Challenges in Equitable Global Distribution of Covid-19 Vaccines
By Maya Luong, UNA-NCA Research Assistant
The Covid-19 pandemic has brought to light the immense vulnerability of an intricately linked but unequal global health system. With the rollout of Covid-19 vaccines, many see a light at the end of the tunnel. Nonetheless, the inequitable Covid-19 vaccine procurement among countries has brought more obstacles to our global challenge of inequity, as already-disadvantaged countries and communities will likely see prolonged impact from the pandemic and late obtainment of the vaccine — our best bet to reduce deaths and revive economic activities. The question of whether governments and international NGOs will be able to fill in the holes of the inherent inequity in vaccine procurement among countries will shed light on the global community’s commitment to public health. If the distribution of the vaccine stays inequitable, the practical reality of whether even those in the developed world will be really safe if holes remain.
The longer the pandemic lasts, the more economic and public health vulnerabilities will be compounded. Last year, the world economy shrunk by 4.3%. Within and among countries, vulnerable groups such as those with disabilities, marginalized communities, and elders face heightened impact due to unequal access to prevention and treatment of Covid-19. In the United States, Black and brown communities experience disproportionately higher cases and deaths from Covid than white communities, and more limited access to testing. One study estimates that in terms of life years lost, the pandemic will result in a reduction of life expectancy for Black and Latinx Americans 3–4 times as large as the reduction for White Americans. In Brazil, an epicenter of the pandemic in 2020, approximately 83.5% of the labor market was pushed to a state of vulnerability. Black Brazilians were more likely to have Covid symptoms, face pay cuts or lose their jobs than White Brazilians. Around the world, girls leaving schools due to lockdown are much less likely to return, exposing them to higher risks of sexual exploitation as well as loss of learning and future economic potential. These are only some of the ways that the pandemic had disproportionately affected the world’s most vulnerable.
In the race to obtain as many vaccines as possible as quickly as possible, the risk of a global unequal distribution runs high, as governments that are the most equipped economically to secure bilateral purchase deals with vaccine manufacturers and distribute obtained vaccines are also the most likely to inoculate a critical mass of their citizens the fastest. According to a BBC estimate, US, UK, and the EU all purchased numbers of vaccine doses much higher than what’s needed to vaccinate their populations. The number of excess vaccines from these 3 regions combined is enough to vaccinate everyone over the age of 16 in 20 countries most at risk of humanitarian disaster. By the end of summer 2020, the United Kingdom, the EU, and Canada had purchased in advance enough vaccine doses to cover more than their populations. By January 2021, Canada had purchased enough vaccines to inoculate its population five times over. The Duke Global Health Innovation Center reports that the majority of the vaccine had already been purchased by high-income countries, where only 19% of the global adult population reside, and predicts that there will not be enough vaccines to cover the entire world’s population until 2023 or 2024. Based on current data, high-income countries collectively own enough vaccine doses to vaccinate more than twice their populations, while low and middle-income countries only own enough to vaccinate a third of their total populations. Meanwhile, as of March 2021, India had only procured enough vaccines to vaccinate 8% of its population and the African Union had procured enough vaccines to vaccinate 38% of the continent.
To tackle the issue of equitable distribution of the Covid-19 vaccines, a global coalition called COVAX — led by the World Health Organization, Gavi, and the Coalition of Epidemic Preparedness Innovations (CEPI) — aims to distribute at least 2 billion doses by the end of 2021. COVAX pools resources and risk across 190 countries, including 78 higher-income countries, to accelerate the development and production of the largest portfolio of vaccines. Countries may join as self-financing countries and purchase a number of vaccine doses sufficient to vaccinate up to 50% of their population based on their ability to pay, while also paying a premium for vaccines to subsidize poorer countries. Alternatively, countries may join COVAX under its Advanced Market Commitment (AMC), where funding is drawn from the Official Development Assistance (ODA) by the Organization for Economic Co-operation and Development (OECD), private sector contributions, and philanthropy. 92 middle- and lower-income countries are currently in the COVAX AMC program. The most up-to-date forecast by COVAX indicates that 1.8 billion vaccine doses will be available to countries in the AMC program — enough to vaccinate approx 28% of the population. Even though self-financing countries can purchase doses sufficient to vaccinate up to 50% of their population, once any of the vaccines in the COVAX portfolio have been proven to be safe, effective, and had gained regulatory approval, doses will be allocated to all 190 participating countries at the same rate based on population size. COVAX says vaccine doses requested by self-financing countries will be fulfilled by the second half of 2021. Factors that may influence vaccine distribution projections by COVAX include vaccine manufacturing progress, regulation, funding availability, final contract terms and the readiness of countries enrolled in COVAX to begin vaccinating their citizens, adding to the uncertainty of projections.
While the COVAX initiative is one way in which the world’s population can more equitably receive vaccine doses — rather than relying on only bilateral deals between countries and vaccine manufacturers alone — COVAX’s model of proportional allocation based on population size still does not prioritize countries with the highest need for the vaccine, which is determined by potential life lost, health and economic consequences. If vaccine distribution through COVAX were to be based on minimizing the risk of death, disease, and economic disruption due to the pandemic, countries such as Mexico, Brazil, Iran, and Ecuador, where the pandemic is most likely to increase rates of death, disease, and social and economic disruptions, should be prioritized to receive a higher proportion of the vaccines. An analysis from the Kaiser Family Foundation finds that without redistribution of vaccine doses already purchased by high-income countries (through donations) or increased support for production of additional vaccines, more than 4 in 10 of adults in the world will not be able to be vaccinated.
In the face of this challenge, a variety of non-profit organizations and news outlets have joined the United Nations in urging rich countries to consider contributing more to the COVAX effort or to ship surplus vaccine supplies to poorer countries. In December 2020, COVAX said that they had a shortfall of $4 billion in unfulfilled pledges from a variety of countries. The Biden administration announced on February 18 that they would donate $4 billion to COVAX, starting with $2 billion immediately and another $2 billion over the next two years when other countries have fulfilled their pledges to support COVAX. The Gavi alliance, which co-leads COVAX, had also said that COVAX will need greater political support in negotiating and securing limited supplies of the vaccines from manufacturers. While the United States announced that it will donate surplus doses to countries in need — though details have not been released — when all Americans have been vaccinated, the urgency of tolls caused by the pandemic globally necessitates the most immediate procurement and distribution of Covid-19 vaccines to areas most affected, not simply charitable donations of surplus vaccines once high-income countries are done vaccinating a substantial number of their populations, which could take months at minimum.
In a statement at the virtual World Economic Forum’s Davos Agenda meeting, UN Secretary General Antonio Guterres emphasized the importance of equitably distributing Covid-19 vaccines: “If we believe it is possible to vaccinate the global north and forget about the global south… you [will] let the virus spread like wildfire in the global south [and] it will mutate.” Given new developments in virus mutations, which have been found to include strains that are more lethal and more transmissible, right now is a critical time to slow the spread of Covid-19 even as vaccines are rolling out. The reality of an interconnected world, and the reality of how Covid-19 had managed to spread so rapidly across the globe call for a plan for coordinated vaccine distribution that reaches far and wide, targeting the most vulnerable populations of all countries, not just those that have the means to secure vaccines the quickest. An unequal distribution of the Covid-19 vaccines may hurt all countries in the long run.
