“Vaccine equity is the challenge of our time,” Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation (WHO), told a recent gathering in his opening remarks. “And we are failing” he said.
Earlier, the G7 leaders wrote a letter of support declaring that wealthier countries should pay the cost to vaccinate low and middle income countries.
The United States announced that it would donate 500 million doses of the Pfizer and Moderna vaccines to the COVAX programme to supply COVID vaccine doses to countries in need. In addition, several countries pledged support to a waiver to Intellectual Property (IP) restrictions, which could allow countries to produce the vaccine(s) generically to amplify production and supply.
While these are essential steps in the right direction, a global system in which poor countries are unable to develop and produce their own vaccines to match their demand is not sustainable, particularly when they face potential future pandemics.
Global vaccine equity
Stringent measures, with global solidarity and commitment to build global vaccine equity and ensure that the last person gets the vaccine in rich and poor countries alike before the next global health crisis hits is the need of the hour. This is a time when internationalism should win over nationalism, and globalism will work better than localism.
Globally, indiscriminate inequity exists in the procurement and distribution of vaccines, which has hit the developing countries in Asia and Africa the most. According to the World Health Organisation, among the 832 million vaccine doses that have been administered so far, 82 per cent have gone to high- or upper-middle-income countries, while only 0.2 per cent have been shipped to low-income countries in Asia, Latin America and Africa.
According to a United Nations (UN) report, in high-income countries alone, 1 in 4 people have been vaccinated, a ratio that drops precipitously to just 1 in 500 in low-income countries.
This inequitable vaccine access is rooted in the power, influence and the control of the few rich countries who have determined vaccine allocation. Early on, despite COVAX’s commitment to vaccinate the world’s population, Western countries developed vaccines separately, in bulk, more than what was necessary, hoarded and vaccinated nearly everyone, including their young people (12-17 age group), who are considered much less at risk.
Citizens of low income countries faced a severe shortage of vaccines, even those who were at risk for COVID-19. As a result, many countries have been left behind in the vaccine race.
In the Global South, countries have welcomed and celebrated the ‘noble’ decision of rich countries to donate overstocked vaccines. However, we must take a step back to understand why countries need donations in the first place.
COVID pandemic
Our struggle to access vaccines is not a consequence of our present shortcomings but of our long histories - many of which are burdened with the legacy of violent colonialism. If poor countries need to rely on donated vaccines, it’s a sign that the global health system is not working. Global Health has failed in this global COVID pandemic.
It is not just about purchasing doses. A painful history of unequal power relations has shifted resources out of low- and middle-income countries to their high-income counterparts.
We are working against a persistent lack of support for the infrastructure that allows countries in the Global South to independently drive scientific development. Moreover, our material resources and human capital have supported the Northern economies for decades.
This is exacerbated by the problem of brain drain, in which talent is pulled from low- and middle-income countries to their high-income counterparts, perpetuating dependence and inequities. For example, it is estimated that researchers working internationally from low-income countries produce 10 times more patents than their compatriots at home.
Scientific and health sovereignty are strategic drivers of equitable access to health. Rich countries are often lauded for aid and donations – but real progress can only be made when we move from charity to rights-based models.
To sustain development efforts, international cooperation and collaboration that enhances local capacity and expertise, enables country infrastructure and retains the talent to generate innovation at home is crucial. It is all about Human Rights, Social Justice and Equity.
In the short term, developing countries need to be able to produce vaccines and access them equitably. This includes relaxing the World Trade Organisation’s (WTO) Trade Related Access to International Property Rights to enable countries to produce the needed vaccines on site.
Developing countries
In the long term, international collaboration across nations is urgent. For example, the Sputnik-V vaccine programme in Argentina involves cooperation between the Gamaleya Institute, the Russian Direct Investment Fund and a national pharmaceutical company, Richmond Lab, to develop and produce vaccines for Argentina and the Southern Cone. This type of cooperation is strategic to expand vaccine production and enhance technology investment in developing countries.
Regional cooperation will strengthen the health and technology sectors in developing countries. During the last few months, Oxford AstraZeneca vaccines have been produced between Argentina, which produces the active substance of the product and Mexico, which subsequently completes and bottles the doses.
COVID is a global threat today. There will be more, severe threats in future. As we move forward, let the lesson learned from this crisis not go in vain. Together, in solidarity, we can each do our bit to advance our shared vision of an equitable world. It has taken an extraordinary drive to develop the vaccines in a very short period of time. Reimagining Global Health should be about the deliberate intention to get this vaccine down to the very last person.
Jonatan Konafino MD, MSc, PhD is a Senior Atlantic Fellow for Health Equity and Professor of Public Health at Universidad Nacional Arturo Jauretche and George Washington University. Secretary of Health in the Municipality of Quilmes, Buenos Aires, Argentina.
Shubha Nagesh is a medical doctor by training and a Global Health Consultant. She presently works for The Latika Roy Foundation, Dehradun, India. She is a Senior Atlantic Fellow in Global Health Equity.
- IPS
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