Ahead of the second Global COVID-19 Summit, held on 12 May 2022 and co-hosted by the United States, 13 Nobel Laureates and former world leaders sent a letter to the White House in an appeal to the government to help finance the global response to the pandemic. “Almost 3 billion people remain entirely unvaccinated. The Covid-19 death toll is estimated to be four times higher in lower-income countries than in rich countries,” the letter states.
The COVID-19 vaccination rollout was the largest in history, with nearly 11.5 billion doses administered overall as of the time of writing, at a high of 40 million people vaccinated per day in June 2021. But according to Our World in Data, only about 16% of people in low-income countries have received at least one dose of the vaccine, which is vastly below the World Health Organization’s (WHO) global target of 70% of the world’s population to be fully vaccinated by June 2022. This target has only been achieved by several low-income countries, such as Nepal and Cambodia.
Inequality of Vaccine Distribution
Recent reports have pointed out that efforts to increase vaccination rates have stalled in the past few months. Unsurprisingly, a part of this delay is related to costs. COVAX, the vaccine acquisition initiative, co-led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations; and the WHO, was established in 2020 as a mechanism for low-income countries that were unable to buy vaccines directly from manufacturers.
While the idea of equitable allocation of vaccines to low- and middle-income countries was praiseworthy, the approach of buying vaccines from manufacturers to donate them proved inadequate; the market for vaccines was tight at the beginning of the rollout and high-income countries were prioritized. To make matters worse, these countries stockpiled many more doses than their populations required, and it’s estimated that 30−50% of the vaccines were unused and may expire soon. COVAX aimed to deliver 2 billion doses to low- and middle-income countries by the end of 2021, yet less than one billion were delivered.
Ensure Future Vaccine Procurements
The costs of the vaccines themselves are just a fraction of the price tag. Shipping and storage, including cold-chain equipment to store vaccines in low temperatures, as well as human resources, are crucial in advancing vaccination rates. In April, Gavi co-hosted the Break COVID Now Summit, which secured $4.8 billion in new commitments to COVAX, mainly from high-income countries. The aim of the summit was not only to improve vaccination rates in low-income countries, but also to ensure future vaccine procurements.
With the current spread of the Omicron BA.2 variant and its subvariants, there are sentiments that increasing the overall rate of vaccination of the broad population may not be the best resolution. Newly published research suggests that the Omicron variant bypasses immunity received from vaccines or from infections with previous variants, although natural infection and a full course of vaccination still protect from severe disease and hospitalization. One argument is that only healthcare workers and those most vulnerable to the virus should be vaccinated, especially considering limited resources and other pressing public health concerns, such as HIV and malaria. Other viewpoints underline that the funds are available, and low vaccination rates are the result of mismanagement; for example focusing on large vaccination centres in cities rather than smaller ones close to key areas for local communities (e.g. marketplaces, town squares).
Science Communication as Key to Reach Vaccination Targets
Communication between health workers and the public is key to overcoming vaccine hesitancy, although studies show that there is a higher acceptance of COVID-19 vaccines in low- and middle-income countries, as compared to high-income countries. In one study focusing on Ethiopia, 33% of survey respondents were willing to hypothetically pay for the vaccine.
Abandoning vaccination targets brings more than feelings of injustice that wealthy countries are administering fourth doses and vaccinating children while most elderly citizens of Sub-Saharan Africa are still waiting for their first dose. Analyses published by the United Nations Development Programme (UNDP) in March point out far-reaching consequences of vaccine inequity-loss of income, delayed economic recovery, long-term decrease in public health spending, and a widening poverty gap between and within countries. UN human rights chief Michelle Bachelet said this could lead to a “lost decade for development”.
Long-term Instruments for Infrastructure and Education
Building up infrastructure and funding for COVID-19 vaccination in low- and middle-income countries isn’t just a short-term strategy to end the pandemic. It can be an instrument of implementing much-needed social-assistance and education programmes, and can be an opportunity to carry out paediatric vaccinations as well.
Let’s hope that lessons learned from the COVID-19 pandemic will have an impact on the response to future international health emergencies.