David Pratt on The World: A vaccine for the haves ... and another for the have-nots

Yet in the midst of the latest challenges it is worth remembering that only a few months ago there was still no vaccine ready to roll out.

Now, however, all that has changed with news last week that by “late spring” a substantial number of people will have been offered a coronavirus vaccination in the UK. Elsewhere on the vaccine front too the news is encouraging.

“We are starting to turn the page on a difficult year” was how Ursula von der Leyen, president of the European Commission, summed it up, adding that the EU has “secured enough doses for our whole population of 450 million people”.

While here on our doorstep such news is undeniably welcome, the wider story of the vaccine rollout is shaping up to be a very different prospect when looked at on a global level. In fact, as the world ushers in the first week of 2021, many of our fellow global citizens do so with even greater trepidation as to what lies ahead.

Just who gets the supply of vaccines, how many and when is only part of a huge ethical debate unfolding daily across the planet. For some time now Covid-19 has been described as a disease of the haves and the have-nots. Only last month, on December 10, The New York Times reported that three of President Donald Trump’s close political allies, who were infected with the virus but quickly recovered, were given medications that were unavailable to the rest of the Americans.

While it might have been one instance, the story brought home the inequity many feel exists in terms of the help and support those threatened or who succumb to Covid-19 can expect.

Already campaigners have warned that an estimated nine out of 10 people in dozens of poor nations could miss out on getting vaccinated against Covid-19 this year because rich countries have hoarded far more doses than they need.

That warning last month from the People’s Vaccine Alliance, a coalition including Oxfam, Amnesty International and Global Justice Now, has taken on fresh resonance with news that the new virus variant continues to spread globally from Finland to Japan, India to South Africa and beyond.

As early as last November, says the People’s Vaccine Alliance, rich nations home to 14 per cent of the global population had bought 53% of the total stock of the most promising vaccines.

According to alliance member Oxfam, Britain, the EU, US, Canada, Japan, Switzerland, Australia, Hong Kong, Macau, New Zealand, Israel and Kuwait have acquired more than half of these potential doses.

The UK alone has secured enough to cover nearly three times its population. The EU and the US could immunise almost all of their inhabitants twice with the number of vaccine doses they have reserved. Canada, meanwhile, has bought enough to vaccinate its population anywhere between four and five times over.

“This shouldn’t be a battle between countries to secure enough doses,” Mohga Kamal-Yanni, an adviser for the People’s Vaccine Alliance, told Reuters news agency last month.

“During these unprecedented times of a global pandemic, people’s lives and livelihoods should be put before pharmaceutical company profit,” she added.

As history has more than once demonstrated, a vaccine of this sort is often quickly given to those lucky enough to live in the world’s richest nations, while the rest of the globe’s population suffers for several decades before deadly diseases are eradicated, if they ever are. Polio is typically one example.

This was a disease for which vaccines were first found in the 1950s and 60s, leading to the eradication of the virus in most developed countries. But, staggeringly, it was only in August last year that the World Health Organisation (WHO) declared the continent of Africa free of wild polio.

Speaking to the news agency Inter Press Service (IPS) a few days ago, Ben Phillips, campaigner and author of How To Fight Inequality, highlighted how the scandal is not limited to the fact that rich nations are marginalising poor nations from scarce supplies.

By far an even bigger outrage is that there is only such scarcity of supplies because companies are being allowed to hoard licences and know-how.

IPS cited Phillips as observing how, between1996 and 2001, the prioritisation of companies’ intellectual property over people’s health meant millions of people in poor countries died from Aids when the treatment for HIV was known and able to be produced cheaply, but was kept by profit-driven policy deliberately too costly and too rare.

“It’s astonishingly mean-spirited, and utterly short-sighted, that the same approach is being pursued now with Covid-19,” said Phillips.

For many of us the very idea that the fight against Covid-19 could be hampered worldwide by battles between countries to secure surplus doses or pharmaceutical company profit is both noisome and baffling.

After all, from very early on it quickly became clear that if distribution of the vaccine was based solely on the ability of a country to buy it alongside other treatments and test at scale, poorer countries would be left behind and all of us would be less safe.

Unequal access to vaccines too was likely to happen not just between countries but within them, leaving millions of vulnerable people defenceless against the virus.

Throughout this crisis such transnational realities always seemed to play second fiddle in a pandemic lexicon that increasingly stressed what bioethicists call “vaccine nationalism”.

Looking back now, it’s obvious that the principle put forward by many of the world’s leading health experts that “no-one is safe until everyone is safe” was from the outset always likely to be drowned out by the clamour of “me first” demands by certain wealthy countries.

