Vaccine inequity: Why it exists + how to solve it
10th May 2021
The pandemic has exacerbated healthcare inequalities around the world, disproportionately affecting those in poorer countries. A grim figure suggests that if the 20 most vulnerable countries in the world had an active infection rate of 0.4%, these countries will run out of ICU beds. A study from the Imperial College indicates that low and lower-middle income countries are at a 32% increased risk of dying from the virus due to lack of access to treatment, high exposure to the virus and lack of protective measures. Distributing medical equipment, clean water and sanitation products to poorer rural regions of the world can be challenging. We also know that variants can impose strains on hospitals, as they mutate into more infectious forms. Poorer countries bear the brunt of the pandemic with more strains to their healthcare systems and already existing healthcare access inequities are widening.
Delivering vaccines to countries in conflict will also be an obstacle in achieving global inoculation. When examining outbreaks of infectious diseases, the risk is increased in countries affected by fragility, conflict and violence. By the middle of 2022, only 2 out of 20 countries with the highest levels of conflict worldwide are forecasted to be largely vaccinated with the rest waiting until 2023 or later to be largely vaccinated. Policy measures which are supposed to curtail the virus have been weaponized by the conflict parties to increase state control and suppress opposition. For example, in Colombia, armed groups have taken over parts of the country and have threatened, killed and attacked people for breaching lockdown rules. This amplifies mistrust in people in power which could undermine the vaccine roll-out in their countries. It could also enable abuse of power, leading to unfair distribution of doses by the state. These countries have faced economic downturn, damaged healthcare infrastructure and lack of resources to ultra cold freezers, healthcare staff etc., all of which are necessary to set up a workable vaccination strategy. The logistical challenges in these countries makes it even more difficult to have fair vaccine equity.
“Refugees, asylum seekers and undocumented migrants also face barriers in accessing vaccines. 80 million people are forced to be displaced in excess of 100 countries. This demographic group is more vulnerable to other population groups. Some live in refugee camps and deportation centres where there is little to no room to implement public safety measures.”
Furthermore, refugees also face unequal access to healthcare, increased risk of exploitation and poor working conditions. A disappointing 57% out of only 90 countries developing a vaccination programme are including refugees as a priority group. Many stateshave a history of discrimination and xenophobia, creating mistrust and warranting a more education-based approach to beat the stigma. Moreover, some fear excluding other groups in place of displaced people in case controversy arises over vaccination rollout and order of priority.
The vaccination disparity needs ambitious and innovative solutions to reduce accessibility issues . The access to COVID-19 Tools (ACT) Accelerator is designed to “accelerate development, production and equitable access to COVID-19 tests, treatments and vaccines”, according to the World Health Organisation website. It was first set up after G20 called for a collaborative response to the pandemic back in March 2020. Some of the participating organisations involved include the Bill and Melinda Gates Foundation, WHO, the World Bank and the Global Fund. This is an initiative set up with the help of scientists, philanthropists, governments, business and global health organisations. It aims to provide medium term solutions, reduce the spread, make tests and treatments more accessible and to restore economic activity and societal growth. Since its launch they have reviewed healthcare systems of over 100 countries, procured treatment for 2.9 million patients in relatively low income countries and plan to make 120 million diagnostic tests available for low income countries.
Within the ACT Accelerator, the COVAX pillar is established to end vaccine inequity by ensuring each country is able to inoculate 20% of their population. Co-led by WHO, Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) along with UNICEF, it pools a portfolio of 10 vaccines to eliminate competition and ensure a quicker and fairer distribution of doses. This involves negotiation with pharmaceutical companies on fairer prices to poorer countries, especially in the global South. Over 180 countries are participating in this scheme. It hopes to deliver 2 billion vaccines doses in 2021 with around 1.3 billion of those to low income countries. 92 low income countries benefit from this. However, a buffer of up to a maximum of 5% of each participating country’s stock is used as a backstop if their national vaccination programmes fail to reach certain populations such as displaced people and frontline workers.
UNHCR, the UN Refugee Agency has announced that they will work with Gavi to ensure that displaced migrants are prioritised in their countries’ national vaccination plans. However, it is limited in terms of directly implementing vaccination programmes. UNHCR works with its partners to increase vaccination uptake and to support vaccination roll-out with refugees being considered.
A European response has also been launched by the President of the European Commission, Ursula von der Leyen. The EU Vaccine Sharing Mechanism aims to permit EU member states to donate surplus vaccines to non-EU countries. In a continent with 450 million people, Europe has managed to secure 2.9 billion doses with plenty to share, albeit COVAX is considered the preferable route for pooling vaccines. ‘The Global Goal: Unite for Our Future’ was a summit to acquire €6.15 billion in additional funding for countries affected by fragility, conflict and violence, including €4.9 billion from the European Investment Bank, €485 million from the EU member states as well as pledges from non-EU countries like Canada and Japan and even private stakeholders like FIFA and Vodafone. The European Commission has successfully sourced around €15.9 billion as part of the Coronavirus Global Response.
These collaborative, multilateral projects are welcome in the midst of a global emergency. Both of them have received firm backing from the G7, with investment of around US$7.5 billion. The G20 are also under pressure to address the financing gap for COVID therapeutics and diagnostics. But the potential financial dividend makes economic sense; a successful vaccination programme which will save the global economy US$375 billion per month.
There have been calls for a waiver of Trade and Intellectual Property Rules (TRIPs) for vaccines including from former president and UN Human Rights Commissioner Mary Robinson. She isn’t the only one 150 global leaders and Nobel laureates have signed an open letter to US president Joe Biden. With cases surging in India and other countries at the moment, there has also been increasing pressure in the Dáil for our government to support the waiver to no avail. The European Commission, the US and other high income countries have said that they oppose the patent waiver at a World Trade Organisation (WTO) meeting held in March this year. Supporters argue that this waiver would allow countries all over the world, but especially in the global South, to manufacture vaccines and therefore increase vaccine supply and lower costs.
If there is one thing is certain, it is this: vaccine nationalism only serves relatively wealthy nations. In the interest of a timely immunization, a two-pronged approach encompassing private deals with pharmaceutical companies, to cater for their own population and fair distribution of vaccines to vulnerable countries everywhere, for the greater public good. But, successful vaccine equity distribution is also underpinned by public trust and peaceful governance, especially in countries which have been damaged by the state. This sentiment is even shared by Simon Coveney, Minister of Foreign Affairs, who emphasized, at the UN Security Council meeting held in February 2021, the need to uphold ceasefires and pause hostilities to allow humanitarian aid. We also need to make sure to tackle misinformation and to educate people on the facts about the virus and the vaccine. Ireland has now a seat on the UN Security Council and is a member of the EU. Our potential global imprint is significant when we act collectively with other countries. We need to look outward and be an active global citizen: no one is safe until everyone is safe.