Editor's note: This article was updated on Aug. 23, 2021.

Within a year of the first reported case of COVID-19, the Pfizer-BioNTech vaccine became the first fully tested immunization to be approved for emergency use against the deadly virus.

The lightning-speed development and approval of the vaccine was an extraordinary success in global health, and was received internationally with a sigh of relief. But the approval of safe and effective vaccines was only the first step to ending the pandemic. After that came the need to produce enough vaccines to immunize everyone globally, and to distribute and administer those doses in an orderly and efficient manner. 

This is where the concept of "vaccine equity" comes in. How can we ensure that COVID-19 vaccines are distributed fairly to all populations, and that people of all regions, means, and backgrounds are able to access them? 

“We can all agree that everyone should have a right to health, regardless of their socioeconomic status, their background, or the kind of passport they hold,” Dr. Yvonne Commodore-Mensah, assistant professor at John Hopkins Schools of Nursing and Public Health, told Global Citizen. “But because of the disparity in economic resources, the playing field is not level in terms of resources to acquire the vaccine.”

Rich nations like Canada and the UK quickly bought up more than their fair share of vaccine doses relative to their populations — known as "vaccine hoarding" or "vaccine nationalism" — securing enough doses to vaccinate their populations several times over. Meanwhile, low- and middle-income countries have struggled to secure enough doses to protect their most at-risk individuals, such as health care and other frontline workers, and older people. 

Now, as many rich nations start to think about when and how a third booster vaccine can be rolled out to their populations, just 1.3% of people in low-income countries have received a first dose. 

Why Is Vaccine Equity so Important?

World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus warned earlier this year that the mentality of vaccine nationalism puts the world on the brink of “catastrophic moral failure.”

But the inequitable distribution of the COVID-19 vaccine on the global sphere isn’t just an issue of morals or ethics. When it comes to an infectious disease that does not respect borders, COVID-19 and emerging variants such as Delta will continue to be a threat to the international community as long as it exists anywhere in the world.

“Vaccine nationalism only helps the virus propagate,” Dr. Angela K. Shen, visiting scientist at the Vaccine Education Center at Children’s Hospital of Philadelphia, told Global Citizen. “In order for a vaccine to work, you need most of society to be protected — and that protection happens when you get everyone vaccinated. So you want to roll this out to everyone because, inherently, that’s how you protect everyone collectively.”

Especially with the appearance of new variants in the context of the current COVID-19 pandemic, the more people left unvaccinated, the bigger and potentially more severe the collective risk.

How Can We Make Sure Vaccines Are Shared Equitably?

In order to help prevent an allocation system based on a country’s purchasing power, the COVID-19 Vaccine Global Access Facility, known as COVAX, was created to help low- and middle-income countries vaccinate their populations. 

The global collaboration, co-led by the WHO, Gavi, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI), aims to secure at least 2 billion doses by the end of 2021 and ensure equitable access for 92 low- and middle-income countries.

Beyond equitable distribution on the global scale, individual countries also face the issue of unequal access to the vaccine among their own populations. Just as high-income countries can hoard vaccines for their citizens, wealthy individuals can use their purchasing power to get priority access if no guidelines are implemented.

To prevent this from happening and to ensure equitable access, countries have been conducting phased rollouts that prioritize vaccinating people with the highest burden of COVID-19 hospitalization or death — including health care workers, older adults, and essential workers — before opening up the vaccine supply to the rest of the population.

But even with a fair national rollout system, existing structural inequities can pose challenges to vulnerable populations. For instance, in poorer or rural areas, hospitals and clinics often do not have the ultra-cold freezers required to store Pfizer’s COVID-19 vaccine, making supply more limited and the rollout slower. 

The COVID-19 Vaccine Equity Project (CVEP) — co-led by the Sabin Vaccine Institute, Dalberg, and JSI Research and Training Institute — aims to solve these more localized challenges by supporting vaccine tracking, supply management, community engagement, and more, in low- and middle-income countries.

“COVAX and Gavi are focused on equity in terms of getting vaccines to low- and middle-income countries, and that’s no small issue,” Jennifer Siler, Sabin Vaccine Institute’s vice president of global community engagement, told Global Citizen. “But once you actually get the vaccines to these countries, how do you get them to the people who really need them, and how do you prioritize the population?”

Siler said some of the main challenges the CVEP team has witnessed include combating vaccine mistrust and misinformation, preparing health facilities to administer COVID-19 vaccines without an increase in staff, and developing a better understanding of what’s going on at the localized level. 

To help ensure vaccine equity for all people, Global Citizen is calling on the G7, European Union, and other rich countries to share all their excess and unused doses with countries in need in coordination with COVAX. We're calling for a billion doses to be redistributed by the end of September, and another billion by the end of this year — which can be done, as long as world leaders work together to ensure an equitable distribution. 

Join the movement calling for cooperation and equal access to vaccines for all by taking action here to help end this pandemic for everyone, everywhere. 

You can join the Global Citizen Live campaign to defeat poverty and defend the planet by taking action here, and become part of a movement powered by citizens around the world who are taking action together with governments, corporations, and philanthropists to make change.

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