Challenge Accepted

Ann Marie Kimball knows about pandemics — in fact, she wrote a book about them. An epidemiologist and physician, Kimball lectured on emerging infections at the University of Washington, worked with the White House to set up the Asia-Pacific Economic Cooperation (APEC) Emerging Infections Network, earned Fulbright and Guggenheim awards for her work on global trade and emerging infections, designed a global disease surveillance strategy for the Bill & Melinda Gates Foundation, and authored Risky Trade: Infectious Disease in the Era of Global Trade.

Kimball was introduced to Rotary not by a member, but by vaccines. “Part of my job when I first started working in West Africa was to ensure that the vaccines arriving at airports moved from the tarmac into storage safely,” she says. “I started seeing these crates with the Rotary wheel, and I didn’t know what Rotary was. So I resolved to find out.”

Now a member of the Rotary Club of Bainbridge Island, Washington, Kimball also serves on Rotary’s COVID-19 task force, which is exploring the organization’s role in responding to the pandemic. The task force is encouraging actions such as mobilizing clubs and promoting vaccinations.

Kimball spoke with Rotary senior staff writer Diana Schoberg in May about the pandemic and Rotary’s work.

My role is primarily technical: to advise the members on the global state of the pandemic. Unfortunately, worldwide, we still have a very active pandemic. We’ve lost more than 3.5 million people across the globe, and we believe that’s an undercount. The other thing we’re tracking very closely is vaccine equity and access. Despite 1.4 billion doses [as of 13 May] being administered worldwide, fewer than 1 percent of those are in sub- Saharan Africa. So we’re seeing real inequality. I will advise the task force on situation awareness and policy options as we move forward.

You’re seeing a lot of great work by Rotarians across the board, and it’s very heartening. There’s a lot of altruism and community spirit. To a certain extent, we hear all of the bad news and we don’t hear enough of the good news. And Rotary is in the business of creating good news.

Rotary is a very powerful partner in COVID-19 response because our organization is multisectoral; it’s not confined to the health sector. And it also brings a strong level of volunteerism. Our response is both diverse and tailored locally, which makes it even more valuable.

Altruism is very much a core value of Rotary. So in speaking about why an individual should get a vaccination, you can cite the figures, that it’s 94 percent protective or it’s 80 percent protective. But the conversations that I’m hearing in my community, for example, are about what is your responsibility to get vaccinated to help protect the rest of your community and the people you interact with. And that’s what I think Rotary can really bring forward.

Community education is a way of providing the science and awareness of the situation to an individual community. It also involves reaching out to other civic organizations and government entities to coordinate and collaborate.

So many people have died, and so we have a mission of the heart, too. Many Rotary clubs have committees that reach out to support bereaved people and people who are ill. That’s another piece of it, in terms of values.

It depends on what the rumors are. I’ve tried to keep my ear to the ground in my own community, and it just means listening and then having respectful conversations. People who believe misinformation aren’t stupid; they’re just misinformed. Bringing credible information forward in a respectful manner can often make the difference.

We can tell them, from our experience with polio and our long experience with childhood vaccinations, that these vaccines are safe and they’re highly effective, and that we know vaccines work.

When I first joined the task force, I recommended a book to the other members titled Stuck: How Vaccine Rumors Start — and Why They Don’t Go Away, by Heidi Larson. It draws from years of research on vaccine hesitancy. The takeaway is that you need to listen, and then there has to be an interchange. You may or may not be successful at persuasion, but really listening is very, very important. I was amazed at some of the rumors going around that have a slim basis in some piece of fact but have been entirely distorted and misinterpreted.

It’s really a dialogue. Rotary is nonpolitical. We have a vast array of Rotarians with a vast array of political beliefs, and we don’t do politics in our clubs. And that is very important for Rotary’s credibility.

