COVID-19 vaccines: can equity be achieved in a context of inequity with millions of vulnerable people?

Developed countries are far more likely to vaccinate their citizens than developing countries, a situation that risks prolonging the pandemic and increasing global inequality. On the sidelines of a dialogue between senior UN officials on Monday, UN News explains the importance of equal access to vaccines.

Simply put, it means that everyone should have equal access to a vaccine that offers protection against the coronavirus, regardless of where they live.
The World Health Organisation has set a target of vaccinating 70% of the world's population by mid-2022. However, if this target is to be met, more equitable access to vaccines will need to be achieved.

The director general of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, stresses that equal access to vaccines "is neither space engineering nor charity. It is smart public health, and it is in the interest of all".

The director general of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus, stresses that equal access to vaccines "is neither space engineering nor charity. It is smart public health, and it is in the interest of all".

Apart from the ethical argument that no country or citizen, however rich or poor, deserves the vaccine more than any other, an infectious disease like COVID-19 will remain a global threat as long as it exists anywhere in the world.

Unequal distribution of vaccines not only leaves millions or billions of people vulnerable to a lethal virus, but also allows even deadlier variants of the disease to emerge and spread around the world.

Moreover, unequal distribution of vaccines will deepen inequalities and widen the gap between rich and poor, and reverse decades of hard-won progress in human development.

The UN says that unequal access to vaccines will have a lasting impact on socio-economic recovery in low- and lower-middle-income countries and set back progress on the UN's Sustainable Development Goals.

The UN says that unequal access to vaccines will have a lasting impact on socio-economic recovery in low- and lower-middle-income countries and set back progress on the UN's Sustainable Development Goals.

For example, the United Nations Development Programme (UNDP) predicts that eight out of ten people who fell into poverty during the coronavirus pandemic will be living in the world's poorest countries by 2030.

Forecasts also suggest that in low-income countries the economic impacts of COVID-19 may last until 2024, while high-income countries could reach pre-coronavirus GDP growth rates by the end of this year.

No, Dr Tedros warned last April when he declared that "vaccine equity is the challenge of our time... and we are failing".

Although enough vaccines will be produced by 2021 to cover 70% of the world's population of 7.8 billion people, most vaccines are reserved for rich countries, while other vaccine-producing nations restrict their export by prioritising the vaccination of their citizens, an approach that has been termed a "nationalistic attitude to vaccines".

A clear example of this trend occurs in countries where already inoculated citizens receive a booster vaccine, rather than prioritising leftover doses for unvaccinated people in poorer countries.

Still, the good news is that as of 15 September, more than 5.5 billion doses have been administered worldwide, although given that most of the available vaccines require two doses, the number of people protected is much lower.

While rich countries receive the majority of vaccines, many of the poorest nations struggle to vaccinate even a small number of citizens.

According to the Global Vaccine Equity Dashboard (established by UNDP, WHO and Oxford University) on 15 September, only 3.07% of people in low-income countries had received their first dose compared to 60.18% in high-income countries.

Thus, about 70.92% of people living in the UK were inoculated with the first dose of the vaccine, while in the US the figure is 65.2%.

However, other high- and middle-income nations do not fare as well. In New Zealand, only 31.97% of a population of about five million has been vaccinated, while in Brazil the vaccination rate now stands at 63.31%.

These figures contrast with statistics from some of the world's poorest countries. In the Democratic Republic of Congo, only 0.09% of the population has received a dose of the vaccine, while in Papua New Guinea and Venezuela, the rate is 1.15% and 20.45% respectively.

UNICEF data show that the average cost of a COVID-19 vaccine is US$2-37 (with 24 vaccines approved by at least one national regulatory authority) and the estimated cost of delivery per person is US$3.70. This represents a significant financial burden for low-income countries, where, according to the United Nations Development Programme, the average annual per capita health expenditure is US$41. 

The Global Vaccine Equity Dashboard shows that, without immediate global financial support, low-income countries would have to increase their health spending to 57% to meet the target of vaccinating 70% of their citizens.
 

The World Health Organization and UNICEF have worked with other organisations to establish and manage the COVID-19 Global Vaccine Access Facility, known as COVAX. Launched in April 2020, the UN's first agency called it an "innovative global collaboration to accelerate the development, production and equitable access to COVID-19 tests, treatments and vaccines".

It aims to ensure fair and equitable access for all countries around the world based on need rather than purchasing power.
According to the UN-supported Gavi Alliance, COVAX currently has 141 participants, but this is not the only way countries can access vaccines, as they can also enter into bilateral agreements with manufacturers.
 

While this is obviously a crucial step, and in many of the richer countries life for many people is returning to some sort of normality, the situation in less developed countries is more difficult.

While the delivery of vaccines provided under the COVAX Facility is being welcomed around the world, weak health systems, including a lack of health workers, are contributing to increasing problems of access and delivery on the ground.

Moreover, equity issues do not disappear after the physical delivery of vaccines in each country; in some nations, both rich and poor, inequities in distribution may persist.

It is also worth remembering that the requirement to provide equitable access to health care is not a new issue but is central to the achievement of the Sustainable Development Goals. Specifically for Goal 3 on health and well-being, which seeks universal health coverage and affordable essential medicines and vaccines for all.

Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization; Achim Steiner, Administrator of the United Nations Development Programme; and Vera Songwe, who heads the United Nations Economic Commission for Africa participated in Monday's conversation on vaccine equity as part of a series of meetings called 'Momentum for Advancing the Sustainable Development Goals'.