Can the world close the 9-year vaccination gap between high- and low-income countries?

May, 2021

“Vaccine justice is a precondition to the longer path to social justice” 

After months of uncertainty, less than a year after the first warning signs, the first COVID-19 vaccine was applied on December 2nd, 2020. The vaccine signifies hope, the beginning of the end of an extremely challenging year in many ways, and an unprecedented demonstration of scientific and technological progress in the world, as it was developed, tested and approved at record speed. Swift vaccination seems the way back to normal, reducing the number of cases, deaths, allowing people to go back to work, school and thrusting social and economic recovery. However, now that we have a vaccine, the main questions are: who is enjoying its privileges and the short-to long-term implications of vaccine unequal distribution between high- and low-income countries?

Only a few months after the COVID-19 outbreak, in May 2020, high-income countries like the UK and the USA struck the first deals to pre-purchase millions of doses of the developing vaccines. In some cases, the financial capacity to invest high sums of money into vaccine development (not knowing what the results would be) allowed for rich countries to put themselves in front of the line of vaccine distribution, at times, for a number of doses that covered their total population several times. This pushed lower-income countries to the back of the line, having to wait several months into 2021 for their first vaccine shipments, which are intermittent and in low quantities, far from what is very much needed. 

COVAX, an initiative formed by three global health groups (World Health Organization, Coalition for Epidemic Preparedness Innovations, and Gavi Vaccine Alliance), was originally planned to ensure that vaccine distribution was equitable, and that lower-income countries were not left out. However, by the time the alliance was created, the richer countries had secured their bilateral deals with big pharma and restricted access for the rest. Therefore, as of April 2021, COVAX had only purchased half the amount they originally planned (2 billion) and delivered 45 million doses –nowhere near enough to cover frontline health workers in the countries where these doses are being delivered. 

The miracle of vaccine development is now limited with the injustice of vaccine haves and the have-nots. The divide is clear: citizens of high-income countries had earlier access and faster deployment of COVID-19 vaccines.

The difference is abysmal: 97.2% of people living in high-income countries live in societies where a vaccination programme is ongoing whereas only 60.9% of people living in low-income countries are citizens of countries where such a programme has begun. At the current rates, half of high-income countries will reach a level of vaccination (75% of adults) that under certain circumstances would mimic herd immunity in 242 days – less than eight months. Low-income countries would reach the same milestone in 3899 days – more than 10 years. This is a ratio of almost 16 to 1. 

To date, Paraguay has vaccinated 0.7% of its total population (1.1% of the population over 18 years of age and 1.0% of the population over 16 years of age). To this day, its vaccination rate is 740 people per day. According to the estimate, it will take 9,572 days to vaccinate its entire population, 6,252 to vaccinate its population over 18 and 6,606 to vaccinate its population over 16.

What are the consequences? 

The impact of that nine-year vaccination gap is beyond any stretch of the imagination. More people will die, economies will suffer from the mix of lockdowns, uncertainty and disease; People will be affected by isolation and stress. In the short term, global economic recovery will be slower if vaccine access is not prioritized. Much of the economic impact of the pandemic has been mediated by the labour market. The ILO has documented the enormous shock to labour markets in 2020: the total number of lost working hours around the world are equivalent to 255 million full-time jobs. The ILO also shows that job losses have disproportionately affected low-paid and low-skilled jobs. Countries with a fast and widespread vaccine rollout will jump start labour markets. Vaccine inequality will be quickly transformed into an uneven recovery. 

Vaccine justice is also a precondition to the longer path to social justice. The pandemic has already upended the process of human capital accumulation due to school closures, lost income and increases in poverty, and the redirection of health facilities and budgets to fight the pandemic. These dynamics will have long term consequences, particularly in children and even more so in girls. Some high-income countries have started vaccination programmes in teenagers: on May 10, 2021, the United States approved the use of Pfizer/BioNTech on children ages 12-15. At the same time, hundreds of millions of people in low-income countries do not have access to vaccines. 

As if the pandemic had not encroached upon previous vulnerabilities that lower-income countries face (such as limited education and health services), richer countries, which used their wealth to hoard vaccines, will suffer less and recover faster at the expense of the poorer societies. The development gap will become even more challenging to close, both within and between countries.

The COVID-19 pandemic has shown the many faces of humanity and societies. In a short period of time the world came to a halt in the midst of chaos, fear and lack of information. A few months later, dozens of vaccines (some using cutting edge technology) were being developed by different pharmaceutical companies with the support from governments. And in late 2020, the vaccination roll-out started. But to truly leave the pain and suffering of the pandemic behind, the world and its leaders need to close the gap in access between high-income countries and the rest of the world. Until the whole world is vaccinated, no one will be truly safe. Vaccine justice is not only the right thing to do, but also humanity’s only choice. 

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