Three years ago today, on 23 March 2020, our country took the unprecedented step to go into national lockdown, in the wake of the WHO (World Health Organization) declaring COVID-19 a public health emergency of international concern.

As images of wards filling up with patients with this disease emerged from China, South Korea and the Lombardi region of Italy, it was clear that action was required.

There are many who say we entered lockdown two weeks too late, and if events such as the Cheltenham races had been postponed, we could have saved hundreds more lives. There are others who refer to this as the most significant infringement on our civil liberties since the Second World War.

Technological leaps

Whichever side of this debate you’re on, the tragedy of 760m cases, 6.9m deaths and untold millions of patients with longer-term complications is inescapable.

However, from this very dark cloud there have been a few silver linings. We have seen clinical academics working closely with pharmaceutical companies, NHS clinical colleagues and government funders to achieve the Recovery platform study, cutting through red tape with unprecedented speed that could deliver clarity over which drugs are effective for the management of acute COVID at which time point in their disease.

We have seen vaccine technologies that were early in the usual 10-year development programme progress through phase two and three clinical trials simultaneously, with many of the usual hurdles that delay the high-quality research the UK is famous for being reduced or eliminated completely. As a result, after only nine months, we were able to reduce the risk of hospitalisations, severe infections and ultimately death with the fastest and biggest vaccination programme in the world.

This technology has not only allowed protection of our population from current and future variants of COVID, but allowed development and approval of new novel vaccines against Ebola and opened up the possibility of vaccines against Epstein-Barr Virus, and even possibilities against HIV. Further, the technology will be an essential tool against future pandemic threats, knowing that a new vaccine can be manufactured within 45 days of a pathogen being sequenced.

Global inequality

An important phrase in that last paragraph was ‘our population’. Access to vaccines has highlighted – indeed exacerbated – global health inequity, and will have certainly undermined the possibility of a fair pandemic recovery.

While the UK was launching the 2021 winter booster campaign to mitigate the risk against the Omicron variant, there were millions in lower-income countries that had not had their first vaccine. According to a Nature analysis based on a study published in the Lancet, this inequity caused 1.3m preventable deaths worldwide in that first year of the COVID-19 vaccine rollout.

Inequitable vaccine distribution and the consequential dismal immunisation coverage in low-income countries was described by the UN secretary general as ‘an obscenity’ and in part, a result of vaccine nationalism and hoarding by wealthier nations. According to Amnesty International, it was also a result of side deals with COVID vaccine manufacturers and pharmaceutical companies who ‘restrict[ed] fair access to life-saving pandemic products’.

A course correction rooted in equity, human rights and justice is necessary if we are to avoid a repeat of failures in the global response to COVID-19. Indeed, until we are all protected against COVID-19, the risk of new mutations occurring among partially vaccinated populations represents significant global risk: no-one is protected until we’re all protected.

Global vaccine equity must be enshrined into any international treaty to ensure everyone is better protected against future pandemics

The draft WHO pandemic accord that is currently being negotiated by member states provides a blueprint for effective pandemic prevention, preparedness, response and recovery – compelling governments and non-state actors such as pharmaceutical companies to work in collaboration rather than competition, and supporting equitable access to medical counter-measures.

The People’s Vaccine Alliance – a coalition of over 100 organisations and networks, calling for a ‘people’s vaccine’ free to everyone – notes in its recent letter to global leaders that we already have the necessary tools and know-how to plan an equitable response to the next global health crisis, ‘including by supporting low- and middle-income countries to host research and development hubs and to manufacture vaccines, tests, and treatments. Commitment from world leaders now can prevent a repetition of the pain and horror of the COVID-19…pandemics’.

The alliance calls on world leaders to take four urgent steps including supporting the pandemic accord, investing in scientific innovation and manufacturing capacity in the Global South, investing in global commons goods, and removing the intellectual property barriers that prevent knowledge and technology sharing.

There is no time for rhetoric and passive support for collaboration for the crises we face: in an inherently interconnected world, we believe global vaccine equity must be enshrined into any international treaty to ensure everyone is better protected against future pandemics.

The BMA will not stop demanding global access to life-saving tools and treatments, and has called on the UK Government to ramp up commitments to ensure equitable access to knowledge and technologies, push for the removal of intellectual property barriers, and support manufacturing capacity in lower-income countries. 

David Strain is chair of the BMA board of science and Kitty Mohan is chair of the BMA international committee