2022: The Year For Vaccine Equity

Written by Declan Tomlinson, GPI Undergraduate Fellow

We are soon marking two years with Covid-19 in the United States. That’s two trips around the sun, a college experience, half a high school experience, and 10% of our lives–if you are a student at LMU. Two years of virtual graduations, missed family reunions, canceled study abroad trips, and not being able to see each other’s faces. Two years of placing faith in institutions to listen to the scientists and epidemiologists who are working to eradicate this virus.

When the vaccine was finalized in late 2020, and later distributed in 2021, we were told we would be ‘back to normal’ by the summer. With our trust in science affirmed and our faith in institutions renewed, normalcy was on the horizon. Then summer came, and something different happened. Instead, new variants emerged and spread from developing countries, crippling the United States’ efforts to return to that anticipated normalcy. Government officials spoke of being blindsided despite global health experts’ warnings. What happened?

Here’s what we know: Coronavirus is highly contagious and highly mutable.The Delta variant, Omicron, and all other variants to come, have developed outside of the United States. The virus spreads fastest in unvaccinated areas, and because of this, it thrives in low-income countries. This is no fault of their own. These countries fulfill Covid requirements just like everyone else. In fact, looking at neighborhoods outside of Nairobi, Kenya, you might see more masks than in some neighborhoods in the United States. No, this is not a country issue. This is a global issue that stems deeper than domestic policy. This is an issue of global equity, specifically vaccine equity, between developed and developing countries.

Inequality between the Global North and Global South.

Currently, only 11 percent of people are vaccinated in low income countries compared to 67 percent in rich countries. The United States has let 15 million vaccines go to waste, and wealthy countries are set to have 1.1 billion excess vaccines this year. These numbers are staggering, highlighting the clear discrepancies of vaccine accessibility. This vaccine apartheid stems from a greater trend of resource accumulation and hoarding by the global rich, which is why it is so hard for poor countries to receive vaccines. As people in the Global North are receiving their third dose of the vaccines, some in the Global South are set to receive their first vaccine in 2023.

Peeling back the curtain on these statistics, it isn’t hard to see the systemic challenges that low-income countries are facing. These countries do not have the same health infrastructure nor access to vaccine supplies that wealthy countries take for granted. To vaccinate 70 percent of their population, these countries need to increase their healthcare spending by nearly 57 percent (for reference, wealthy countries need to increase their budgets by 0.8 percent). To add to this disparity, low-income countries also face pricing differences. Reported price differences between Moderna vaccines for rich and poor countries show that some lower income countries are paying almost 2x the price for vaccines compared to the US.

Broken Promises

Global health experts argue that the Global South needs between 5 to 6 billion vaccines in order to effectively inoculate against the virus. The United States has pledged to donate 1.1 billion vaccines to low- and middle-income countries, and other wealthy nations have pledged to donate hundreds of millions more. However, along with these pledges totalling well below the 5 to 6 billion mark, the United States has donated only a third of these pledged vaccines. Other wealthy countries have similar discrepancies. A big reason behind these unfulfilled promises are the supply chain and logistical issues of transporting highly sensitive medical content. These issues could have been prevented through early cooperation. COVAX is a global pooled mechanism created by various international institutions including the WHO, which aims to create equitable access to the COVID vaccine. However, early on measures by rich countries to bypass the COVAX initiative led to vaccine hoarding, leaving behind this multilateral mechanism to get vaccines to poor countries. 

Another issue is the government’s inability to pressure pharmaceutical companies to produce more vaccines for the Global South. In some cases, these companies are accused of price gouging and delaying deliveries to poorer countries. Are these accusations correct? Professor Scott Galloway at NYU Stern coined the term ‘rundle’, or recurring revenue bundles that create a steady income stream for businesses. We see this in tech with subscription based services, but the same principle can be used by pharmaceutical companies. Having the Global North vaccinated and in need of a booster every 6 months for various Covid variants is a perfect ‘rundle’ for companies that have a stake in vaccine manufacturing. The Daily Show host Treavor Noah observed this, noting that the people who have the most to financially gain from vaccine distribution are ironically the same people giving the recommendations about distribution.

So what can we do?

First, the government can listen to scientists who warn that variants will continue to spread if the world population is not rapidly inoculated. Knowing the inequalities between high- and low-income countries, rich countries need to ramp up the distribution of vaccines to be redistributed around the globe. Whether this be through the COVAX multilateral system or through individual processes, there needs to be a higher distribution of coronavirus vaccines. This also includes donating therapeutic resources for a global vaccine rollout and increasing access to the materials needed to create and store the vaccines.

Another avenue yet to be explored is in waivers to vaccine patents. There is skepticism of whether this simple policy can significantly increase access to vaccines, as it does not take into account the logistical nightmare of having the facilities and proper transportation for Covid-19 vaccines. While this skepticism has merit, vaccine patents still pose a barrier to vaccine equity. The People’s Vaccine Alliance, a global coalition of activists and human rights organizations, argues that “pharmaceutical corporations must allow the Covid-19 vaccines to be produced as widely as possible by sharing their knowledge free from patents.” President Biden even shared support when asked by health care activist Ady Barkan, saying “absolutely, positively” that vaccine patents would be waived. While this has not happened yet, there is still an option for a waiver. This could be done through a Trade-Related Aspects of Intellectual Property Rights (TRIPS) Waiver brought on by the World Trade Organization. Through a proposal like this, pharmaceutical patent protection, including Covid-19 vaccines, would be temporarily waived which could reduce the cost of manufacturing vaccines around the globe. Already, 90 countries including India and South Africa have supported this measure, despite opposition from the industry. Opposing arguments are made about stifling future innovation through waiving intellectual property rights, but they fail to take into account the context of the global pandemic along with the billions in government funding used to develop the vaccines.

Along with these first two approaches, there is also a third, more systemic and long-term option. This can be accomplished through a long-term investment strategy in health systems across the world. Experts argue that “beyond expanding short-term supply, fostering global cooperation will better situate the global economy to rapidly supply vaccines and therapeutics in the future.” While the pandemic has derailed many of the UN Sustainable Development Goals, this approach could motivate a more unified effort to focus on health systems in development. Focusing on building global health infrastructure will not only spur development, but it will bring social justice to already entrenched global inequality between the rich and the poor. This solution, while most meaningful, is also the most unlikely. It will take extraordinary funding to make health systems around the world robust. 

To end, I have three incentives for vaccine equity to suit whomever is reading this. 

For the humanitarian, reducing vaccine inequity will be the quickest way to reduce global cases and deaths from Coronavirus. An end to the Covid-19 disarray will allow all states to continue working towards the UN Sustainable Development Goals and more quickly provide humanitarian access to those who need it. Reducing vaccine inequality is a first step to reducing overall inequality in systems of entrenched poverty.

For the religious: Pope Francis, the leading figure of the Catholic church, has positioned himself and the church fairly progressive on the idea of vaccine equity. He has pleaded with pharmaceutical companies to release Covid-19 patents to “make a gesture of humanity and allow every country, every people, every human being, to have access to the vaccines.”

For the business interest: A thriving economy requires some form of stability and certainty in the markets. To fully bring back a “new normal”, we should target the problem where it stands. We should listen to the scientists, and get the world vaccinated, reducing the chances of new variants.

The views represented herein are those of the author and do not necessarily reflect the views of the Global Policy Institute.