Addressing Global Covid Vaccine Inequity
February 24, 2022
By Zoë Levi
As the world enters the third year of the Covid-19 pandemic, many have accepted it as a new way of life, yet those most vulnerable continue to suffer. The vaccine is a solution to the pandemic but remains inaccessible to a large proportion of the world, specifically those who need it the most. Covid-19 vaccines were developed in record time, and many were approved for use in December of 2020. There have been 10.35 billion doses administered around the world and 4.11 billion people are fully vaccinated . However, global vaccine inequity remains a pervasive issue all around the globe. Global vaccine inequity contributes to the spread of the virus globally and to the different variants emerging seemingly one after the next. This paper will outline why there is a need for global Covid-19 vaccine equity, an analysis of existing World Health Organization (WHO) frameworks, and takes an equity and human rights approach to recommendations.
The world needs equitable allocation of vaccines regardless of a country's developmental or economic status. Yet, vaccination rates are significantly different depending on the income level of a country. The United Nations Development Programme (UNDP) has reported that vaccination rates of at least one dose in high-income countries stand at 67.5% while rates in low-income countries are at 11.1% . While high-income countries' vaccine rates have grown exponentially since the approval of the vaccine, low-income countries’ rates remain stagnant. Vaccine inequity places additional burdens on lower income countries that have already been greatly impacted economically by the pandemic. Overall healthcare spending in high-income countries has increased by 0.8% to reach the WHO benchmark of vaccinating 70% of the population, while lower income countries’ spending has increased by 56.6% . Working toward vaccine equity can contribute to the economic recovery of these countries.
On an individual level, those who are unvaccinated are more likely to face serious illness when contracting Covid-19 and need emergency care . Not only does this lead to detrimental health outcomes for the individual, but this also places a significant burden on the healthcare system. As an example, in the United States between June and November 2021 there were 690,000 vaccine-preventable Covid-19 hospitalizations, where an average hospitalization cost is $20,000 . Vaccine inequity is contributing to billions of dollars in healthcare spending in developed countries, however, many developing countries lack access to adequate healthcare.
Combining access to care with the elevated transmission and burden of Covid-19 infection, developing countries are significantly worse off. A systematic review found that the infection fatality rates in lower income countries to be twice as high as high-income countries . While there is poor reporting of death and infection in some low-income countries, those with satisfactory reports indicate death rates are ten times higher than in other developing countries . This report highlights the need for global vaccine equity especially for vulnerable populations in developing nations who experience the impact of Covid-19 significantly worse than the developed world. In low-income countries, hospital beds are only accessible to a small proportion of the population contributing greatly to Covid-19 deaths . Healthcare access and poor infrastructure are a wicked problem in their own right, yet there is a solution to prevent death from Covid-19: a vaccine.
What the developed world fails to see is that vaccine inequity does not only impact individual countries but the global community. Health systems continue to struggle under the burden of the pandemic, healthcare workers succumbing to illness and death restrict the response to Covid-19 and already existing health issues, rates of childhood vaccination have also dropped and been delayed to the most vulnerable countries . These issues happen across the globe and will not be eliminated until vaccine equity is achieved, until then people will continue to get sick and die and the health system will feel the strain as will the global economy. Vaccine equity requires a global effort to achieve and should bring countries together to solve an issue that impacts the entire world.
Continued vaccine inequity also bolsters the mutation of the virus generating novel variants that are often worse than the last. This poses additional global challenges to those who remain unvaccinated or who are unable to be vaccinated. Evidence suggests that those who are vaccinated are able to clear the infection of variants faster than those who are unvaccinated, and the severity of the illness was reduced . This exhibits the benefits of vaccination in light of emerging variants and furthers the evidence of the importance of vaccination against Covid-19. Each variant that emerges is a reminder of the ongoing pandemic and the need for global vaccine equity.