If I had a crystal ball, I could tell you. There are a lot of questions about variants. Variants will always evolve, although the coronavirus mutates more slowly than influenza, and more slowly by far than HIV. But it is an RNA virus [which mutates more rapidly than a DNA virus]. So the more it transmits, the more opportunities there are for variants to occur. Vaccination remains our only tool, and if you were able to vaccinate everyone successfully, you could really tamp down transmission and variants. Generally, viruses mutate toward more infectiousness, but they don’t mutate toward more lethality for their host — that’s a very broad generalization. The virus wants you walking around and passing it on to other people.

You’re asking something we just don’t know yet. The strategy is to vaccinate as much as we can and cut down the transmission, and that should cut down on the variants. But you have to remember that influenza is totally different than the coronavirus, except that they’re both RNA viruses. We thought the coronavirus was going to be seasonal because it tended to have peaks that correlated with winter, but now we’re seeing that it also has peaks correlating with summer. So in that sense, it’s not exactly like the pattern of transmission of influenza. Influenza shifts and drifts on an annual basis, and flu vaccines are composed to match what strain is circulating. And that may eventually become what we see with the coronavirus. But because it’s a new virus, its transmission patterns related to seasonality and to other dynamic forces are not really clear. We don’t know how long a person’s immunity from the shot will last.

There are experiences and infrastructure that will be helpful: the emergency operations centers, for example, in Nigeria. And also the cold chain logistics and management of the shipment of vaccines, and the vaccination campaigns and the messaging — although the message is different, and it’s a different age group.

What Rotary has done with the Global Polio Eradication Initiative has been absolutely phenomenal. With our 36,000 clubs, we’ve mobilized populations and community leaders all over the world. Rotarians can work fast and know how to get resources where they are needed most.

Clubs are promoting vaccines through publicity and advocacy, and Rotary members who have a medical background are helping with the actual shot administration. We have great experience in logistics, and our members are helping with traffic and sign-up and reception at vaccination sites, depending on the club. It’s been very hands-on for Rotarians.

The thinking behind the rollout in the United States primarily came from the National Academy of Medicine. Their recommendation was focused on who had the greatest morbidity and mortality from the disease.

 

So first you have health care workers, because they’re continuously at risk and your health care system will break down if you cannot protect them. And then there was a large discussion about the disproportionate risk for communities of color and public-facing workers, especially wage workers, and for the elderly. They looked at the burden of disease and used that to form a decision on what equitable distribution would look like. That would be a little bit different for every society.

We know what we don’t mean when we talk about equitable. We don’t mean that vaccines only go to the wealthier class that can pay for it. Or to important politicians who happen to have access to it because they jumped the line. We’ve seen what inequitable distribution can look like.

I think our information basis is pretty imperfect. But focusing on countries that have high transmission would make strategic sense. The barriers to doing that have been remarkable. There has been a lot of talk about some countries that have three to five times the number of doses reserved as their population. And that’s the process that COVAX [a global public-private partnership to secure and distribute COVID-19 vaccines] is trying to orchestrate more equitably to ensure vaccine access for lowand lower middle-income countries.

That’s exactly where Rotary’s impact could be the strongest. But it will be different in each place. I certainly see economic recovery as part of what we will be addressing. There are some other areas as well. In February, the United Nations Security Council called for a global ceasefire in order to allow for vaccinations. I see Rotary as being part of that peace effort. In the environmental arena, we know that deforestation and the wildlife trade have led to the emergence of these kinds of pathogens, and Rotary can be involved there as well. If you look at our areas of focus, you can’t find one that hasn’t been impacted by this pandemic.

Everyone knew that a respiratory pathogen could be dangerous. No one had planned for complete science denialism in leadership, which we have seen [in some countries]. I have colleagues who had worked very closely on the pandemic plans that had been in place, and that playbook was thrown out. No one foresaw that. Everyone assumed that if you have all of these plans and you have a pretty good idea of what you need to do, you’ll do it. We need to be a lot more conscious of the political economy than we have been as a scientific group.

I think the big lesson we have learned is that science-based leadership is critically important. You need to have the very top of your government supporting the very best measures that society can take to protect itself. That has to be really clear and it has to be said many, many times.