Unfair Distribution Of Vaccines-‘Catastrophic Moral Failure’

Last week, Dr. Tedros Ghebreyesus, the Director of the World Health Organisation (WHO) warned of an impending “catastrophic moral failure“. He pointed out the fundamental unfairness that a young healthy person in a rich country with a low risk of dying would get vaccinated before a vulnerable elderly person in a poor country. That he had to say this is as disappointing as it is predictable.  One of the brightest points of this wretched pandemic is the previously unimagined speed of the development, testing, and licensing of COVID-19 vaccines, some of which are based on completely new technology and seem extraordinarily effective. However, the COVID-19 pandemic has highlighted the glaring fact that technological miracles have not been matched by similar creativity and will to ensure equitable accessibility of these vaccines.

More than a decade after the last pandemic, we are struggling with the same issues. Vaccine nationalism has reappeared and countries have made huge bilateral deals to protect their populations. Once again, a WHO legal and financial framework, COVAX, has been established and commitments made to ensure access to vaccine doses for lower-income countries. However, COVID-19 is far more deadly than the 2009 swine flu pandemic, and, unusually for infectious diseases, has hit some high-income countries hardest. But will COVAX work? The cost of the vaccine per se is not a huge bottleneck; at least two pharmaceutical companies AstraZeneca and Johnson & Johnson have committed to providing the vaccine at low cost during the pandemic, although additional support is needed for the logistic challenges to safely and effectively implement vaccination in settings with basic health care systems. A bigger threat to equity is limited production capacity to meet global needs and obligations to higher-income countries, many of whom invested in COVID vaccine research and development, and who have reserved enough doses to vaccinate their whole populations several times over.

The UN secretary-general, António Guterres, has sharply criticized the “wildly uneven and unfair” distribution of Covid vaccines, saying 10 countries have administered 75% of all vaccinations and demanding a global effort to get all people in every country vaccinated as soon as possible. The UN chief told a high-level meeting of the UN security council on Wednesday that 130 countries had not yet received a single dose of vaccine.“At this critical moment, vaccine equity is the biggest moral test before the global community,” said.

Guterres called for an urgent global vaccination plan to bring together those with the power to ensure equitable vaccine distribution – scientists, vaccine producers, and those who can fund the effort. He called on the world’s major economic powers in the Group of 20 to establish an emergency task force to establish a plan and coordinate its implementation and financing. He said the task force should have the capacity “to mobilize the pharmaceutical companies and key industry and logistics actors”.

China’s foreign minister, Wang Yi, criticized the growing “immunity divide” and called on the world to “come together to reject ‘vaccine nationalism,’ promote fair and equitable distribution of vaccines, and, in particular, make them accessible and affordable for developing countries, including those in conflict”.At the WHO’s request, he said, China will contribute 10m doses of vaccines to Covax “preliminarily”.

China has donated vaccines to 53 developing countries including Somalia, Iraq, South Sudan, and Palestine, which is a UN observer state. It has also exported vaccines to 22 countries, he said, adding that Beijing has launched research and development cooperation on Covid with more than 10 countries. India’s external affairs minister, Subrahmanyam Jaishankar, also called for a halt to “vaccine nationalism” and encouragement for internationalism. “Hoarding superfluous doses will defeat our efforts towards attaining collective health security,” he warned.

Two vaccines, including one developed in India, have been granted emergency authorization, the minister said, and as many as 30 vaccine candidates are in various stages of development. Jaishankar announced, “a gift of 200,000 doses” of vaccine for about 90,000 UN peacekeepers serving in a dozen hotspots around the world. Mexico’s foreign minister, Marcelo Ebrard, whose country is president of the Community of Latin American and the Caribbean States, called for speeding up COVAX and stopping the “undue hoarding” and “monopolization of vaccines.”Mexico calls on rich countries not to hoard coronavirus vaccines

He urged that priority be given to countries with limited resources, saying “it’s been pointed out that these countries won’t have generalized access until the middle of 2023 if current trends persist”.

“What we are seeing is a huge gap,” Ebrard said. “In fact, I don’t think we’ve ever seen such a huge division affecting so many in such a short space of time. That is why it’s important to reverse this.”Britain’s foreign secretary, Dominic Raab, whose country holds the security council presidency this month and presided at the virtual meeting, urged the UN’s most powerful body to adopt a resolution calling for local ceasefires in conflict zones to allow the delivery of Covid-19 vaccines. Britain says more than 160 million people are at risk of being excluded from coronavirus vaccinations because they live in countries engulfed in conflict and instability, including Yemen, Syria, South Sudan, Somalia and Ethiopia. Russia’s UN ambassador, Vassily Nebenzia, objected to the council focusing on equitable access to vaccines, saying this went beyond its mandate to preserve international peace and security.

We need a better institutional system for future pandemics so that access to vaccines is needs-based and in order to mitigate nationalistic instincts. This serves everyone’s self-interest and is simply the right thing to do.