By September 2020, the world’s richest countries, which represent less than 15% of the global population, have bought over 50% of all available COVID-19 vaccine doses. What is more, high and middle-income countries have additional bilateral deals to administer further doses that exceed their actual need many times. This has left significantly less supplies for the rest of the world, repeatedly highlighting the issue of global health inequality. For years, developing countries have struggled with getting fair access to vaccination programs to get control over preventable diseases, and at this rate, COVID-19 might be yet another example.

According to different NGOs such as Amnesty International or Oxfam, this “vaccine nationalism” contradicts all human rights obligations that the more developed states have. By not taking into consideration urgent demands of other countries, it is a violation of the right to health to secure so many supplies that others are left with nothing. WHO director Tedros Adhanom Ghebreyesus declares that the hoarding of vaccine doses by wealthy countries leaves the world’s poorest and most vulnerable at risk. To try and countervail this circumstance, the WHO, in collaboration with other organisations, launched COVAX, a global initiative for equal distribution of vaccines. However, the battle for vaccine doses remains.

Health inequality and lessons from the past 

Stop Transmission of Polio (STOP) team member Yatender Singh administers vaccinations on a hard to reach farm in Nigeria (Photo: Yatender Singh/STOP Volunteer)

A glance at the past shows where vaccine nationalism has been put first, before vaccine cooperation. During the 2009 H1N1 influenza pandemic as well as in the case of polio and smallpox, vaccines for developing countries were only available after the more developed countries secured enough supplies for themselves. Moreover, the COVID-19 vaccination program brings up memories from the 1990’s, when antiretrovial (ARV) treatment for HIV/Aids was developed in the United States. It took more than six years until the treatment became widely available in Africa, despite the much higher infection rates and casualties in these poor regions. 

Another example of health inequality in terms of vaccination is the Tuberculosis disease. The Bacille Calmette-Guérin (BCG) vaccine was first used in 1921 and up to this day remains the only licensed vaccine against Tuberculosis. In 2019 alone, 1.4 million people died from the infection, making COVID-19 the only recent disease to rival its death toll. Even though actions have been taken through new vaccine candidates which have been entering trials, Tuberculosis remains the problem child of the world’s health situation.     

The legitimate question at this place is why the BCG vaccine, which mainly grants protection to people getting the vaccine during childhood but loses its effect little by little, has not been replaced by other, more effective and long-lasting versions. One of many reasons is that Tuberculosis cases in many Western countries have declined and thus the interest of pharmaceutical companies to invest in research has diminished. Africa and other affected regions in the rest of the world are left alone and have to rely on existing supplies, as they are not able to finance research and the production of remedies against Tuberculosis infection themselves.

COVAX and other approaches to overcome health inequalities in the Corona pandemic

A vial of the COVID-19 vaccine at Walter Reed National Military Medical Center, Bethesda (Photo: Lisa Ferdinando for U.S. Secretary of Defense)

These examples show the need for global commitment and great effort to successfully combat medical crises, and COVID-19 is no exception. However, the course of action in the ongoing endeavors to take control of the pandemic gives the impression that lessons have not been fully learnt from previous health catastrophes. 

Yet, the WHO in collaboration with other organizations have established a global mechanism called “Access to COVID-19 Tools Accelerator (ACT)” in April 2020, to avoid repeating the mistakes from the past. The ACT is a global collaboration to drive forward development, production and fair access to COVID-19 tests, treatments, and vaccines. The vaccine pillar of this program is COVAX, which intends to ensure equitable access to the COVID-19 vaccine on a global level. The aim is to get vaccine doses free of charge for at least 20% of every low-income country’s population by the end of 2021 so that the most vulnerable groups and health workers can be protected. The program is funded by 190 member countries and has raised US$4 billion so far. 

COVAX was also brought to life to prevent the monopolization of vaccine supplies by wealthy countries doing one-on-one deals with suppliers. These deals are boosting competition to such a degree that low-income countries do not have any chance at even setting foot in the game. According to the program,  COVAX has had a good start with being able to secure enough doses to reach its goal. However, COVAX itself has to compete for enough vaccine supplies, and therefore vaccines might be available for the poorest and most vulnerable no earlier than 2022. To succeed and reach herd immunity in order to defeat the virus, a substantial proportion of a population has to get the vaccine. It is questionable if current endeavors will pay off eventually. 

To run a vaccination program in an effective way, an adequate supply of vaccines is of course essential. But it requires much more than access to vaccine doses. GAVI, the Global Alliance for Vaccines and Immunization, addresses other key priorities that have to be taken into consideration to make sure that everybody has equal chances to profit from the vaccine. One of them is that Africa has had a long history of vaccine hesitancy and mistrust due to fear of physical harm and cultural beliefs. These issues need to be approached with information campaigns and community engagement to address doubts of leaders and the general public. 

Another priority is to overcome logistic challenges of vaccine delivery, a mammoth task itself, because the vaccines have to be kept at a stable, cold temperature as soon as deliveries leave the site of manufacturing. Developing “cold chains” is necessary, and solar-power systems could be of great help to have enough resources for fridges to store the vaccines even in rural parts of Africa where power hardly is available.  

All these approaches are desperately needed as vaccination programs have started to run in the last couple of weeks. As stated by many international players, it is essential that existing health inequalities are not being ignored. COVID-19 will not be defeated in the West alone, and as long as access to vaccines in low-income countries is denied, every nation is at risk of further outbreaks. To prevent this, a clear strategy is needed as well as an end to the “me-first approach”. Because the virus does not care about borders.

Mirjam Zehnder