As we applaud breakthroughs in COVID-19 vaccine development across the globe, we are also hoping to see a fair and equitable vaccine allocation. Unsurprisingly, the distribution of vaccines is never a straightforward medical challenge. As we have seen in the United States and other developed countries, underprivileged populations are often left out of COVID-19 medical care and vaccine rollout initiatives because of politics, lack of financial means, and poor public health infrastructure in the community.
While countries in the developed world are struggling to vaccinate their domestic populations, vaccine access and delivery pose even more dire challenges in developing economies. Based on a report issued by the Economist Intelligence Unit (EIU), mass immunization of adult populations in advanced economies will be completed by mid-2022. In comparison, the timeline for middle-income countries will take until late 2022 or early 2023, while that for the poorer nations will stretch to as late as 2024. Another report published in February has shown that the world’s highest-income countries are on track to accumulate over 1 billion more doses of vaccines than they need to vaccinate their populations. Transportation logistics, political conflicts, and international regulations have further hindered the progress of protecting people in the less developed world from getting COVID-19.
As pointed out by Dr. Tedros Ghebreyesus, the Director-General of the World Health Organization (WHO), “The world is on the brink of a catastrophic moral failure and the price will be paid with lives and livelihoods in the poorest countries.” 1 Studies have also shown that unequal access to COVID-19 vaccine doses could cost the global economy trillions of dollars, and that failure to immunize the most vulnerable populations globally would only prolong the pandemic.2 Equitable access to vaccines not only carries moral responsibility, but also brings visible public health benefits to both individuals and societies at large. In this article, we will take a look at issues around COVID-19 vaccine equity on an international scale, with a focus on middle- and low-income countries.
Africa
African countries have seen some of the direst COVID-19 vaccine shortages, mostly due to funding shortfalls, cold chain requirements, and economic discrimination in vaccine pricing. According to Dr. Ghebreyesus, nearly 40 million doses have been given in at least 49 higher-income countries, compared to merely 25 doses administered in one of the lowest-income countries. South Africa’s leader Cyril Ramaphosa has accused developed countries of bulk buying much-needed COVID-19 vaccines at the expense of poorer nations. Logistical issues in international regulations further complicated vaccine delivery in the region. According to various officials working towards getting doses for the continent, Africa will have to wait “weeks if not months” for the COVID-19 vaccines to be approved by WHO.3 In some African countries, mismanagement at the governmental-level also hindered vaccine distribution. For example, the Tanzanian government has been criticized for not having a national vaccination plan by insisting that the country was free from COVID-19.4
As calls for equity grow, vaccine access programs have been launched to promote vaccination of lower- and middle-income populations internationally, including those in Africa. One of the largest programs has been the joint UN-led COVAX initiative, which has successfully delivered its first round of doses to many countries in Africa, Eastern Europe, and the Middle East in 2021.5 6 7 However, such programs only mark the beginning of a long-term endeavor needed to promote vaccine equity in Africa. As Dr. Matshidiso Moeti, the WHO Regional Director for Africa, puts it, “Africa has watched other regions start COVID-19 vaccination campaigns from the side-lines for too long. This planned rollout is a critical first step to ensuring the continent gets equitable access to vaccines. We know no one will be safe until everyone is safe.” 8
Middle East
The deep-rooted political tension and economic inequalities in the Middle East seem to pose a different set of challenges to vaccine equity in the region. As cases continue to rise in hotspot countries like Iran and foreign-made vaccines were flown in, political and public health stakes have never been higher. Compared to oil-rich Gulf Arab nations that were among the first in the world to vaccinate their populations, COVID-19 vaccine accessibility is increasingly concerning in war-torn countries like Syria and Yemen. Already on their knees amid humanitarian and economic crises, those countries are incapable of purchasing their own vaccines or delivering them in territories broken into armed factions. Hope for reaching those populations relies on international aid from organizations like GAVI, the vaccine alliance that co-leads COVAX.
