In November 2020, Director-General of the World Health Organisation, Tedros Adhanom, addressed the G20 Leaders’ Summit, calling for action to: ensure COVID-19 vaccines are allocated fairly as global public goods; fully implement the International Health Regulations and address the vulnerabilities and inequalities at the root of the pandemic. Although the “prospect of preventing illness and death, and avoiding the harm and misery of extended restrictions, is a cause for optimism”, Covid-19 as a public health and socio-economic issue is far from over.
On one hand, according to the Lancet, due to trial results being announced via a series of press releases, there remain many scientific uncertainties that can alter the perceived efficacy of vaccines during the course of the pandemic. Little safety data is available and consequently, questions such as how well the vaccines work longitudinally, among different ethnic and age groups, or those with underlying health conditions remain unclear. Although some of these issues may be resolved soon, others will remain unanswerable for quite some time..
On the other hand, pharmaceutical giants Pfizer and Moderna have predicted up to 1 billion people will be vaccinated by the end of 2021. As a result, many millions will continue to be at a high risk of disease over the next few years. According to the pathologist, Owen Dyer, immunisation inequality will last even longer than this, with at least “90% of people in low-income countries” standing little to no chance of receiving vaccinations in 2021. The People’s Vaccine Alliance, which includes Amnesty International, Frontline AIDS, Global Justice Now, and Oxfam claims that inequality is rooted in two critical factors.
The first being, wealthier nations have reserved far more vaccines than they need. Mohga Kamal Yanni, a physician speaking on behalf of the People’s Vaccine Alliance, reports that “rich countries have enough doses to vaccinate everyone nearly three times over, whilst poor countries don’t even have enough to reach health workers and people at risk.” The second factor is the unwillingness of the current pharmaceutical system. Due to pharmaceutical corporations using government funding as their main source for research, they retain exclusive intellectual property rights and keep their technology under tight security. This has led to profit-boosting being prioritised over the loss of lives.
The impact of this is seen with some 67 low-income countries having made no purchases of their own and relying wholly on the Covax programme – a collaborative effort by WHO, UNICEF and the World Bank, among others. The programme has secured around 700 million vaccine doses, enough to immunise only 10% of the population in those 67 low-income countries.
According to researchers at Manchester University’s, Humanitarian and Conflict Response Institute, research from the 2014-2016 West Africa Ebola outbreak can provide invaluable insight and a set of key lessons for decision-makers to ensure that the most vulnerable members of the international community receive fair and equal access to immunisation. Although Ebola was a regional crisis, its impact was widespread and provides a glimpse of how informed and regulated vaccine responses are integral to easing the strain of the current global pandemic.
A useful summary of lessons learnt from the Ebola vaccine experience is illustrated by the npj’s ‘Applying lessons from the Ebola vaccine experience for SARS-CoV-2 and other epidemic pathogens’. Key findings include:
• Public-private partnerships help accelerate product development and distribution by leveraging expertise from different organizations.
• Policy, program, and system innovations are needed to realize the full promise of new vaccines in advancing global public health preparedness
• Need to build and maintain clinical development capacities, laboratory and adverse event reporting infrastructure in outbreak-prone regions.
• It takes me to convert different formats and languages used to collect the clinical data into standard formats required by regulatory agencies.
• Global and regional harmonization is critical for the efficient development and licensure of pandemic vaccines.
• Regulatory agency collaboration is critical for success.
• Clinical data requirements for licensure need to be clearly defined and harmonized across global regulatory agencies.
• Frequent discussions with regulatory agencies and expedited regulatory pathways can accelerate the program.
• WHO’s leadership is needed to facilitate innovative review processes and collaborative mechanisms to expedite global approvals.
• Additional regulations for recombinant live virus vaccines can lead to delays in starting clinical trials, manufacturing, testing and shipments.
• Harmonized labelling and packaging requirements would facilitate pandemic vaccines distribution.
The message here is clear: The vaccine alone is not enough to address the current vulnerabilities and inequalities rooted in the Covid-19 pandemic. There must be a stronger and more collaborative global effort to ensure that the most vulnerable members of our global society are protected. To do this, we must ensure that the efficacy and distribution of vaccines are truly fair and equal. This requires a resilient and regulated environment in which principles of justice and collective action persevere.
Written by: Zahira Rafiq
Edited by: Zahira Rafiq
Art by: Kieran Blakey