Vaccine equity: What, how, and when?

February 26, 2021
Written by Hannah Myerson

The rapid development of COVID vaccines has been extraordinary. But the pandemic will only end when everyone across the globe is protected – and that process is way off track. Here’s a deep dive into what’s going wrong, and what can be done.

The toll of the pandemic

One year on, the coronavirus pandemic has disrupted every society on earth and fundamentally changed how we live our everyday lives. 2.25 million people have died – and the lives of billions more have been put under strain.

At Concern, we’ve seen first-hand the catastrophic impacts of COVID-19 in the world’s poorest places. The economic toll of lockdowns has led to unemployment for millions, which in turn means people are unable to feed their families. Healthcare systems that were already weak simply don’t have the resources to deal with the virus, and a lack of access to clean water and soap is preventing efforts to curb the spread.

“People here are very worried.”

Malawi is a good example. “The biggest problem is oxygen supplies in a country with a health system that is already very fragile,” according to Yousaf Jogezai, Concern Malawi Country Director. “Hospitals in Malawi need sufficient supplies of oxygen to save lives, but it is extremely hard to get right now, with demand so high in many countries. Hospitals are also full, short staffed and in need of more equipment. People here are very worried.”

While many high-income countries have provided social protection to those who have lost jobs (like the PPP and direct pandemic payments here in the U.S. ), this type of assistance isn’t possible in many low-income countries. The result is a worrying increase in hunger, while the World Bank’s projections of the number of newly impoverished people in 2021 have been updated from between 88 and 115 million to between 119 and 124 million – a sharp increase. Against this stark backdrop, the need to extinguish the threat of COVID-19 has become ever more urgent.

Concern’s Judith Cent distributing soap for distribution by health workers and community volunteers in rural Malawi. Photo: Concern Worldwide

Vaccine politics: harmful and unethical

The successful development of a number of vaccines has given the world hope that it’s possible to get the pandemic under control. But equal access to a vaccine is critical if we are to suppress COVID-19 for good. This means distributing vaccines based on need first, regardless of someone’s nationality or wealth. Health workers, other essential front line workers and those most vulnerable or at risk of contracting the virus in every country must be prioritized.

Unfortunately, this isn’t what is likely to happen in 2021.

The vaccines (and the science behind them) are currently being treated as the private property of pharmaceutical corporations – despite being developed largely with public funding provided through governments around the world. The Pfizer company – owners of the patent for the most effective COVID vaccine – expects to earn about $15 billion in 2021 sales from the vaccine, while AstraZeneca has promised to keep prices low for the “duration of the pandemic” – but could start charging higher prices as early as next year, depending on the path of the disease.

A mobile health clinic in Chad

A Concern mobile clinic in the Lake Chad region. Countries like Chad are unlikely to see widespread vaccination any time soon. Photo: Gavin Douglas/Concern Worldwide

At the time of writing, high-income countries hold a confirmed 4.2 billion doses of the available vaccines, while low-middle income nations hold 670 million. There is competition between high-income countries for access to vaccines, which is increasing political and diplomatic tensions and depriving other countries access to limited stocks. At the current rate, global vaccination may be impossible before 2024.

What needs to change?

1. We must acknowledge and agree that vaccines alone is not enough.

A vaccination program alone cannot stem the pandemic: it is one of a number of essential tools and approaches that all countries require to combat the virus and deal with this multi-dimensional crisis. The lessons learned in 2020 of how countries dealt with exposure and depended on their resilience must be used to respond to further waves of this pandemic and to prepare for the next global crisis. A global commitment to resilience will help build the foundation for stronger responses and quicker containment of similar crises in the future.

2. Mutations of the virus could reduce the efficacy of existing vaccines.

The race between high-income countries racing to buy up vaccinations is short-sighted, as we’ve already seen the virus is rapidly mutating in ways that could reduce the efficacy of some vaccinations. Furthermore, the World Health Organization has said that the proportion of the population that must be vaccinated to achieve herd immunity is likely to be higher than previously estimated. The longer the virus exists in a context of patchy immunity, the greater the chance of mutations that could render the existing vaccines less effective or ineffective.

3. Patenting vaccines is being prioritized over a culture of sharing and transparency.

We must do everything we can to share knowledge, scale up production, reduce the cost of vaccines, and ensure the most vulnerable people in all countries get access to vaccines, as soon as possible. Political pressure could help ensure that investments in vaccine development translate into patent waivers and prevent privatization of profit from public money.

Governments must back South Africa and India’s proposal to the World Trade Organization Council to waive intellectual property rights for vaccines, treatments and tests – as has already been done for HIV treatments – until the world has reached critically needed herd immunity and the pandemic is under control. Similarly, initiatives like the World Health Organization’s COVID Technology Access Pool (C-TAP), where companies can share data and patents on their innovations, should be mandatory.

To date, not one company has joined C-TAP and AstraZeneca is the only company that has committed to selling the vaccine for no profit for the duration of the pandemic.

A Concern-supported dispensary in Niger. Weak supply chains and lack of refrigeration will be among the challenges facing low-income countries in rolling out COVID vaccines. Photographer: Darren Vaughan/ Concern Worldwide

What is the U.S. government doing?

President Joe Biden recently announced a $4 billion injection of funds for COVAX, the global access program aimed at creating a fair distribution system for low-income economies. The first $2 billion will be available immediately, with the second tranche paid over when other countries meet their pledges. Money, however, may not be enough. The decision by wealthier nations to hoard stocks for themselves means that supplies simply might not be there, even if the funds are available. In the words of WHO Director-General Tedros Adhanom Ghebreyesus, “If there are no vaccines to buy, money is irrelevant”.

“Failure to think, plan, and act in the best interests of the global herd puts the herd’s very survival in peril.”

We know that no one is safe until everyone is safe. Concern U.S. CEO, Colleen Kelly recently wrote: “At every level and from every perspective, we should learn the lesson so starkly presented by the pandemic. Failure to think, plan, and act in the best interests of the global herd puts the herd’s very survival in peril.”

Vaccinating those on the front line and the most vulnerable everywhere – irrespective of their wealth or nationality — is not a choice but a necessity. It is the only way back to ‘normality’.

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