October 5, 2021 | by Julia Masselos
One of the core tenants of the human right to healthcare is the right to equal and fair access to treatments. This is perhaps now more relevant than it has been in the last century. Indeed, the National Academies of Sciences, Engineering, and Medicine (NASEM) went so far as to list the “mitigation of health inequities” as an overarching ethical principle for allocation of COVID-19 vaccines in the United States.
Here, we will explore what equitable vaccine acces is, why it is important, and examples of inequalities that have been highlighted over the last 10 months of the COVID-19 vaccine roll out.
What is Equitable Vaccine Access?
The development of safe and effective vaccines is only the first step in a long fight against ending the Coronavirus pandemic. Another crucial part of the equation that needs to be considered is making sure people all around the world are able to access the vaccines once they are mass produced. This is where the idea of equitable vaccine access comes in.
How can we ensure that COVID-19 vaccines – regardless of whether we’re talking about the Moderna, AstraZeneca, PfizernBioTech, or any other type – are distributed fairly to all populations around the world? It is a vital question at the intersection of the UN Sustainable Development Goals, the Bill of Human Rights, and ensuring we transition into a fair and healthy post-pandemic society.
One of the UN SDG targets outlined in 2015 states, “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”
Similarly, the World Health Organization states that the “right to health must be enjoyed without discrimination on the grounds of race, age, ethnicity or any other status,” and that every human being has “the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health.”
Yet despite these aspirational goals, the realities of the COVID-19 vaccination roll-out has been riddled with inequalities on multiple fronts, such as:
Global disparities between economically robust and under-resourced countries: Rich nations quickly bought up more than their fair share of vaccine doses relative to their populations, meaning they’d be able to theoretically vaccinate their population several times over. This phenomenon is known as “vaccine hoarding” or “vaccine nationalism”. By contrast, low- and middle-income countries have struggled to secure enough doses to protect their most at-risk individuals, despite initiatives like COVAX meant to support these nations.
Speed of roll-out: According to Reuters, at the time of writing, Portugal has fully vaccinated 80% of their population – one of the highest rates in the world. By stark contrast, only 0.5% of the population of Chad has received a first dose, with just 0.1% being fully vaccinated.
Socio-demographic factors leading to inequalities within the country: A survey jointly carried out by Northwestern, Northeastern, Harvard, and Reutgers in early 2021 showed that education level was a greater predictor of whether Americans were getting vaccinated than race. It is clear then that even within countries or regions, there is a systemic disparity at play that is reflected in vaccine uptake.
The Importance of Equitable Vaccine Access
Fair and equitable vaccine access is of course needed for the successful transition into a post- pandemic world. However, on a more conceptual level, our success in executing such an equitable transition will also serve as a sort of litmus test for our morality as a global society, and a benchmark for future generations when looking back at this moment in human history.
The fact of the matter is that while politics and economics might care for borders, nationalism, and ideology, biology does not. The virus was and is a threat in all corners of the world – until we are all safe from it, no one is safe from it. This sentiment is echoed by Dr. Angela K. Shen, visiting scientist at the Vaccine Education Center at Children’s Hospital of Philadelphia. “Vaccine nationalism only helps the virus propagate. In order for a vaccine to work, you need most of society to be protected — and that protection happens when you get everyone vaccinated. So, you want to roll this out to everyone because, inherently, that’s how you protect everyone collectively,” she states in an interview.
We are already seeing some of the negative consequences of vaccine hoarding – there are some countries that simply don’t have any vaccines at all. These places – also known as vaccine deserts – are the most at-risk of becoming the hotbed for new and more virulent variants of COVID-19.
One such nation is Chad, where just 0.1% of the population have been fully vaccinated. Despite being part of the WHO’s COVAX scheme, they have not received enough vaccines to even cover their frontline health workers.
