"On the brink of catastrophic moral failure": How the Coronavirus vaccine highlights global healthcare inequality like never before
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“12 years ago, a new virus emerged and sparked a pandemic. Life-changing vaccines were developed, but by the time the world’s poor got access, the pandemic was over. One year ago, a new virus emerged and sparked a pandemic. Life-saving vaccines have been developed. What happens next is us.”

These are the poignant words of Director-General Tedros Adhanom Ghebreyesu of the World Health Organisation, speaking remotely from his office in Geneva at a week-long executive board meeting on the 18th of January. In his opening statements, Ghebreyesu highlighted the enormous accessibility gap between the world’s wealthier countries and the world’s poorest, warning of a “catastrophic moral failure” on the part of global political leaders who continue to hoard vaccine supplies.

While approximately 70 million doses have been administered internationally so far, a significant majority of these have been in higher-income countries, such as Israel, which at present has vaccinated over a third of its population.

While this is an undoubtedly incredible feat, it highlights the vast privilege and wealth wielded by developed countries – the Israeli government reportedly pre-ordered their stock early, paying a heavy premium for access to the supply. Meanwhile, lower-income countries are left unable to access sufficient stocks of the vaccine to immunise even a small proportion of their population. Specialist condition needed for storage and transportation – such as the super-cold fridges required for the Pfizer-Biontec vaccine – also make rollouts ever more unattainable. Lower-income countries are therefore left more vulnerable to the social and economic devastation the pandemic leaves in its wake.

“Another brick wall of inequality between the worlds of the world’s haves and have-nots”.

For some nations, the two-dose requirement of vaccines such as Moderna and Pfizer-Biontec mean that they are unable to finance a large-scale rollout; many are left waiting for approval of cheaper, single-dose options, such as ones currently in development at Johnston and Johnston. In his opening statement to the WHO, Ghebreyesu accused some vaccine developers of prioritising countries where they can make the most profit, resulting in one less economically developed country allegedly receiving just “25 doses”. (Although he did not specify the country in question, a WHO spokesperson later identified it to be Ghana.)

Ghebreyesu further expressed his frustration at the growing inequity in the global vaccine effort, saying that while it is only ‘right’ that governments want to prioritise vaccinating their key workers and vulnerable citizens, it is reprehensible for them to allow young, healthy adults in rich countries to receive the immunisation before health workers and the clinically vulnerable in poorer countries’.

However, a small coalition of lower-income countries has taken matters into their own hands. At a World Trade Organisation ‘TRIPS’ conference on the 16th of October, a group co-sponsored by the governments of Bolivia, Kenya, Mongolia and Venezuela, to name a few, proposed a waiver on intellectual property rights surrounding licensing and production of the vaccine, notably in the areas of Patents and Undisclosed Information. In an interview with Health Policy News, Mustaqeem De Gama, Counsellor at the South African Permanent Mission in Geneva, explained that the waiver would make available “any drug, vaccine or technology” that would help “everyone” to deal with the immediate or long-term threat of Covid-19. The waiving of the intellectual property rights held by manufacturers would allow individual governments to produce cheaper versions of the vaccine in their own countries, increasing distribution and reception globally.

As explained by Dr Seth Berkley, CEO of ‘Gavi’ (the Vaccine Alliance), it would also be of great benefit to all countries for the vaccine to be rolled out as widely as possible, as insurance of global immunity would protect against future resurgences of the pandemic. However, the proposal was blocked by representatives from the UK, US and EU, where pharmaceutical countries have significant political influence — arguing that such patents allow companies to generate profits that in turn allow them to continue to create life-saving medical innovations.

So what are our governments doing to help?

A potential strategy to combat the rapidly widening healthcare disparity between wealthier and poorer countries arises in the form of COVAX, one of three pillars launched in April by the World Health Organisation as part of their ‘Access to Covid Tools Accelerator’, in partnership with the European Commission and French Government. Conceived out of a need, according to a Gavi statement, to guarantee “rapid, fair and equitable” access to vaccine supply for all countries, the alliance aims to secure stocks of the shot that can be accessed by all “participating countries” regardless of their financial resources or economic status.

 It brings together a wide range of private, scientific and political sectors in a bid to provide “innovative and equitable” access to the “diagnostics, treatment and vaccines” required to combat the novel coronavirus. COVAX aims to maximise chances of developing vaccines that can be developed and manufactured cheaply and on a large scale by creating a “diverse portfolio” of vaccines, from which governments can request doses sufficient to immunise specified proportions of their population. The Gavi-COVAX AMC was set up to ensure that 92 middle and low-income countries who cannot fully finance a vaccine rollout will have an equal opportunity to access enough doses to protect their population, while simultaneously serving as a “critical insurance policy” for other countries, ensuring that they will be able to secure a vaccine supply even if their own bilateral deals fail.

 A ‘COVAX Facility’ would also retain a small stock of the vaccine, for emergency humanitarian efforts in areas where there are acute outbreaks. Many self-financing countries have already signed up for the COVAX initiative, and international governments have committed billions of dollars to the endeavour: according to Ghebreyesu, the COVAX facility have already obtained two billion doses, with an aim of beginning deliveries in February.

However, for some who have weighed in on the debate, the COVAX initiative is too little, too late. De Gama explains that while it is a good idea, it is not a “long term solution”. He states that even if COVAX were able to procure “large volumes” of vaccines, it would still fall short of providing immunity to even a fifth of the population of middle and lower-income nations. In the closing remarks of his speech to the WHO, Director-General Ghebreyesu urged countries that have already signed bilateral contracts with pharmaceutical companies to be more transparent about their contracts with COVAX, and to give COVAX “much greater priority” in the “queue”, especially once they have vaccinated the vulnerable members of their population and healthcare staff, thus allowing other countries to do the same. He also called on producers of the vaccine to “allow countries with bilateral contracts to share doses with COVAX”, and to prioritise a vaccine supply to the organisation, rather than to new trade deals established with individual governments.

This fierce debate will undoubtedly rage on for months to come, however it is clear, both through the words and actions of the World Health Organisation and their partners, that they intend to hold pharmaceutical companies accountable for their priorities and actions. It is imperative that they be expected to take responsibility for the fair and equitable distribution of their vaccine stock. While the path to a ‘new normal’ will undoubtedly be difficult for all nations of the world, this must be a path that is open and accessible to everyone – not just the highest bidder.