That any government should prioritise its own citizens is doubtless a viewpoint many would subscribe to. What, after all, is a government’s role if not looking out for the safety and wellbeing of its own citizens? In that respect there are probably many more “vaccine nationalists” among us than some might willingly admit.

Speaking to BuzzFeed News recently, Arthur Caplan, head of the division of medical ethics at the NYU School of Medicine, said he partly defends the “vaccine nationalist” school of thought.

Not only should those countries that can afford it take care of their own first with a little extra supply for insurance, says Caplan, but also the virus has “wreaked such havoc on the world that equity is not part of the decision-making when it comes to vaccine distribution among countries”.

Such views are a far cry from those expressed in September 2019 when several months before Covid-19 swept across the globe world leaders made a historic declaration at the United Nations General Assembly, committing themselves to achieving universal health coverage (UHC) that recognised the right to health for all.

Included in this global commitment was “financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all”.

Now here we are, just over a year on, with millions of people affected by Covid-19 and millions more lacking access to basic health services due to lockdowns and overburdened health systems.

In a recent joint op-ed piece for the British Medical journal (BMJ), four global health experts from the UN and international medical research institutions highlighted how even before the pandemic hit, at least half of the world’s population was not receiving the essential health services it needed.

“When it comes to vaccine coverage levels, a proxy measure to assess how well a health system is functioning, the Gates Foundation and Institute for Health Metrics and Evaluation (IHME) has estimated that the pandemic has set the world back by about 25 years in only 25 weeks, with childhood vaccination rates dropping to levels last seen in the 1990s,” the experts pointed out.

While among the wealthier developed nations there is a collective sigh of relief given that the vaccine offers a way out, across much of Africa, Asia and Latin America there is still no light at the end of the tunnel.

As the world watches mass vaccinations begin in the UK, John Nkengasong, director of the Africa Centres for Disease Control and Prevention, warned that Africa might not see vaccines until after the second quarter of 2021.

Speaking to broadcaster Al Jazeera following the report released by the People’s Vaccine Alliance, Nkengasong called it a “moral issue” and urged the UN to summon a special session to discuss the ethical and fair distribution of vaccines to avoid “this North-South distrust in respect to vaccines, which is a common good”.

At the time of his remarks, Africa’s 54 countries had recorded more than 2.3 million confirmed infections.

Like many low-income countries around the world, those in Africa would be reliant on COVAX, one of three pillars of The Access to Covid-19 Tools (ACT) Accelerator, which was launched last April by the WHO for a more equitable distribution of Covid-19 vaccines. COVAX has 700 million doses at the moment, far from its two billion-dose goal. Even if COVAX reaches this goal, it will only be enough to vaccinate 20% of people in low-income countries: medical workers and vulnerable populations.

The implications are obvious. Without concerted collaboration, the rollout of vaccines will be uneven and risks exacerbating inequalities and global tensions.

As The New York Times highlighted last week, beyond the issue of health itself the iniquity of vaccine distribution will also most likely worsen a defining economic reality.

“The global economy has long been cleaved by profound disparities in wealth, education and access to vital elements like clean water, electricity and the internet,” observed Peter S Goodman, the NYT’s European economic correspondent.

“The pandemic has trained its death and destruction of livelihood on ethnic minorities, women and lower-income households.

“The ending is likely to add another division that could shape economic life for years, separating countries with access to vaccines from those without,” Goodman continued.

For the moment many of those rich countries already with access to the vaccine appear happy to pay only lip service on the issue of equitable access to the medicine.

Asked about these glaring inequalities in places like Africa during a press conference at the start of last month, UN secretary-general Antonio Guterres admitted that what the world was witnessing was “vaccine nationalism moving with full speed”.

“But the vaccines the African continent needs, and we all need … has to be properly supported. Or we will not be able to fight the pandemic anywhere effectively,” he added.

As the recent joint op-ed in the BMJ pointed out, while the rollout of the Covid-19 vaccine has been met with optimism and hopes that we may soon turn the tide on the pandemic, they continue to present the world with another challenge in the shape of ensuring equitable access to the medication globally.

It is only natural that those living in countries where the vaccine is already being made available have cause to be upbeat and celebrate.

While hopes remain high that huge numbers of people in the UK and elsewhere will be immunised by late spring, relief for millions of others in far-flung countries may not, however, come until the end of 2021, or even later.

In that respect the world that emerges from this frightening chapter in our history will likely be more unequal than ever.

If there is to be any true celebration resulting from the Covid-19 vaccine, perhaps it should wait until every one of our fellow global citizens has access to it, regardless of where they live and how much money they or their country have.