Urgent action needed to make global vaccine equity a reality

by Kitty Mohan

The effects of the COVID-19 pandemic on global health have been unprecedented, but they have not been felt equally.

Those who live in poverty and in crowded conditions, those whose work means they cannot avoid exposure to the virus and those who struggle to access healthcare have borne the brunt of illness and death.

The health and wellbeing of hundreds of millions of people worldwide continues to be affected by disruption to healthcare services and the mental, physical and economic impact of government interventions to prevent uncontrolled spread of the virus.

Make no mistake – for most of the world, the pandemic is raging as fiercely as ever.

Unfair distribution

But while high-income countries are vaccinating their way out of the pandemic, less well-off countries don’t have the option. Over 60% of people in high-income countries have received at least one dose of vaccine – in low-income countries that number is only 3.3%, or 1 in 30 people. (1)

It would take six months to fully vaccinate 75% of the world’s population if delivered equitably – but the world’s highest-income countries are vaccinating their populations at 20 times the rate of the world’s poorest countries. (2)

At the current rate, many areas of Africa and Asia will not achieve widespread vaccine coverage until 2023.

Higher-income countries have already bought up 70% of the expected global vaccine supply for this year, often ordering enough doses to cover their population many times over.

The UK is no exception, having secured more than 540 million vaccine doses – enough to vaccinate the entire UK population four times over. (3)

While some of these doses are being held in reserve for a booster programme, many more are surplus to requirements.

Vaccine stockpiling

Collectively, wealthy nations have amassed a stockpile of hundreds of millions of surplus vaccine doses, which are not needed – at least not immediately – for their own populations. Many countries have committed to share surplus doses with low-resource countries, but only a fraction of these vaccines have actually been made available.

The UK has pledged to provide 100 million vaccine doses, primarily through the WHO’s COVAX initiative, by June 2022 with 30 million to be delivered before the end of the year, but only 9 million doses had been mobilised by early September. (4)

The EU has also pledged 450 million – 250 million by the end of this year, although only 28 million have been delivered to date. (5)

Worryingly, there are now reports that many of the stockpiled vaccines are nearing their use-by dates. More than 100 million doses could expire and be thrown away if not used by December. (6)

The BMA has always been clear that avoiding wastage must be an overriding principle of the UK’s vaccination campaign, and this principle holds true for the global vaccine rollout.

Too little, too late

It’s clear that getting vaccine doses to the places they’re needed most is of the utmost urgency – 100 million doses by June 2022 will be too little, too late.

But raising the ambition of pledges and accelerating their delivery is only the beginning. Ongoing financial and practical support will be needed to make vaccination campaigns a success on the ground, and to see shots reach the arms of the world’s most vulnerable populations.

That’s why we wrote to Boris Johnson ahead of yesterday’s Global COVID-19 Summit, taking place at the UN General Assembly, calling on him to show leadership in driving forward global vaccine equity. We have called for transparency on the number of surplus doses in the UK and for pledges to COVAX to be increased accordingly.

Raising ambitions

At the Global COVID-19 Summit, convened by President Joe Biden, the US made substantial new commitments to donate 500 million additional vaccine doses (a total of over 1 billion the nation has pledged to date), alongside new funding to support delivery of vaccination campaigns. In addition, a US-EU agenda was agreed ‘for beating the global pandemic: vaccinating the world, saving lives now, and building back better health security’. (7)

We need to see more world leaders raise their ambitions. Only by making a firm commitment to vaccinating 70% of every country’s population in the next 12 months can we end this pandemic everywhere: ‘No one is safe, until everyone is safe’.

The UK is a world leader on domestic vaccine coverage – we can and must do more to play our part on the global stage and make vaccine equity a reality for all.

The BMA will continue to press the UK Government to publish its plans for ensuring that surplus doses reach priority groups, including healthcare workers, in low-income countries as soon as possible – and to use its influence to ensure other wealthy nations do the same.

Kitty Mohan is BMA international committee chair