Vaccines, Global Health, and Inequity - A Tale as Old as Time

Guest Author: Assia Meziane Tani

The world was turned upside down with the emergence of SARS-CoV-2, the virus that causes COVID-19. Almost as quickly as countries entered lockdown in early 2020, the quest to find effective treatments and a vaccine before the end of the year began. Now, there are several vaccines either already released or on the verge of release to the general public and much of the world is anxious to get vaccinated, particularly as the death toll continues to rise.

But the question at hand remains – are these vaccines truly available to the global public? This brings us to our current discussion concerning global vaccine equity. What is vaccine equity, and how do we address the problem?

Vaccine equity – the equitable distribution of vaccines worldwide – is essential to curtailing the transmission of infectious diseases. Particularly during the modern age of readily accessible travel, any infectious health risk to one nation becomes a risk to all nations. However, since research into manufacturing a vaccine began, we have seen how certain populations and communities are viewed and treated differently than others. One of the most inflammatory and ethically concerning comments was made early in the pandemic - “If I can be provocative, shouldn’t we be doing this study in Africa, where there are no masks, no treatments, no resuscitation?” This was posed by Dr. Jean Paul Mira, while discussing the pandemic on a French television program. Critics were quick to call the comment overtly racist and drew an uncomfortable comparison to the infamous Tuskegee Study of Untreated Syphilis conducted in the US from 1932 to 1972.

From testing and personal protective equipment to treatments and vaccinations, the concept of healthcare equity must always remain at the forefront of our minds. Quite simply, if a pandemic is not controlled everywhere, then it is not under control anywhere. This does not only affect people’s safety and health – losing global control of the pandemic could lead to a significant economic impact as well.

In December of 2020, the U.K. inoculated its very first patient, soon followed by the U.S. and others. Since then, several countries have started vaccinating, with Israel, the UAE, Chile, and the UK leading the pack and followed closely by the US and Bahrain (as of March 29 per the New York Times vaccine tracker).

However, with the release of new vaccines and many vaccine rollouts already underway, human rights groups are concerned about the development of vaccine hoarding or vaccine nationalism, which is essentially the “me first” approach in the process of a nation purchasing and distributing a vaccine. This leads to wealthy nations leading the way in vaccine administration while less wealthy countries are left behind – either waiting for distribution of doses or resorting to administering doses of a vaccine without sufficient published data on its safety and efficacy.

To tackle this, the WHO, in alliance with Coalition for Epidemic Preparedness Innovations (CEPI) and GaviI, has initiated COVAX (or COVID-19 Vaccines Global Access) – which is a pillar of the Access to Covid-19 Tools (ACT) Accelerator. In this time of urgency, it aims to increase development and production of vaccines as well as working to ensure equitable access and distribution of vaccines that are deemed safe and efficacious to low- and middle-income countries. It hopes to distribute 2 billion doses by the end of 2021, with Ghana and the Cote d’Ivoire being the first African nations to distribute vaccines under COVAX. However, the rollout has been slow. Ghana received its first doses almost 3 months after the U.K. and the U.S. Even now as countries are racing to vaccinate their populations, there is a clear disparity between wealthy countries and those with lower GDPs. The Duke Global Health Institute reports that countries that comprise only a total of 16% of the world’s population have claimed about 70% of the available vaccine, and that while COVAX plans to distribute 2 billion doses globally, those will only account for 20% of the world’s population. With this knowledge, it is clear that we still have a long way to go, as the death count continues to rise, nearing 2.8 million deaths at the time of this publication (according to the JHU Covid Resource Center).

So where do we go from here? The WHO has announced that more countries are putting in greater efforts to aid COVAX, with the US donating $4 billion to help buy doses, and Norway also pledging to aid in the effort. However, these same wealthy nations are making deals with manufacturers independent of COVAX which will decrease the available vaccine supply and threaten to prolong the pandemic. A recent study by the National Bureau of Economic Research reviewing the economic implications of COVID-19 estimated that delaying vaccination in poorer countries could lead to a near $9 trillion economic loss – the brunt of which would be borne by wealthier nations. One could argue that this in itself could be incentive enough to to avoid vaccine hoarding.

Aside from basic empathy and the need to curtail the pandemic to preserve both lives and livelihoods, a lack of vaccine equity poses a large threat to global biosecurity. During the avian influenza epidemic in 2005, some nations were unwilling to share virus samples due to worries that higher income countries would then use the samples to develop vaccines and treatments - only to prioritize their own populations or sell treatments at a higher price. The COVID pandemic is our chance to show that when it comes to a global disease, we are willing to prioritize the health of the global community at large and work together as a team.

COVID demonstrated how international travel (whether for business, trade, or pleasure) can exponentially increase the spread of disease and how all societies are intricately connected and reliant on each other, much more than we may have realized previously. The time is now to speak up and push for global vaccine equity - our lives depend on it.