By Ioanna Moriatis
The COVID-19 pandemic has brought to light health inequities across the world, underscoring disparities among lower-income communities in terms of both rates of exposure to the virus and access to vaccine supplies.
Jamal Haidar, assistant professor of economics, reminds us that while such inequities in the global health space are not new, the scale and gravity of the current pandemic captured international attention more than ever before. “Vaccines and drugs that cost cents to make don’t reach millions of people who need them. However, the COVID-19 pandemic has exposed inequities in a striking manner,” Haidar noted.
The disparity in vaccine access can be seen in international trends of vaccination.
“Today, some rich countries are vaccinating children as young as 12 years old, who are at an extremely low risk of developing severe COVID-19 illness, while poorer countries don’t even have enough shots for health care workers,” said Haidar. “Of the COVID-19 vaccine doses administered to date, 75% have gone to people in high-income and upper middle-income countries. The low-income countries received only 4%.”
Shahjahan Bhuiyan, associate professor of public administration and associate dean for undergraduate studies and administration at AUC’s School of Global Affairs and Public Policy, shared similar sentiments: “With some exceptions, the 72 countries who have succeeded to vaccinate over 50% of their populations — meaning they have administered at least one dose — are predominantly resource-rich countries. It is evident that resource-rich countries are quickly transforming into vaccine-rich ones due to their capability of either producing or controlling the large share of vaccines manufactured globally.”
These disparities are particularly disconcerting when put into a cross-country context. “While 69% of the people in high-income countries, as defined using the World Bank country income classification, received at least one dose of COVID-19 vaccines as of now, only 2.3% of the people in low-income countries did,” said Haidar.
Economics and Governance
Despite COVID-19 vaccines being licensed for use around the globe, low-income and middle-income countries are struggling to sufficiently expand their supply of vaccine doses in order to move toward a more rapid path of recovery from this major health crisis.
Highlighting four factors that continue to pose challenges to countries that have not been able to vaccinate their populations at the same rate as higher-income states, Haidar explained, “In addition to licenses, vaccines need to be produced at larger scales, priced in ways to allow low-income citizens to afford them, allocated widely so that they are available where needed across the globe and efficiently deployed in local communities. These dimensions of the vaccination challenge are still barriers preventing lower-income countries from accessing vaccine doses and distributing them rapidly.”
Haidar noted that while development banks and international institutions like the World Bank have set aside funding to support countries in accessing vaccines, the economic states of these countries still present major obstacles.
“Many of these low-income and middle-income countries are already under huge debt and thus may be less willing to borrow more for much needed vaccines, as that could deviate domestic resources from other investment priorities they have,” he said.
Many of the obstacles preventing the access of lower-income countries to vaccine doses may also be rooted in deep-seated governance problems, Bhuiyan said. “It is interesting to note that most of the lower income countries that are currently suffering due to their lack of access to vaccines and inability to distribute them are also ranked poorly in the World Bank’s Worldwide Governance Indicators. Good governance deficits, among other things, play a key role in reducing the capacity of these countries to deal with major challenges, including vaccine-related issues.”
Another core issue is one of public demand for vaccines. “Intellectual property protection for COVID-19 vaccines have been waived, allowing for new manufacturers to help increase the supply of vaccines,” added Haidar. “In the long run, demand matters more than supply constraints. This is the sense in which supply bottlenecks are a red herring. They slow you down, but without demand, you don’t reach the vaccination goal at all. That said, more work is needed from governments in low-income and middle-income countries in order to create more awareness and increase demand for vaccines.”