Take for example the most recent variant of the Covid-19, Omicron, which quickly spread across the globe. The Omicron variant brings to light the glaring failures in policy as high-income governments and pharmaceutical companies neglect equitable access to vaccines . Governments that have the capacity to manufacture vaccines continue to withhold the intellectual property and technology for global production . In October 2020, India and South Africa proposed that World Trade Organization-enforced intellectual property rights should be suspended for the duration of the pandemic–the TRIPS Wavier proposal–as a global response to Covid-19 . This initiative would encourage those countries with the capacity and knowledge to develop and manufacture vaccines share that information with the world. The TRIPS Waiver could offer the world a solution to vaccine inequity with sharing of knowledge and global cooperation. However, this initiative has hardly moved from its starting point as global civil society organizations attempt to convince all World Trade Organization (WTO) member governments to agree as soon as possible . This stall is largely impacted by the lobbying of the pharmaceutical industry to governments resulting in inaction . The TRIPS Waiver exhibits the global deprioritization of human rights and health equity over economic benefit.
As vaccine equity continues to present itself as an uphill battle, what more is being done on a global level to work towards this goal? The WHO has developed the COVAX pillar which works toward equitable global access to Covid-19 vaccines. It acts as an insurance policy with a portfolio of vaccine candidates, and pooling the buying power of wealthy countries into vaccine development and manufacturing through the COVAX facility, founded upon the pillar of equitable access . Thus far, COVAX has shipped over 1 billion vaccines to 144 participating countries mainly in North America, South America, Africa, South Asia, and Australia . However, this number was short of their goal of 2 billion doses by the end of 2021 .
From its emergence, COVAX ran into numerous issues in funding the initiative while wealthy countries made deals with vaccine makers outside the COVAX facility and bought up the limited supplies . Yet, this response seems unsurprising when compared to the sentiments and inaction surrounding other global initiatives, like the TRIPS Waiver. The COVAX distribution metrics are similar to other public health crises , leading to a new goal of 2 billion doses in the first quarter of 2022 . The COVAX initiative is placing blame on the world’s wealthiest countries which are stockpiling vaccines limiting the global access to vaccines . Experts are estimating that lower income countries will only have most of their populations vaccinated by 2023, even with the assistance of COVAX . This estimation is disheartening to discover as the pandemic enters its third year and is only expected to continue until global herd immunity is achieved. More must be done to work toward vaccine equity and new dynamic changes must be made.
Vaccine equity falls within the human right to health which is defined by the WHO Constitution (1946) as “the highest attainable standard of health as a fundamental right of every human being” . It is unjust and unethical for people’s health to remain at risk when there is a solution to this global threat to health. Vaccine equity cannot exist without human rights; it is necessary for advocacy and sustained, long-term solutions . Equity approaches must be combined with human rights to reach an appropriate solution to global vaccine inequity. Global assemblies often shy away from concrete human rights action due to political pressure and power that find equity to be more ‘politically palatable’ placing equity against human rights . The COVAX initiative itself takes an equity-based approach and does not incorporate human rights. This opposition and pressure prevent the global community from moving forward with lasting change.
The tenet of international human rights law indicates the obligation of nation states to go beyond their borders and have a responsibility to international assistance and cooperation . Developed nations have the capacity and obligation to aid developing countries in need of vaccine supply. Global cooperation is demanded of human rights law and the same is demanded in the journey towards vaccine equity. The Universal Declaration of Human Rights indicates that “all human beings are born free and equal in dignity and rights,” which is reflected in the attention to the dignity and rights of those countries who are most vulnerable to the impact of Covid-19 [8,9]. The global community must work with human rights and equity approaches collaboratively to achieve global vaccine equity.
In conclusion, it is apparent that the global community continues to suffer at the hand of the Covid-19 virus despite there being a solution available. The failure of the global community to collaborate in the name of human rights and health equity continues to suppress efforts toward vaccine equity. Without it, the world remains at risk and those most vulnerable continue to suffer. Combining an equity-based approach with human rights is the most effective way toward sustainable change and victory over the Covid-19 pandemic.
Zoë Levi is currently completing her Master’s in Bioethics at the University of Toronto and has an undergraduate degree in Health Sciences from Western University. Zoë is a Research Ethics Officer at Western University. Her main interests surround research ethics, health policy, human rights and reproductive rights.
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