Another prominent vaccine disparity is faced by the 4.5 million Palestinian people living in the occupied territories of the Gaza Strip and West Bank. The Palestinian territories, particularly Gaza, have been under effective blockade by Israel for more than half a century, resulting in shortages in clinical capacity and medical supplies well before COVID-19. After the pandemic hit, the fragile public health infrastructure in occupied territories have collapsed — COVID-19 infection and case fatality rates grew disproportionately higher among Palestinian communities than their Israeli neighbors, according to WHO data.9 Now, as Israel reported the highest rate of COVID-19 vaccination per person in the world, Palestinian territories appear to be significantly behind. Palestinian residents in East Jerusalem with Israeli residency status are entitled to be vaccinated, whereas those living in the West Bank and Gaza are not part of Israel’s national vaccination program. While the Palestinian Ministry of Health was able to secure some vaccines from international humanitarian aid and foreign companies for their residents, these doses are far from enough. The United Nations (UN) human rights body has issued a statement that Israel has the responsibility to provide equitable access to vaccines for Palestinians in Gaza and the West Bank. Some experts are concerned that differential access is not only morally and legally unacceptable, but also carries public health risks: Israeli and Palestinian populations often mingle in their daily commute to work and school, which can lead to further spread of the virus in Israeli cities as well.10
Asia
By leveraging experience in the 2002–2004 SARS outbreak and earlier COVID-19 responses, countries in Asia have been managing the pandemic relatively well compared to their Western counterparts while keeping the economy on track. However, despite being able to cap recent outbreaks. Asian countries are also facing obstacles to achieve equitable access to COVID-19 vaccines. East Asian countries, which have been able to control the spread of infections relatively well, seem to be facing their own logistical hurdles in vaccine rollouts. For example, with its plans for wide-scale inoculations before the Olympics rescheduled to take place between July and August 2021, Japan is challenged with shortages of dry ice, containers, and healthcare staff.11 On the other hand, Southeast Asian nations have mostly been able to sign deals with producers from countries like China to launch national vaccination programs, while navigating regulatory obstacles, growing cases, and supply bottlenecks across their populous and diverse communities. Experts are concerned, however, that the socio-political dynamics in Southeast Asia might pose unique challenges to equitable delivery of those vaccines. For example, there have been reports showing recent political unrest and military coup activities in Myanmar disrupting the COVID-19 testing and vaccination plans.12 In the Philippines, where no COVID-19 vaccines were approved nor legalized until recently, the president’s military guards have reportedly received unauthorized vaccines as early as September 2020. President Rodrigo Duterte defended the guards’ actions, claiming that they could not afford to wait for regulatory approval.13 This violated the Philippine Health Ministry’s previous warning against the use of unregistered vaccines, which led to a credibility crisis of the government.
Concluding Thoughts
Vaccine equity in this pandemic is a borderless issue and requires global solidarity. After all, the goal of developing vaccines in the first place is to save more lives, not to serve as a tool for scientific nationalism and deepen the entrenched health inequalities around the world. As we witness global powers competing to win the COVID-19 vaccination race, we should always remember to look back and ask ourselves: who is being left behind?
Sources
(1) WHO chief warns against ‘catastrophic moral failure’ in COVID-19 vaccine access. (2021, January 21). UN News. https://news.un.org/en/story/2021/01/1082362
(2) Vaccine nationalism could cost the global economy trillions of dollars, new analysis finds. (2020, October 29). The Telegraph. https://www.telegraph.co.uk/global-health/science-and-disease/vaccine-nationalism-could-cost-global-economy-trillions-dollars/
(3) Soy, A. Africa’s long wait for the COVID-19 vaccine. (2021, January 22). BBC News. https://www.bbc.com/news/world-africa-55751714
(4) Coronavirus in Tanzania: The Country That’s Rejecting the Vaccine. (2021, February 6). BBC News. www.bbc.com/news/world-africa-55900680
(5) First COVID-19 COVAX vaccine doses administered in Africa. (2021, March 1). UNICEF. https://www.unicef.org/press-releases/first-covid-19-covax-vaccine-doses-administered-africa
(6) Republic of Moldova first country in Europe to receive COVID-19 vaccine through COVAX facility. (2021, March 10). WHO. https://www.euro.who.int/en/countries/republic-of-moldova/news/news/2021/3/republic-of-moldova-first-country-in-europe-to-receive-covid-19-vaccine-through-covax-facility
(7) Afghanistan receives 500,000 vaccine doses via COVAX. (2021, March 8). Anadolu Ajansı. https://www.aa.com.tr/en/asia-pacific/afghanistan-receives-500-000-vaccine-doses-via-covax/2168994
(8) Dispatch of millions of COVID-19 vaccines to Africa expected to start in February: WHO. (2021, February 7). UN News. https://news.un.org/en/story/2021/02/1083882
(9) Coronavirus disease 2019 (COVID-19) occupied Palestinian territory. WHO. http://www.emro.who.int/pse/palestine-news/landing-page-for-covid19.html
(10) Covid-19: Why are Palestinians behind in vaccine efforts? (2021, March 10). BBC. https://www.bbc.com/news/55800921
(11) Swift, R. (2021, January 27). Dry ice, containers and staff shortages: Japan’s vaccine rollout hurdles. The Japan Times. https://www.japantimes.co.jp/news/2021/01/27/national/japan-vaccine-hurdles/
(12) Myanmar COVID-19 testing collapses following coup, civil disobedience. (2021, February 9). Al Arabiya. https://english.alarabiya.net/coronavirus/2021/02/09/Coronavirus-COVID-19-testing-collapses-following-Myanmar-after-coup-civil-disobedience
(13) Philippine president blocks Senate attempt to probe guards’ use of COVID-19 vaccine. (2021, January 5). CNN. https://edition.cnn.com/2021/01/04/asia/philippines-duterte-vaccines-intl-hnk/index.html
