Danielle Milankov
The ever-present COVID-19 pandemic has emphasized many latent issues, such as wealth inequality, but one issue has remained relatively under the radar: the global distribution of vaccines, or vaccine equity. Although various organizations like the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have worked towards global vaccine equity for many years, the effort is still ongoing. The advent of the COVID-19 pandemic and the distribution of COVID-19 vaccines are a strong reminder of the challenges and importance of global vaccine equity.
Vaccine equity is based on the concept that every person around the world should have equal access to every vaccine, regardless of their socio-economic status, race, politics or any other type of social condition. To achieve this goal, global organizations like the WHO and UNICEF distribute vaccines to poor countries and populations, along with the help of some governments. A large part of this pursuit was the WHO’s Global Vaccine Action Plan (GVAP), which was created in 2011 with a main goal of extending immunization to everyone in the world. The GVAP included strategies such as providing reliable funding and supplies to countries that need vaccines, helping to create health care immunization systems in these countries and providing education on the importance of vaccination. A tangible marker of the GVAP’s success occurred on August 25, 2020, when the WHO declared that Africa was free from wild polio virus.
Table of diseases that are preventable through vaccination. (Image Source: GVAP Publication Book, 2013)
Although these organizations have made progress, achieving vaccine equity is no easy task as there are many complex challenges and barriers that must be overcome. One of the most notable barriers is poverty. Unfortunately, vaccines cost money, which leaves poor nations, and the people in those nations living in poverty, without access to vaccines. For example, take Madagascar, where children in the poorest regions are three and a half times less likely to be vaccinated than children in the wealthier urban areas.
Adding to the issue of cost is distribution. People living in highly rural areas around the world are difficult to reach, as they may not have electricity or telephones. In addition, trying to vaccinate a large population — like that of an entire region or country — requires the help and coordination of thousands of health care workers, which is not an easy task to organize. These distribution challenges are worsened when the country in question has an unstable government or is devastated by war.
To complicate the physical logistics of vaccine equity further, there are numerous social issues unique to each population that also challenge vaccine equity. In non-Western countries, there is often suspicion of foreign or unfamiliar vaccines, which may result in conspiracies that vaccines from the West sterilize or otherwise harm the population. Conspiracies and mistrust mixed together with politics are powerful enough to result in the refusal of vaccination and disbelief of any evidence against the conspiracies. Such was the case with the Nigerian boycott of the polio vaccine in 2003, which resulted primarily from fears of sterilization. These fears stemmed in part from the violent and contradictory relationship between Western medicine and the history of Western colonialism; while medicine itself was meant to help people, it was practiced unequally and unethically. However, it is also important to note that there are other personal, political and religious beliefs that add to the fear of vaccination and challenge vaccine distribution.
So, with all of these challenges, why pursue vaccine equity? It seems that there are endless physical barriers and complex social issues that cannot be easily solved by the efforts of the WHO. While that much is true, it is critical to understand and remember the immense benefits of vaccine equity. Vaccinating everyone in a population prevents deaths, disease and disabilities in all age groups. In fact, between 2011 and 2020, it was estimated that vaccination against measles alone prevented over 14 million deaths worldwide. Vaccination also eradicates diseases, such as smallpox, which greatly reduces risks of infection and death around the globe. However, this only works if most, if not all, people get vaccinated, or else there would be a group of people of which the disease could continue spreading.
On a more pragmatic note, vaccine equity also provides great economic benefits. Vaccination prevents disease, and therefore saves governments and civilians billions of dollars on hospitalizations, treatment, medication and any other expenses involved in the process. Additionally, when a population has a lower mortality rate and fewer illnesses, its economic productivity increases. Studies have found that for every US dollar that is invested in vaccination, about $16–18 in health care costs are saved, and up to $44 is saved in economic benefits.
Graph illustrating the COVID-19 vaccine rollout gap between high and low income countries. (Image Source: Global Dashboard for Vaccine Equity)
The struggle towards vaccine equity becomes overwhelmingly obvious when we look at the ongoing COVID-19 pandemic. Although vaccines against COVID-19 were developed in record time, only the wealthiest countries have been able to afford to purchase and distribute it to their populations. The WHO stated that 56 countries have been excluded from getting any vaccines due to the issue of cost. To make matters worse, wealthy nations like Canada have failed to deliver on their promise to help donate vaccines. As of October 2021, Canada had only delivered 8% of the 40 million doses it promised. Although as of January 2022 the WHO’s global COVID-19 vaccination effort had delivered one billion doses to poor countries, its pace is not rapid enough and leaves many people still at risk.
The COVID-19 pandemic is a reminder that vaccine equity is an ongoing struggle, one that is driven by issues of wealth and distribution, alongside social issues. However, it is only through global vaccine equity that we can protect ourselves and our communities; without it, we cannot claim the full benefits of vaccination.
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