When I had my first Covid-19 vaccination this time last year, I was surprised at how emotional I felt, as well as immensely grateful to the NHS workers who were administering it in such a friendly and reassuring way. After long periods in lockdown, when I felt cut off from friends and family in semi-isolation, it seemed like the beginning of a brighter way forward, despite Covid numbers and deaths still being very high.
In comparison to a range of strategies used by other countries, such as New Zealand and South Korea’s zero-Covid approach or Sweden’s “light-touch” strategy, the British government has used vaccines as the main line of defence against the virus. Vaccines can certainly be seen as a key success factor in combating Covid here, as well as globally. However, it is easy to forget that the availability of vaccines differs widely across the world and that many countries still have little access to them.
Shocking imbalance: low income, low rates
Latest data from the United Nations Development Programme (UNDP) shows that, whilst two in three people in high income countries have been vaccinated, only one in eight people have been vaccinated in low income countries. Indeed, in some countries, such as Haiti and the Democratic Republic of Congo, almost none of the population has received full vaccine protection. Countries in Africa, South America and Oceania have the lowest vaccination rates in the world.
Amnesty reports that the UK alone has administered nearly twice as many vaccination doses as the entire African continent, despite its population being 20 times smaller.
Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation (WHO), calls this a “shocking imbalance” and argues that “Vaccine inequity is the world’s biggest obstacle to ending this pandemic and recovering from Covid-19 .” The WHO highlights the need to share Covid vaccines globally, prioritising health workers and those at highest risk.
Rich nations ordered more than they needed
The Organisation for Economic Co-operation and Development (OECD) reports that most high-income countries, including the UK, USA and Canada, “placed large advance orders to ensure priority access.” Boris Johnson continually boasts that the UK was “the first country in the world to administer a vaccine” and those of us here have benefited from this approach.
But, as Raka Banerjee from the World Bank Development group points out, “many wealthy countries actually pre-ordered far more vaccine doses than they even needed to vaccinate their populations.” For example, the US bought enough for twice its population, the UK for four times its population and Canada for five times. By the end of 2021, 11 billion vaccine doses had been created, but almost 10 billion had already been promised to the richest countries.
There are clearly major health and moral, as well as economic, implications to this situation.
The UN Refugee Agency (UNHCR) has called on world leaders to “ensure equitable access to vaccines” between and within countries. Former UK Prime Minister Gordon Brown is appealing to wealthy nations to adopt “extraordinary measures” to tackle vaccine inequality and help low-income countries acquire Covid vaccines.
COVAX lacks funding
In an effort to tackle this challenge, WHO, UNICEF and other bodies have established COVAX (also known as the ACT-Accelerator initiative), a global collaboration which aims to “accelerate the development, production and equitable access to Covid-19 tests, treatments and vaccines.” However, according to the OECD, it is under-funded and competing for supply with agreements between governments and vaccine manufacturers. There is currently a US$16 billion funding gap for this vital initiative.
Many governments, including Canada, Australia and the EU, have agreed to share their surplus vaccines. However, although COVAX distributed nearly 1 billion doses to 150 countries last year, some countries have only donated doses to the scheme that are near their expiry date. Reuters reports that poorer nations such as Nigeria rejected more than 100 million Covid-19 vaccine doses last month because of their short shelf life, as they had no means of storing or distributing them in time. Uganda accepted 10 million doses but was unable to administer them owing to lack of resources.
Big Pharma and ministers resist patent sharing
Another way in which Covid vaccines could be made more accessible is through patent sharing, enabling a larger number of countries to produce their own vaccines, but this has been opposed by a number of wealthy nations, including the UK. In May last year, the US rather surprisingly came out in favour of a patent waiver. This was welcomed by WHO’s Director as a “monumental moment in the fight against Covid-19”.
However, by October 2021, the British government was still opposing such a move, despite a Parliamentary motion signed by 24 opposition MPs. Vociferous protests were organised in London by Global Justice Now, who argued that the UK position was “short-sighted” and “morally obscene”.
Unsurprisingly, the pharmaceutical industry is against patent waivers, arguing that patent rights encourage scientific innovation and that the onus is on governments to share their vaccines more widely. It is interesting then that Oxford AstraZeneca has taken a different position to Pfizer or Moderna by offering royalty-free licences and setting up a licensing deal with the Serum Institute in India. This is arguably a more ethical stance, even if the consortium still prioritises UK needs.
Omicron cases still rising globally
As Covid numbers fall in the West, we see measures such as face mask wearing and Covid passes being dropped in England and restrictions beginning to be lifted across Europe. However, the Omicron variant is now raging in other parts of the world, especially Africa, Asia and the Pacific, where vaccine rates are lowest. Cases have been rising in South Africa and other African nations, where more than 80% of the population have yet to receive a single dose.
Many countries in South Asia, where Omicron is threatening to overwhelm health services, have vaccinated less than 50% of their population. Pacific islands are also suffering from a surge in cases, leading to greater demand for vaccinations in hard to reach locations.
Promising sign from Africa
As we go to press, a ground-breaking project has just been announced by WHO that will enable six African nations to produce their own MRNA vaccines, with the aim of ending their reliance on vaccines produced elsewhere. If successful, this scheme could be replicated elsewhere and expanded to other vaccines.
But this is just a start. There is clearly still an urgent need to address the basic question of vaccine inequity, to share vaccines and make patents available more widely. World leaders need to step up and contribute their share of financing to the COVAX scheme and not just give away out of date vaccines that countries cannot use. We must not be complacent. As the UN makes plain: “No one is safe until everyone is safe.”
