previously infected with dengue. Otherwise, children will have a higher risk of severe symptoms and hospitalization if they are infected after receiving the vaccine.

According to Takeda Pharmaceutical, the developers of QDENGA, another dengue vaccine used in European countries, Indonesia, Thailand, Argentina, and Brazil. However, the vaccine lacks certainty of a positive impact on individuals infected by DENV-3 and DENV-4, with the latter having higher uncertainties.  

QDENGA and Dengvaxia® vary drastically in price. Dengvaxia® is the vaccine brand used in the US and retails for around $104.01, according to the CDC. However, the price of QDENGA varies from country to country. For example, the retail price of QDENGA in Indonesia, a country with a GDP per capita of 4,798 USD, is 40 USD. The price is even higher in other countries.

The difference in price and efficacy of dengue vaccines shows a greater inequality in the international healthcare system. Uneven distribution and access to the most effective vaccine must be addressed internationally to reduce discrepancies and ensure the delivery of vaccines to endemic regions. Superiority in Global Health, usually by the Global North, must be internationally discussed and eliminated as it significantly impacts vaccine policies, regulations, and investments. Instead, countries impacted by a specific endemic, including dengue, must be centered and represented in international health forums.

Like COVID-19 and many other global health concerns, Dengue is not an individual nation's responsibility to eradicate. It is a global challenge that requires a collective response. Responsible collaborations, as learned from COVAX, are crucial to inform the international community's response to dengue. There will be a continuous need for equitable distribution of the most effective vaccines and diagnostics. Each of us has a role in this, and our collective action will make a difference.

The failure of COVAX must be treated as a lesson for improvement, not an excuse to neglect global commitments. Everyone is responsible for acting on these issues to promptly respond to outbreaks. Proactive surveillance, community engagement, and evidence-based public health communication save lives and control pandemics. The most important lesson is, “No one is safe until everyone is safe.”