Global Response to COVID-19 and the Vaccine Equity
Junaid Nabi and Javaid Iqbal
In many respects—armed with the wisdom of hindsight—one can make an argument that it was possible to mitigate the devastating consequences of the ongoing COVID pandemic, if all the stakeholders—countries, public health organizations, and global coalitions—had acted in a manner consistent with their stated aspirations on global solidarity and justice.
For the global public policy brouhaha, the pandemic has revealed the extractive nature of global health practices. A recent study revealed this lack of equity, illustrating that while the risks of care delivery are often shared by many countries (participating in drug trials for new medications in this research), the benefits are not. Apart from the press releases that touted justice for all, promises in media have led to limited impact or improvement in enabling global vaccine equity.
To end the ongoing pandemic, global vaccine equity—a fair and need-based allocation of vaccines, internationally—is imperative. From the beginning of COVID-19, we did not observe any equitable policy; instead, there was a unique sense of “otherness” associated with the infectious outbreak. We still remember, in the early part of 2020, there were mostly casual mentions of how an outbreak that was devastating a province in a major country could lead to a public health crisis in the West. So, it was not a surprise to witness how the response to the pandemic has a distinct quality of being “otherized.” The framing of national policy solutions around the world was divided into parochial binaries: “my” problems and “your” problems—rarely as “our” problems.
The United States recently announced the donation of 500 million doses to increase the supply of vaccines in low-resource countries. While these announcements provide a semblance of distributive justice at the global level, the hesitancy by rich countries to share raw materials and technical know-how for manufacturing vaccines in countries that are struggling to contain the surge in infections and hospitalizations demonstrates the inadequacy of these measures. Instead of this broken approach—or “donations” as some called it—the focus of international partnerships should have been on sharing of knowledge and practical wisdom that countries who have managed to contain the spread of the infection.
The announcement about providing millions of vaccines was made around the start of this year’s Group of Seven (G7) summit, an indication of the US’s reorientation to lead the global collaboration on COVID-19 response. While the goal of the COVAX initiative—a coalition tasked with global distribution of the COVID vaccines—was to supply vaccine doses for up to one-fifth of the populations in low- and middle-income countries, the initiative continues to face supply issues even after months of global cooperation. A large part of the reason was that countries such as the US and other nations in the G7 started focusing on global vaccine equity too late in the progression of the pandemic. Delay in developing global partnerships on this issue has led to the development of dangerous variants of the virus. The Delta variant is being reported in 74 countries, further straining the health systems in fragile economies.
To make global cooperation effective, investments and partnerships should have focused on three major areas: transparent data-sharing, collaborative research and innovation practices, and equity-based policymaking. Early on in the pandemic, we observed significant investments in data gathering and monitoring, especially in Western nations. Developed countries created virtual dashboards that tracked case numbers and death rates in real-time; however, while the technical knowledge (code) needed to develop these dashboards was publicly available, concerted efforts to enable the creation of such data-driven tools in partnership with low-resource countries was rare. Research and innovation also faced similar challenges—while COVAX was developed to enable fairness in global vaccine distribution, the leadership required from rich countries to make these ideas a reality, was missing. Lastly, policymaking based on equity—to provide need-based assistance to different countries—has also languished, evidenced by the reluctance of developed countries to share vaccines when developing nations were going through a major surge in infections.
With less than one percent of the population vaccinated in low-resource countries, the global economy is on a tumultuous track. Lockdowns implemented without thorough preparation and adequate communication have already led to a decimation of the economy in these countries. It is estimated that the first wave of the pandemic pushed approximately 230 million people into poverty in India; these statistics will likely be exacerbated by the recent surge in infections that continues to strain the health system in the country. For the poorest 29 countries around the world that house 9 percent of the global population, only 0.3% of the vaccines have been administered. Some analysts forecast that achieving mass immunization for developing economies can take up to 2024. In developed economies, Europe and UK have vaccinated a large proportion of their populations already and the US has crossed 300 million doses.
Recently, the WHO, the World Bank, World Trade Organization, and the International Monetary Fund suggested that it can take approximately $50 billion to enable developing economies to return to normalcy on a timeline that matches rich countries. However, while the G7 countries pledged to donate up to 1 billion vaccine doses, without a concrete plan on distribution and delivery, it is unclear how this partial donation will enable global vaccine equity. In addition to consequences for public health systems, establishing equity at the global level is necessary for restricting the economic damages from the pandemic: the global economy could suffer a loss of up to $9.2 trillion according to research from the International Chamber of Commerce Research Foundation.
Addressing these issues requires strong leadership and commitment to international collaboration from global political powers, but apart from a few countries, that element of international diplomacy has been missing. Until now, COVAX has only been able to deliver only 78 million vaccine doses globally. The raging spread of the dangerous variants poses a significant threat, not only on the public health infrastructure of the developing countries but also on the clinical care capacity, given how the ratio of physicians and care providers to the general population has been chronically low in these countries. Recent reports suggest that more than 400 physicians have died in India on the frontlines of the pandemic; the ramifications of such loss will be felt by the care delivery system for years.
Another consequence of these dangerous variants is that they seem to cause serious health problems in young people, who were previously thought to be at a lower risk. As young people constitute a large segment of the population in India and several countries in Africa, these emerging variants pose a threat to the demographic dividend—the economic and development growth achievable with a large working-age population—in these countries. Recognizing that a curtailed approach to global vaccination would not be enough for addressing the ongoing crisis, the United Nations has also criticized the pledge by G7 nations.
With rich countries taking up approximately 350 percent of vaccine doses, the current trends are a reminder that justice, especially in global health, is elusive. It is also a reminder that global public health advocates and scholars need to continue developing effective partnerships with local leaders and communities that can engender sustainable change, both in academia and implementation. Global leaders must recognize that without understanding the vaccine delivery aspect through the lens of justice, they threaten to undo the gains that took more than a year to accomplish.
Dr. Junaid Nabi is a physician and health systems researcher working at the intersection of health care reform and innovation. He is a New Voices Senior Fellow at the Aspen Institute and serves on the Working Group on Regulatory Considerations for Digital Health and Innovation at the World Health Organization.
Javaid Iqbal, MBA, MA, MS is a former management consultant working on health economic projects and a Fellow at Harvard Public Health Review. He has previously served in an advisory role at the United Nations and a Global Fellow at Brandeis University.
This article is featured in JUSTIN Development Review (JDR) Vol. 01 Issue 01 — June 2021