A global pandemic calls for global response: The importance of equitable global vaccine distribution

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By Dr. Seleem R. Choudhury

According to the United Nations, 75% of all COVID-19 vaccinations have been administered among just 10 countries, while 130 countries have not received even a single dose of the vaccine, as of mid-February 2021 (Al Jazeera, 2021). Global health and political leaders have condemned this unbalanced distribution of vaccines and are taking action to ensure vaccine equity. Dr. Tebros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO), said in a recent address, “The world is on the brink of a catastrophic moral failure—and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries” (United Nations, 2021). 

Vaccine equity is the global intent to ensure that all have fair access to the COVID vaccine in order to overcome the virus that is threatening every nation. Unless the roadblocks to success for international cooperation on equitable vaccine access and delivery are removed, the world risks prolonging the pandemic by creating a two-tier vaccine system—the haves and the have-nots, the eternal battle of rich versus poor. Many rich nations have set the lofty goal of vaccinating at least 80% of their populations. Even if these countries were to achieve this goal, without the equitable distribution of vaccines to poorer nations, they run the risk in a global economy of contracting a COVID-19 variant more immune to the vaccine and bringing it back to their own nation, thus perpetuating the pandemic.

The movement to increase the distribution of vaccines to poorer nations has gained momentum under WHO’S 100-day challenge (United Nations, 2021). In February 2021, G7 leaders pledged to intensify cooperation on COVID-19 and increase their contribution to vaccine-sharing initiative COVAX (Parker, Williams, Peel, & Chazan, 2021). As the WHO’s January 2021 Vaccine Equity Declaration states: 

“We must act swiftly to correct this injustice. Multiple variants are showing increased transmissibility and even resistance to the health tools needed to tackle this virus. The best way to end this pandemic, stop future variants, and save lives is to limit the spread of the virus by vaccinating quickly and equitably, starting with health workers.” (World Health Organization, 2021).

The data of equity 

As of this article’s publication, over two million people have died from COVID-19. As a New York Times article puts into perspective, that is more than the population of the state of Nebraska, and nearly equal to the population of the entire country of Slovenia (Santora & Wolfe, 2021).

Though it has been several months since the first COVID vaccine was administered, the virus continues to spread despite the vaccine, especially in the poorer nations. Vaccine supplies are low due to richer countries purchasing more vaccines than they could distribute in the required time frame.  As a result, some experts predict that many low-income countries may not be able to reach mass immunization until 2024. Worse, some nations may never get there (Safi, 2021).

To support the equitable distribution of the vaccine moving forward, the WHO established the Covid-19 vaccine allocation plan—known as COVAX—at the end of 2020 (World Health Organization, 2020). COVAX’s goal is to ensure that the research, purchase, and distribution of any new vaccine is shared equally between the world’s richest countries and those in the developing world.  According to the WHO, 172 economies are engaged in discussions about participation in the COVAX initiative (World Health Organization, 2020). 

The variants

Catalyzing vaccine distribution in poorer countries is essential to prevent the development of new variants of COVID that could cost more lives around the world. It is the natural state of RNA viruses such as the coronavirus to evolve and change gradually. The flu, for example, is an ever-adapting virus, which is why people must receive a new vaccination each year.  Viruses are primed to change, but occasionally a mutation occurs that alters how rapidly the virus spreads, its level of infectiousness, or the severity of the disease (Gray, 2021).

This is the primary concern with new variants of COVID emerging in different countries. The most recent variations of the disease in South Africa and Brazil are concerning epidemiologists as they show signs that the virus may be “adapting to evade immunity in some people” (Gray, 2021).  To stay ahead of the evolution of the virus, scientists are evaluating each new mutation to determine which ones are likely to be most impactful (Callaway, 2020). 

We have established that a partially immunized population runs the risk being impacted by variants that are transmitted more easily and are more likely to result in death for those infected with the virus (Toy, 2021).  Embracing vaccine equity is the best solution to guard against this.  If nations insist on focusing only on their own populations, new variants will perpetually threaten them, necessitating changes to the vaccine.  If countries continue to choose not to share, then this ludicrous process starts again.  If everyone has immunity through vaccination, then variants’ effects will be diminished, with virtually no virus circulating or adapting (Toy, 2021).

