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What Is Vaccine Equity and Why Is It So Important?

Why Global Citizens Should Care
Vaccine equity — the equitable distribution of vaccines worldwide — is essential to ending infectious diseases that spread rapidly between countries. The United Nations’ Global Goal 3 calls for good health and well-being for all, which cannot be achieved if countries adopt a mentality of vaccine nationalism rather than supporting the global response. You can join us in taking action on this issue here.

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 a safe and effective vaccine is only the first step to ending the pandemic. The next is to produce enough vaccines to immunize the majority of the world's population, and distribute and administer those doses in an orderly and efficient manner. 

This is where the concept of "vaccine equity" comes in. How do we ensure that the vaccine is distributed fairly to different populations, and that people of different means and backgrounds are able to access it when the time comes? 

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The big question is, especially as supply remains limited, who gets the vaccine and when?

“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.”

Canada and the UK have ordered the highest number of vaccine doses relative to their populations, securing more than nine doses per person and more than five doses per person respectively, according to a recent analysis by the Guardian.

While the United States has purchased 1.2 billion doses of COVID-19 vaccines, enough to give each person more than three doses, the entire African Union has ordered just 270 million, which amounts to one shot per person for 20% of its entire population, the Guardian reported

Why is vaccine equity so important?

World Health Organization (WHO) Director-General Dr. Tedros Adhanom Ghebreyesus has warned that the mentality of vaccine nationalism — where countries push to get first access — 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, it 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 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 poorer 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 that cannot afford to pay for vital supplies on their own.

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) aims to solve these more localized challenges by supporting vaccine tracking, supply management, community engagement, and more, in low- and middle-income countries. Co-led by the Sabin Vaccine Institute, Dalberg, and JSI Research and Training Institute, the project is currently active in Kenya, Ecuador, Nepal, and Ethiopia. 

“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. 

With two COVID-19 vaccines approved for full use and many more in the development process, the international community is on the path to recovery from a year defined by isolation and loss. 

But amid the eagerness of speeding to the finish line, it’s important for countries to remember that no one is safe, until everyone is safe. Join the movement for vaccine equity by taking action here, to help make sure we tackle COVID-19 for everyone, everywhere.