Vaccine Inequity : A Review

Yash Shroff - Public Health Team


Vaccines were, and still are, considered to be the light at the end of the tunnel of this long pandemic. However, not everyone has been able to see the light in a similar fashion. Some have seen it shine brightly, whereas others have only seen glimpses of it. Vaccine inequity is one of the biggest social justice issues of our generation and is one of the biggest hindrances in getting out of the pandemic. Vaccine equity, put simply, means that everyone should have equal access to the vaccine that can ultimately protect them from life-threatening COVID-19.


In the early days of the pandemic, when the vaccines were first being developed, placing orders for vaccines was a huge risk, in case they did not work. However, wealthier countries reduced that risk by placing orders for multiple vaccines which could have been purchased by smaller countries later on. They could afford to put their eggs in multiple baskets. Low-income countries made their deals 8 months after US and UK made their first deal. As a result, the wealthier countries secured enough doses to vaccinate their populations several times over whereas the smaller countries faced problems in securing doses in the first place. As of 31st December 2021, only 9.14% of Africa has been fully vaccinated against COVID-19 while the United States of America and United Kingdom have fully vaccinated 61.51% and 69.51% of their populations respectively. The US is predicted to have approximately 1 billion doses of vaccines in surplus after vaccinating everyone over the age of 5. Even though there have been donations made, they do not meet the required number. G7 countries recently announced a donation of 870 million vaccines whereas WHO estimates around 11 billion would be needed to vaccinate 70% of the global population. The WHO set a goal of vaccinating at least 40% of the populations in each country by December 2021. Except a few handful of countries like Botswana, Morocco and Tunisia, no other African country was on track to meet this target.


COVAX, led by the GAVI vaccine alliance, WHO and Center for Epidemic Preparedness Innovations (CEPI), is an initiative in response to the COVID-19 pandemic. COVAX coordinates international resources to provide middle and low-income countries equitable access to vaccines. COVAX aims at vaccinating 20% of the population in 92 of the poorest countries. However, it did face some difficulty at first. Even though high-income countries were a part of COVAX, it did not stop them from making bilateral agreements with vaccine manufacturers. That led to vaccine hoarding by the richer countries causing the lower income countries to be deprived of vaccines. The richer countries were vaccinating children and making plans for boosters while the poorer countries were struggling to vaccinate their healthcare workers and vulnerable individuals. The US has announced a donation of 857.50 million vaccine doses but has delivered only 193.4 million. The UK has announced 100 million doses but so far has only delivered on 26.2 million doses. It is interesting to note that UK has given 33.93 million booster doses to its own population. India-based Serum Institute was one of the main suppliers to the COVAX initiative but after a devastating second wave in India, exports were banned in order to vaccinate Indians. Exports were recently resumed which provided a much needed relief to the COVAX program. Vaccine nationalism, where countries prioritise their own citizens instead of working together to tackle the pandemic, continues to be one of the main causes of vaccine inequity. A Trade Related Intellectual Property Rights (TRIPs) waiver is being called for to allow manufacturing of vaccines, therapeutics and COVID-19 diagnostics all over the world. This was put forth by India and South Africa and was backed by several low and middle income countries. In May, 2021, the USA agreed to support the waiver but limited to vaccines only. Unfortunately, this waiver continues to be opposed by powerful, high-income countries, including the UK.


Not vaccinating all individuals equally can have severe consequences. Aside from the direct health consequences of illness and death, it burdens the already-fragile healthcare systems of many countries. Illness and death among healthcare and other frontline workers increases the burden on human resources required for battling COVID-19 and non-COVID-19 diseases. Immunisation programs take a backseat as all resources are directed towards battling COVID-19. This reverses years of progress made to eradicate diseases like polio and measles. For example, due to the disruption of healthcare systems, the notification of tuberculosis cases fell which led to an increase in deaths. Modelling projections say that this could get worse in 2021 and the years to follow. Most importantly, leaving large populations unvaccinated gives the virus a chance to infect them and mutate. This leads to emergence of variants which may evolve to evade immunity offered by vaccines or past infections. These immunity-evading variants could, ironically, pose a threat to high-income countries as well. Their emergence may put the world back to square one. Besides these severe health consequences, there have been socio-economic repercussions as well. The continued investment of financial resources in tackling COVID-19 will make it longer for countries in the world to return to pre-pandemic growth levels. The rise of new variants may drive some countries into lockdown which may worsen the already existing inequalities.COVID-19 had a terrible impact on the economies of several countries. Unemployment numbers skyrocketed during the pandemic and people found it tougher putting food on the table as they were pushed further into poverty.


There are ways to tackle this problem. Those countries that have acquired a high number of doses should allow COVAX and African Vaccine Acquisition Trust (AVAT) to take deliveries of vaccines instead of them. Vaccine manufacturers and high-income countries should ensure they deliver the promised doses to COVAX and AVAT on time. Countries should lift export bans to provide vaccines, therapeutics, diagnostics and other necessary raw materials responsible for their production. As Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO said, “Economically, epidemiologically and morally, it is in all countries’ best interest to use the latest available data to make life saving vaccines available to all.” He could not be more right.

 

Note: This article was originally written in January 2022, to review vaccine inequity by the end of 2021.

Yash is currently a junior at Ashoka University majoring in Biology with a minor in Psychology. He is deeply interested in public health, epidemiology, global health and development, health policy and infectious diseases.


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