While it may initially seem that disparities in access to vaccine doses pose a threat only to those countries unable to secure sufficient supplies, vaccine inequity is an issue of global concern. As both Haidar and Bhuiyan note, this matter is deeply intertwined with a range of other social issues. For example, Bhuiyan pointed out that the COVID-19 crisis has had a significant impact on access to employment. Referencing the 2021 World’s Employment and Social Outlook Trends issued by the International Labour Organization, he explained that employment gaps are expected to reach 75 million in 2021 — and 100 million when reduced working hours are taken into account. “This example paints a gloomy picture of the suffering that all countries are experiencing, predominantly in the Global South,” said Bhuiyan. “In addition, evidence suggests that the countries suffering from lack of access to vaccines are also encountering challenges in health security and employment, as well as economic, political and governance-related issues, which are likely to have a disastrous impact on the lives and livelihoods of their people.”
It is also important to look at vaccine inequity through an international economic lens. “There’s an economic reason to distribute vaccines more equitably,” Haidar said. “As the World Health Organization puts it, ‘no one is safe until everyone is safe,’ as countries are economically interdependent.” Given this interdependence, the pandemic’s negative impact on lower income countries can generate economic consequences for the entire global economy. “Vaccines have the potential to enhance public health, life expectancy, educational attainment, work productivity, adult earnings and economic activity,” Haidar added. “In addition, vaccines can reduce government spending on disease treatment. In the absence of vaccines, new diseases can spread faster, and immunity may take longer to develop, causing broader inequalities between and within countries and slowing down economic output at national and global levels.”
Finding a Solution
The complexity of vaccine inequity makes it a difficult challenge to solve in the short term. “There is no quick solution to this ‘messy’ problem,” said Bhuiyan.
While there have been attempts to tackle vaccine inequity by international initiatives such as COVAX — led by Gavi, the Coalition for Epidemic Preparedness Innovations and the World Health Organization — they have not yet been as successful as anticipated. This is, in part, because of the speed with which resource-rich countries have gained monopolies over available vaccine supplies. “COVAX was established to expedite the manufacture of COVID-19 vaccines and increase equality worldwide in the early stages of vaccination,” explained Haidar. “However, COVAX lacked the money to compete with rich countries that captured the market early on by striking purchase deals with vaccine makers.”
Still, Bhuiyan and Haidar see potential for COVAX to accelerate access to vaccines in the immediate future — that is, if the initiative finds increased support from the international community. “For the short term, it is the responsibility of resource rich or vaccine-rich countries to strengthen the COVAX initiative for global equitable access to COVID-19 vaccines and advance the World Health Organization mantra that ‘no one is safe until everyone is safe,’” explained Bhuiyan.
Haidar further emphasized the potential role that COVAX can play. “What COVAX can hopefully achieve is to help countries procure doses at lower prices and thus launch their vaccination campaigns earlier than they would without external assistance,” he said. “With additional funding, COVAX could probably compete better in the global scramble for vaccines and secure a place further toward the front of the queue.”
In the longer term, Haidar noted that the global supply of COVID-19 vaccines still needs to be addressed. “First, production of vaccines needs to expand,” he stressed. “Manufacturers of licensed products need to build new plants and establish new relationships with other manufacturers. Second, more knowledge needs to be shared. For instance, allowing more companies to follow the vaccine recipes developed could boost output.”
The question remains as to the exact financial role high-income countries can play to quicken production and tackle vaccine inequity. Given that lower-income countries are still dealing with the dilemma of prioritizing vaccine production over other debts, Haidar mentioned two approaches: “The global community needs to decide whether to provide funding via lending only to countries that want to borrow or to try financing global public goods, such as vaccines, especially as vaccines have global spillovers as well. In such a setting, institutions such as the World Bank and the International Monetary Fund may need to offer more grants or softer loans to allow countries to buy more vaccines, especially when countries need additional fiscal space as well.”
For Bhuiyan, it is also critical that countries direct their attention toward the underlying gaps that have weakened their access to vaccines. “In the long term, vaccine-poor countries also need to develop dynamic governance designs to deal with any future crises of the COVID-19 nature,” he noted.
This advice extends to resource-rich countries as well. “The pandemic has clearly exposed the unpreparedness of both developed and developing countries to deal with public health crises of this magnitude, as well as the lack of capacity of governments to deliver the needed health care services to treat coronavirus patients,” said Bhuiyan.