“There isn't a united global strategy” – we need to ensure vaccine equity to end Covid-19

The results of the Wellcome Global Monitor 2020: Covid-19 report underscore a desire from people in high-income countries to spend money to prevent and cure diseases wherever they occur.  

As the world continues to battle the coronavirus pandemic, we interviewed people in four countries – Germany, Indonesia, the UK and the USA – to learn more about their views on the current global Covid-19 vaccination drive and their governments' efforts to end the pandemic globally.  

Despite promises of global solidarity and proclamations of "no one is safe until everyone is safe" the data shows that we are failing as a global community. While 7.98 billion doses have been administered worldwide, just 5.9% of people in low-income countries have received at least one dose. 

The picture is very different in higher-income countries, where many countries are rolling out booster programmes and, in some countries, doses are starting to go to waste. In August, the UK threw away 600,000 Covid-19 vaccines. Since March, 15 million vaccines were thrown away in the USA. 

These figures are a stark reminder of the global disparity in access to vaccines.  

And with the emergence of Omicron, a new variant of concern, this disparity is even more pronounced. "New variants are a reminder, if we needed it, that the pandemic is far from over," said Jeremy Farrar, Wellcome’s Director. "Inequity is what is extending the pandemic – everywhere." 

The new variant shows why the world needs to work together to ensure more equitable access to vaccines and other public health tools. 

“I think one of the biggest challenges to get through this as a worldwide community is collaboration. That countries support each other, share vaccinations, but also leave out political conflicts and games,” shared Tim Kriegler, a performer from Germany. 

Access to vaccines is a question of both supply and delivery.  

For a long time, huge global demand for Covid-19 vaccines has outstripped supply and the doses that have been available have been tied up in contracts with a small number of mainly high-income countries. Many of these countries have contractual access to far more doses than they need to vaccinate their entire populations, including booster doses.  

COVAX, a multilateral initiative led by CEPI, GAVI and the World Health Organization, is working to ensure that vaccines are distributed fairly and that no countries are locked out of access to Covid-19 vaccines. However, in September it was reported that it is on course to fall nearly 30% short of its previous goal of 2 billion shots this year because of inadequate supply.

As supply becomes available, countries must also be able to deliver these vaccines to the people that need them – for this, countries need to know when they can expect to receive supply and have the right infrastructure and people in place for delivery. 

The world now has several different types of Covid-19 vaccine at its disposal and trials have shown that current Covid-19 vaccines have proven effective at preventing hospitalisation and death. However, the fact that many countries have been unable to access the same variety of vaccines as higher-income countries has not gone unnoticed by citizens.  

“There is a disparity that exists with the quality of vaccines that were received between developing and developed countries,” noted Amelia Hapsari, an NGO leader from Indonesia. “Developed countries are able to buy the vaccines that are proven to be more effective for their own citizens, [while in Indonesia] the vaccines that were accessible were the vaccines that are proven to be less effective.”

In the immediate term, doses need to be redistributed. The majority of Covid-19 vaccine doses that will be produced in 2021 are already tied up in bilateral agreements between manufacturers and a handful of countries. While rich countries have publicly committed to share doses that they will not need, actions have been limited and timelines are too slow. 

As some countries progress with booster programmes and vaccinations for children, it is imperative that new supply in 2022 does not just go to the highest bidder, but rather where it is needed to protect vulnerable people and save lives.  

“I heard recently that in Israel or Great Britain people there are receiving a third vaccination as a booster where some countries in Africa don't even have enough vaccination for 10% of their own population,” said Ali Farrokhian, a camera assistant from Germany.

“If we don't support the smaller and poorer countries and don't equip them with vaccinations it could happen that in a few months or years we will have another pandemic.”  

To help prevent access issues arising again, many researchers say the best way to ensure equitable access to Covid-19 vaccines is to enable lower-income countries to manufacture their own. Countries and regions that do not have manufacturing capacity are vulnerable to policies and decisions of other countries, such as export controls. 

However, efforts to support the diversification of manufacturing capacity in response to the current pandemic have not received the support they need. A handful of rich countries continue to block a proposal that would temporarily remove some of the barriers to increasing manufacturing capacity for Covid-19 tools globally. Further, the COVID-19 Technology Access Pool, designed to support pharmaceutical companies to share their knowledge and technology with other manufacturers, waited until November 2021 to receive its first license.  

While efforts to diversify manufacturing capacity could take several months to have a positive impact on Covid-19 vaccine supply, sustainably increasing regional manufacturing capacity will have long term benefits for future pandemic preparedness, regional self-sufficiency and capacity to meet region-specific needs. 

Right now, the problem is getting vaccines to those that need them most.  

“Our challenge is that there isn't one international institution that has the ability to monitor and hold countries accountable. No ability to guarantee that every country carries out its commitments. The challenge in global leadership is also the absence of a single institution that can then ask for responsibility from each country and monitor them. As well as give the penalty so that these countries would fulfil their commitments. 

“The UN, WHO, and other organisations can give recommendations... but then there's no mechanism that can make each country carry out their commitments. There isn't a united global strategy,” shared Amelia. 

The Covid-19 crisis has highlighted the need for international co-operation to prevent and mitigate threats that affect the entire global population.

So, what steps should be taken to ensure everyone, everywhere has access to the vaccines they need? 

The recent emergence of the Omicron variant is a sharp reminder that without global access to Covid-19 vaccines, the whole world remains at risk.  

Between now and June 2022, we propose the following actions by G20 countries and vaccine manufacturers to ensure that supply is equitably distributed and is matched with critical support for delivery so that doses reach the arms of the people that need them most. 

1. Redistribute existing supply 

by donating more doses more quickly and allowing COVAX and other regional mechanisms to take priority in vaccine supply queues.

2. Equitably allocate future supply  

by giving COVAX and other regional mechanisms priority for new supply deals and working to diversify supply capacity. 

3. Support vaccine delivery 

by mobilising funds so that vaccines can be turned into vaccinations. 

Special thanks to Rachael Hore, Senior Policy Officer and Chloe Watson, Policy Adviser for contributing to this article.