Next steps

The COVAX initiative is a good start to addressing vaccine equity.  It has gained strength now that the US has joined under its new presidential administration (The White House, 2021). Additionally, at a virtual G7 meeting, leaders pledged $7.5 billion to the WHO-led collaboration (Parker, Williams, Peel, & Chazan, 2021).  This crucial financial backing will allow COVAX to accomplish its aim of securing and equitably allocating 2 billion doses of COVID vaccines, starting with healthcare workers and other high-risk groups as defined by the WHO, by the end of 2021 (Kettler, 2021).

While equitable distribution is being addressed globally, individual nations must also grapple with the challenges of vaccine distribution within their own populations (Liao, 2021).  The WHO has proposed a “Roadmap For Prioritizing Uses Of COVID-19 Vaccines In The Context Of Limited Supply” to aid countries in their own vaccine equity efforts. The Roadmap considers priority populations for vaccination based on epidemiologic setting and vaccine supply scenarios (World Health Organization, 2020).

Summary

Interestingly, several countries are filling the gap created by the United States and the other G7 countries. India, Russia, China and Israel appear to be waging a strategy of soft power towards global health (Mashal & Yee, 2021). It is hard to imagine populations of countries not being grateful to those that help towards timely vaccinations, and it could leave recipients obligated to repay in other ways. This could potentially realign global alliances and change geopolitics

It is hard to ignore WHO Director-General Ghebreyesus’s concerns about the irreconcilable cost of the moral failure of continued inequitable vaccine distribution.  The world’s poorest countries will be disproportionately affected, and richer nations will continue to have on-again-off-again economies as variants of the virus wreak havoc on the health of their own populations.

The immediate sharing of doses will reduce the chance of ongoing variants and begin to revive the global economy.  The only way to vaccinate the majority of the world’s population with urgency is to do it together.  A global pandemic requires a global neighbourhood philosophy and response with no strings attached.

About Seleem R. Choudhury, DNP

Seleem Choudhury is an international clinician and operational executive with over 15 years of experience leading academic hospitals and health systems in community settings.  He writes about clinical excellence and entrepreneurism in healthcare at seleemchoudhury.com.

Resources

Al Jazeera (2021). ‘Wildly unfair’: UN boss says 10 nations used 75% of all vaccines. Al Jazeera.

Callaway, E. (2020). The coronavirus is mutating — does it matter? Nature.

Gray, R. (2021). This is how new Covid-19 variants are changing the pandemic. BBC.

Haseltine, W. (2021). How The Covid-19 Virus Changes. Forbes.

Hernandez, J. (2021). Two Members of W.H.O. Team on Trail of Virus Are Denied Entry to China. New York Times.

Kettler, H. (2021). What is COVAX? Path.

Liao, K. (2021). What Is Vaccine Equity? Global Citizen.

Mashal, M. & Yee, V. (2021). The Newest Diplomatic Currency: Covid-19 Vaccines. New York Times.

Parker, G., Williams, A., Peel, M., & Chazan, G. (2021). G7 leaders vow to boost vaccine supplies to developing world. Financial Times.

Safi, M. (2021). Most poor nations ‘will take until 2024 to achieve mass Covid-19 immunisation.’ The Guardian.

Santora, M. & Wolfe, L. (2021). Covid-19: Over Two Million Around the World Have Died From the Virus. New York Times.

The White House (2021). National Security Memorandum on United States Global Leadership to Strengthen the International COVID-19 Response and to Advance Global Health Security and Biological Preparedness. The White House.

Toy, S. (2021). Covid-19 Vaccination Delays Could Bring More Virus Variants, Impede Efforts to End Pandemic. The Wall Street Journal.

United Nations (2021). WHO chief warns against ‘catastrophic moral failure’ in COVID-19 vaccine access. UN News.

World Health Organization (2021). Call to Action: Vaccine Equity Declaration. World Health Organization.

World Health Organization (2021). COVID-19 Vaccine Equity Declaration. World Health Organization.

World Health Organization (2020). Fair allocation mechanism for COVID-19 vaccines through the COVAX Facility. World Health Organization.

World Health Organization (2020). WHO SAGE Roadmap For Prioritizing Uses Of COVID-19 Vaccines In The Context Of Limited Supply. World Health Organization.

World Health Organization (2020). 172 countries and multiple candidate vaccines engaged in COVID-19 vaccine Global Access Facility. World Health Organization.

One year ago on this day, COVID-19 was declared a pandemic by the World Health Organization. While we have overcome significant challenges in the past year, we must now address the challenge of ensuring that all have fair access to the COVID vaccine in order to overcome the virus that is threatening every nation.

#TheMoment #vaccinequity #covid19

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