Vaccine inequity is the greatest barrier to ending Covid-19 as an international health emergency.
As we inch closer to the two-year mark of the pandemic, we mourn the five million lives that have been lost and fear that millions more may still be.
This time the loss of life will predominantly be in poor countries. Deaths due to Covid-19 are no longer because we are defenceless, but because the world is divided. More than 5.9 billion vaccines have been administered worldwide.
But nearly three-quarters of them were in only 10 countries. High-income countries have 61 times more vaccinations per inhabitant than low- and middle-income countries.
Yet only three percent of the population in Africa has been fully vaccinated. When the pandemic started, the world was fully aware of the unequal access to resources, including the development of potential vaccines. That is why as soon as there was hope for a vaccine, the Covid-19 Vaccine Global Access Facility COVAX was set up.
The aspiration was to protect everyone from Covid-19, including the most vulnerable people in low- and middle-income countries. But due to what some would call a predictable design flaw, COVAX has failed.
It remains underfunded. Further, wealthier countries negotiated directly with pharmaceutical manufacturers and acquired the lion’s share of global vaccine supply So, 18 months after COVAX was established, the platform is still two billion doses short of achieving its goal of vaccine coverage for 40 percent of adults in the poorest 92 nations.
Wealthy countries have now pledged to donate more doses of Covid-19 vaccine to poor countries. This renewed, albeit late, attempt to revive COVAX focuses on the need to end the pandemic for all through increased access to vaccines with an emphasis on speed to combat ever emerging SARS-CoV-2 variants.
Much of this effort includes shipping excess vaccines, including near-expired vaccines, to poor countries.
While this serves as a stopgap measure, we argue that it is not a sustainable solution.
High-income country tactics have led to global vaccine supply scarcity. They have left low- and middle-income countries struggling to find available vaccines to buy, even if they have the money to do so. Consequently, vaccine donation appears to be a necessary, though not sufficient, action.
Vaccine donations are unsustainable and often inefficient to scale when faced with a pandemic. They are a temporary solution to a systemic issue that was supposed to be preempted by a better version of COVAX, which also comes with its own issues.
Behind the commitments of the Group of Seven and other wealthy nations are legal and logistical realities to supply vaccines to recipient countries. The vaccines available from high-income countries are those that were hoarded.
Canada infamously purchased enough vaccine doses to fully vaccinate each person living in their country five times over. The only vaccines that can be distributed are the previously contracted excess doses from countries that are already flushed with supplies.
However, there is often no clear pathway to donate all of the vaccines available. Federal countries often do not allow states to donate vaccines directly without approval from the national government.
There are also liability concerns for pharmaceutical companies if their vaccines are used in another country.
This means donated vaccines now being supplied to COVAX will come directly through the national stockpiles that sit with manufacturers. And, this is why countries across the EU and the US are throwing away millions of soon-to-be expired doses from pharmacies and hospitals not shipping them to Africa.