We have enough jabs for everyone on Earth, so why are most poor countries unvaccinated?

Vaccine inequity will define the Covid-19 pandemic in 2022

A government advertisement promoting the UK government's Covid-19 vaccine booster programme in London. Photo: AFP
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It is now nearly two years since the first Covid-19 case was reported and more than a year since the distribution of the first vaccines began.

Yet with a new tidal wave of infections sweeping around the globe, and Omicron riding high upon it, are we any closer to ending this crisis and better prepared for the next pandemic?

The answer to both of these questions depends very much on what we do now at this critical stage in the global crisis. The fact is we have the tools we need to bring this virus under control, and a road map for how to mitigate the next pandemic threat, but up until this point we have not been making the best use of them.

Thanks to the incredible work of the scientific community and vaccine manufacturers, not one but 21 Covid-19 vaccines were developed and distributed in record-breaking time, and in unprecedented volumes. And we also have in place the global health networks needed to make the world’s largest and most complex vaccine deployment ever possible. The only trouble is vaccines are still not reaching everyone fast enough.

During a global pandemic, speed is absolutely critical. You cannot stop a virus in geographical phases, vaccinating people in some parts of the world while leaving the protection of others until later. Because so long as large populations of unvaccinated people exist anywhere, the virus will continue to spread and mutate, and new and potentially dangerous variants will continue to emerge, as we have seen with Omicron.

This is why it has been so important from the very beginning to make access to Covid-19 vaccines rapid, fair and equitable to people all over the world. So when Covax, the global effort to make these vaccines equitably available, co-led by my organisation Gavi, was able to start delivering them to people in lower-income countries just 39 days after people in the high-income countries first started receiving them, it gave hope to billions across the world that they, too, would soon be protected. The end of the crisis appeared to be in sight.

Yet as we have seen, what followed tells a very different story. Despite this initial success, with Covax getting first doses out to people in 100 countries in just six weeks, we faced a series of obstacles. Export restrictions and vaccine hoarding by wealthy countries repeatedly disrupted our supply of Covid-19 vaccines. As a result, Covax’s trajectory for getting doses to lower-income countries was affected severely.

This is the principal reason why we have seen such appalling global disparities in the distribution of Covid-19 vaccines. Today, the world’s wealthiest nations have protected more than 75 per cent of their citizens, while only in the poorest countries just 8.3 per cent of people have had their first shot.

At the initial stages, demand for vaccines was always going to outstrip supply, but these challenges have persisted even since global production got into full swing. More than 1.5 billion doses are now being produced a month, and by the end of the year around 12 billion doses will have been produced globally, enough to fully vaccinate everyone on this planet. Yet, as things stand, nearly 3.4 billion people – nearly half the global population – remain unvaccinated.

The positive news is that Covax’s supply lines are now ramping up. We are quickly making up for lost ground, with 1.6 billion doses allocated and more than 870 million doses delivered into countries by the end of the year, the vast majority to lower-income countries. And, by early 2022, we hope to have shipped enough for these countries to have protected 20 per cent of their populations, enough to protect the people most at risk, such as frontline healthcare workers and vulnerable populations.

During a pandemic, protecting people everywhere with a primary vaccination should have been the global priority from the start. The greatest impact of vaccination during any outbreak lies with first protecting the people most likely to come into contact with the virus and those most likely to be affected by it, and then slowing the spread by increasing coverage. Yet while many governments have been fast to act on this, particularly when it comes to their own high-risk citizens, it’s a strategy that has not been applied globally.

Until that is remedied, and the task of getting primary doses to people in all countries, particularly high-risk individuals, becomes the global priority, we can only expect to see further resurgences as new variants continue to emerge.

With Omicron once again threatening to bring more disruption, wealthy governments are again turning inward as they race to accelerate their booster programmes. The worry now is that the increased demand for booster doses by governments will create renewed pressure on global supply, creating a vaccine inequity 2.0 scenario that has an impact on Covax’s access to doses and delays our ability to get first doses out to people.

Currently, while there is some evidence to suggest that boosters may provide some additional protection against symptomatic infection, it is still not clear if they provide additional protection against severe disease, admission to hospital or death, or to what extent. Moreover, there is no evidence to suggest that two doses of existing vaccines are any less effective at preventing severe disease with Omicron.

What this means is that while boosters may help slow the local spread of the disease and ease the burden on local health services, in the long term this will do nothing to stop the global spread, and reduce the risk of the next Pi, Rho, Sigma or Tao variants emerging and further resurgences from occurring, if we don’t also get primary doses out to the billions of people who are still unvaccinated, particularly those in lower-income countries.

The Covax Advance Market Commitment, AMC, makes this possible. But if we are to increase coverage and work towards the World Health Organisation’s target of protecting 70 per cent of people in every country by mid-2022, then at least $5.2 billion of additional funding is needed over the next three months.

Compared to when this virus first struck, we are now infinitely better equipped to beat this pandemic. In addition to the vaccines, we also now have all the critical pieces needed to carry out a global vaccination effort. This includes everything from the scaled-up manufacturing, regulatory frameworks, the infrastructure, logistics, personnel, data systems and disease monitoring systems, as well as the necessary compensation, liability and indemnification legal safety nets, much of which Covax was central to putting in place.

For future pandemic preparedness, we now need to build on this, and the global health networks that underpin it all to mount a rapid and robust response. But that response can only ever be effective if it is truly global. With Covid-19, we’re still not seeing that. What we need now is for the global priority to become getting primary doses out to the billions of people in lower-income countries who are still unprotected, and support for countries that are struggling to get shots into people’s arms.

If the world can now rally around this goal, with the same level of urgency with which boosters are being distributed, then this time next year the end of the crisis may finally be within sight.

Published: December 31, 2021, 4:00 AM