Even if the vaccines were to arrive – they were promised a batch of Pfizer doses in June – the next challenge becomes storing them. Every vaccine has its own storage requirements, with Pfizer best being kept between -130°F and -76°F, according to the CDC. This is a huge challenge in a country like Chad, where such cooling infrastructure is not very well developed, and it isn’t uncommon for daily temperatures to soar over 100°F.
Rolling out vaccines in anything but an equitable way risk creating a segregated two-class global society, one vaccinated society able to enjoy a relatively “normal” life within its metaphorical castle walls, and one society without adequate protection, which can lead to new variants of the virus, but can also lead to exclusion from common activities in our global society.
The way policy is moving in the West, with the introduction of vaccine passports and businesses being allowed to turn away unvaccinated people from jobs, venues, and social spaces, it isn’t a stretch to imagine activities like live music, eating out, getting certain jobs, and international travel could become reserved for the vaccinated class – i.e. those from more economically developed countries. The only way to prevent this dystopian future is to ensure equitable vaccine access for all.
Overview of current COVID-19 Vaccination rates
To highlight the type of disparity we are discussing, consider this table showing vaccination rate for economically developed and economically under resourced countries:
Sources: Reuters Vaccination Tracker & Worldometers.info
Looking at the table above, there is a clear trend showing a correlation between GDP per capita and vaccine roll out. Indeed, at a press briefing on April 9, World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus said that 87% of vaccines have gone to wealthier countries, while low-income countries received just 0.2%.
Furthermore, data from the Duke Global Health Innovation Center Launch and Scale Speedometer, which monitors COVID-19 vaccine purchases, shows that high-income countries already own more than half of all global doses. What is more, it is estimated that there will not be enough doses to fully vaccinate the world population until 2023 at the earliest. To put this into context, these high-income countries account for just one fifth of the world’s population – 50% of COVID-19 vaccine doses “belong” to just 20% of people.
However, also visible in the table above are outliers. Bhutan and Turkmenistan are such exceptions, with the latter having approximately double the GDP per capita of the former, but with a fraction of the vaccination rate.
This indicates that there are other factors at play aside from GDP per capita that influence vaccine uptake – for example, the pervasive political ideology of a nation, trust in the local medical system, and infrastructure needed to store and distribute the vaccines.
What Can We Do?
Redistribute vaccines
Several high-income countries like France, Norway, the UK, and the US have all agreed that they will redistribute their excess doses to countries lagging behind in their vaccine roll-out – but only once they have fully vaccinated their entire populations. Indeed, this is the idea behind the COVAX initiative – which aims to secure vaccines for countries which haven’t acquired as many as they need.
Make access as easy as possible
Vaccine centres are not distributed evenly amongst the population in any given country. They tend to be concentrated in highly urbanized areas, leading to vaccine deserts in less inhabited parts. One approach to combat this in the US has been the use of algorithms to identify which CVS would have the biggest impact if turned into a vaccine centre. In other words, AI is finding and optimizing vaccine centre roll out to maximize population benefits from minimal infrastructure development.
Share information about clinical trials and vaccine effectiveness
When it comes to convincing populations whose governments have already secured the necessary doses, directly calling and emailing are some of the least effective tactics. According to a recent Harris Poll survey, only 32% of Americans said they were influenced to get vaccinated due to such outreach strategies. By contrast, a whopping 72% of people said they were convinced by reading or listening to a news story discussing the results of COVID-19 vaccine trials.
A Final Thought
Equitable vaccine access is a human rights issue, and the way the COVID-19 vaccine distribution has been and is going has highlighted a host of structural and geopolitical advantages some countries hold over others. There will be no way to return to some semblance of “normal” without getting everyone immunized against the disease and reduce the burden on our collective health system.
While initiatives like COVAX are great for redistribution resources, there remain some serious systemic barriers to equitable vaccine access on both global and regional levels. Luckily, there is some data to suggest possible ways to mitigate their effects and get us out of this pandemic – so long as we act swiftly and smartly on them.
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