Vaccine equity: What does it mean and how can it be achieved?

One year on, the coronavirus pandemic has disrupted every society on earth and fundamentally changed how we live our everyday lives. 2.25 million people have died – and the lives of billions more have been put under strain.

At Concern, we’ve seen first-hand the catastrophic impacts of Covid-19 in the world’s poorest places. The economic toll of lockdowns has led to unemployment for millions, which in turn means people are unable to feed their families. Healthcare systems that were already weak simply don’t have the resources to deal with the virus, and a lack of access to clean water and soap is preventing efforts to curb the spread.

While many high-income countries have provided social protection to those who have lost jobs (like the UK’s furlough scheme), this type of assistance isn’t possible in many low-income countries. This has resulted in a worrying increase in hunger, while the World Bank’s projections of the number of newly impoverished people in 2021 have been updated from between 88 and 115 million to between 119 and 124 million - a sharp increase. Against this stark backdrop, the need to extinguish the threat of Covid-19 has become ever more urgent.

The successful development of a number of vaccines has given the world hope that it’s possible to get the pandemic under control. But equal access to a vaccine is critical if we are to suppress Covid-19 for good. This means distributing vaccines based on need first, regardless of someone’s nationality or wealth. Health workers, other essential frontline workers and those most vulnerable or at risk of contracting the virus in every country must be prioritised.

Unfortunately, this isn’t what is primed to happen in 2021.

The vaccinations and the science behind them are currently being treated as the private property of pharmaceutical corporations – despite being developed largely with public funding provided through governments around the world. The Pfizer company - owners of the patent for the most effective Covid vaccine - expects to earn about $15 billion in 2021 sales from the vaccine, while AstraZeneca has promised to keep prices low for the "duration of the pandemic” - but could start charging higher prices as early as next year, depending on the path of the disease.

At the time of writing, high-income countries hold a confirmed 4.2 billion doses of the available vaccines, while low-middle income nations hold 670 million. There is competition between high-income countries for access to vaccines, which is increasing political and diplomatic tensions and depriving other countries access to limited stocks. At the current rate, global vaccination may be impossible before 2024.

These approaches are harmful to global efforts to control the pandemic for several reasons:

1. We must recognise that a vaccine alone is not enough.

A vaccine alone cannot stem the pandemic: it is one of a number of essential tools and approaches that all countries require to combat the virus and deal with this multi-dimensional crisis. The lessons learned in 2020 of how countries dealt with exposure and depended on their resilience must be used to respond to further waves of this pandemic and to prepare for the next global crisis. A global commitment to resilience will help build the foundation for stronger responses and quicker containment of similar crises in the future.

2. Mutations of the virus could reduce the efficacy of existing vaccines.

The race between high-income countries racing to buy up vaccinations is short-sighted, as we’ve already seen the virus is rapidly mutating in ways that could reduce the efficacy of some vaccinations. Furthermore, the World Health Organisation has said that the proportion of the population that must be vaccinated to achieve herd immunity is likely to be higher than previously estimated. The longer the virus exists in a context of patchy immunity, the greater the chance of mutations that could render the existing vaccines less effective or ineffective.

3. Patenting vaccines is being prioritised over a culture of sharing and transparency.

We must do everything we can to share knowledge, scale up production, reduce the cost of vaccines and ensure the most vulnerable people in all countries get access to vaccines, as soon as possible. Political pressure could help ensure that investments in vaccine development translate into patent waivers and prevent privatisation of profit from public money.

Governments must back South Africa and India's proposal to the World Trade Organization Council to waive intellectual property rights for vaccines, treatments and tests - as has already been done for HIV treatments - until the world has reached critically needed herd immunity and the pandemic is under control. Similarly, initiatives like the World Health Organisation’s Covid Technology Access Pool (C-TAP), where companies can share data and patents on their innovations, should be mandatory.

To date, not one company has joined C-TAP and AstraZeneca is the only company that has committed to selling the vaccine for no profit for the duration of the pandemic.

The UK has helped raise $1 billion for COVAX, a United Nations coalition that aims to accelerate the development and manufacture of vaccines, and guarantee fair, equitable and quick access around the world. This, combined with a UK aid donation of £548 million, will help distribute one billion doses of vaccines to 92 developing countries this year. Though this step is vital, there’s still more that needs to be done to reach the number of vaccines the world requires and build the capacity of frontline health services who will be essential in distributing doses to their communities.

The government is also calling for global ceasefires to allow for vaccines, while Prime Minister Boris Johnson recently pledged to donate most of the UK's surplus vaccine supply to poorer countries.  

But the government’s decision to double down on their proposal to cut the UK aid budget - at a time of unprecedented humanitarian need - risks undermining these efforts. The UK’s steps to tackle vaccine equity could prevent the needless loss of life in the short-term, but without a significant and continued financial commitment to the world’s poorest people, the paralysing effects of the pandemic – including loss of livelihoods and reduced access to health care - could be felt for decades to come.