Vaccine inequity: The social justice issue of a generation

Last week leaders of the G7 nations met in Cornwall to discuss how to “fight, and then build back better from coronavirus”. At the summit, leaders pledged to donate 1 billion doses of COVID-19 vaccines to low-income countries, falling significantly short of the 11 billion doses that the World Health Organisation says are needed.
Caption: Holding a vial of vaccine. Credit: Photo by Spencer Davis on Unsplash

Vaccine inequity is amongst the most significant social justice issues of a generation, and it poses a major threat to the global response to COVID-19. Donating surplus doses is simply not enough. As public health researchers and practitioners, including those working on epidemic preparedness, response and vaccine development and deployment, we join others including the WHO, MSF, Amnesty International and scientists all over the world,  in calling for a Trade Related Intellectual Property Rights (TRIPs) waiver to allow the manufacturing of vaccines across the world. The proposal to waive TRIPs on COVID-19 products was initially put forward by India and South Africa in October 2020, with the backing of around 100 countries—including, as of May 2021 the United States-- but it continues to be opposed by some of the world’s richest nations, including the UK.

Over the last year, the COVID-19 pandemic has taken the lives of over three million people worldwide. Disruptions to social and economic life because of the pandemic and measures to bring it under control have had wide ranging ripple effects from worsening mental health, growing poverty, and increased domestic violence. COVID-19 has changed our societies in profound ways. Despite hopes that governments and international bodies would act to protect all members of society, the pandemic has instead consolidated existing inequalities within and between countries in terms of prevention and treatment of the virus. This is nowhere more evident than in the global distribution of COVID-19 vaccines.

Vaccines have been widely regarded as the light at the end of the pandemic tunnel. Developed at breakneck speed thanks to the mobilisation of the whole scientific community, they have made it possible for some countries to start planning a gradual exit from lockdowns and other restrictions. However, so far, abundant vaccine supplies remain a privilege of the few. Whilst rich nations such as the UK and the US have purchased enough doses to vaccinate their populations several times over, most people in low-income countries (whose development has been impeded by a long history of extraction by wealthy nations) will not receive a dose until at least 2022. This is both unjust and short-sighted. Tragic developments in India, Nepal and Brazil remind us that the pandemic is far from over and that allowing new potentially vaccine-resistant variants to emerge can set back vaccination programmes everywhere.

G7 leaders have backed the sharing of vaccines through platforms like COVAX. Whilst these initiatives are laudable, they do not go far enough. The targeted immunisation coverage for countries participating in COVAX is around 20% by the end of 2021 and timely supply is in question as “high income countries step to the front of the queue for limited supplies of COVID-19 vaccines”. In addition, a charity model is inadequate and insufficient: it detracts from the realisation of vaccine equity as a social justice issue and from recognition of the role that many high income countries play in making other countries ‘resource-poor’. A TRIPs waiver would allow for expansion of access to vaccines and facilitate scaling up of technology transfers and manufacturing, reframing the conversation on global solidarity.

We recognise that a waiver is only a starting point. It is imperative that vaccine production and distribution capacities are rapidly increased, including high income countries lifting embargoes on exporting raw materials, such as glass vials to low-income countries. Strategies for transferring knowledge and technology and sustained, transparent and free sharing of critical public health information at all stages of vaccine development are essential. This should also include a broader range of COVID-19 products such as diagnostics and therapeutics.

Effective global leadership requires that we urgently move beyond vaccine nationalism, addressing both the moral imperative of vaccine equity and the ‘enlightened self-interest’ of expanded vaccine coverage. The tide is starting to turn. In the last month, the Biden administration in the US signalled their support for a waiver and the European Parliament has backed a resolution. We are adding our voice to growing calls to “share vaccine knowledge and expand global capacity for vaccine production” and ask the UK government to urgently reconsider its position on TRIPs waivers for vaccines.

Dr Luisa Enria
Professor Shelley Lees

Dr Mishal Khan
Anthony Mansaray
Dr Fred Martineau
Dr Neha Singh
Dr Alex Bowmer
Dr James Smith
Professor Jimmy Whitworth
Dr Hana Rohan
Nikita Arora
Dr Sadie Bell
Dr Jennifer Palmer
Dr Tracey Chantler
Rose Burns
Gillian McKay
Emilie Karafillakis
Dr Chrissy H Roberts
Professor Beate Kampmann
Hannah Gladstone
Samuel Boland
Dr Calum Davey
Professor Sian Clarke
Dr Adam Kucharski
Dr Siddharudha Shivalli
Dr Toyin Togun
Stefan Flasche
Dr Finn McQuaid
Dr Ritsuko Kakuma
Dr Gwen Knight
Dr Adrianna Murphy
Dr Yoko Laurence
Dr Sarah Cook
Dr Vladimir Sergeevich Gordeev
Dr David Prieto-Merino
Dorothy Boggs
Dr Vicky Simms
Olivia Heller
Roma Vichhi
Professor Sinéad Langan
Joe Yates
Professor Dorothea Nitsch
Dr Oluwagbemileke Bolajoko
Dr Silvia de Sanjose
Mark Marchant 
Pablo Perel
Dr Kerry Ann Brown
Dr Claire Dooley
Cidalia Eusebio
Dr Sojung Yoon

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