1. Seegert, Liz


Access to COVID vaccines varies significantly and is prolonging the pandemic.


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Omicron cases are now waning in the United States and other high-income nations, but many low- and middle-income countries are still experiencing high COVID-19 case and death rates, primarily due to lack of access to vaccines. It's a situation the World Health Organization (WHO) has called "a global failure."


COVID vaccine inequity is prolonging the pandemic and has been evident since the early days of vaccine development. In 2020, the United States, United Kingdom (UK), and European Union (EU), among others, quickly purchased millions of doses of the newly developed and approved vaccines-leaving low- and middle-income countries, primarily in Africa and parts of South Asia, nearly helpless amid the ongoing pandemic. By the fall of 2021, many higher-income nations were encouraging third and even fourth booster shots. At the same time, the WHO estimated that only two in five health care workers globally were fully vaccinated-and in Africa it was less than one in 10.


The situation is straining many already fragile health systems in low- and middle-income countries, which often lack cold storage and the distribution capabilities needed for widespread vaccination. Without the ability to manufacture vaccines locally, it's almost impossible to vaccinate people in more remote parts of these areas. However, despite pleas from the WHO, United Nations (UN), and dozens of international health and human rights groups, most vaccine manufacturers, who are mainly based in high-income countries, have refused to share their COVID vaccine technology and public health licensing, according to the WHO. An analysis by the AccessIBSA project released in December 2021 notes that 120 companies in Africa, Asia, and Latin America have the potential to produce messenger ribonucleic acid (mRNA) vaccines locally if patent protections are waived.


In late November 2021, a coalition of nurses' unions representing more than 2.5 million health care workers from 28 countries filed a complaint with the UN, saying their rights and those of their patients had been violated by certain high-income countries. The complaint alleges that the EU, UK, Norway, Switzerland, and Singapore violated human rights by refusing to temporarily waive pharmaceutical manufacturers' patent protections during the COVID-19 pandemic.



According to the Duke Global Health Innovation Center, high-income countries had procured upward of 7 billion confirmed vaccine doses by late January, whereas low-income countries had obtained approximately 500 million doses. This has created "vaccine apartheid," according to the equal rights group Global Justice Now.


Meanwhile, wealthier nations that promised to deliver vaccines to poorer countries are lagging behind on their commitments. According to the October 2021 report "Dose of Reality" by the People's Vaccine Alliance, "Of the 1.8 billion doses collectively promised by the G7 and Team Europe, only 261 million doses, or 14 percent, have been delivered to low- and middle-income countries," contributing to worldwide COVID vaccine inequities.


"This inequity is everywhere you turn, and that has an impact on an already stretched workforce where there were shortages," says Howard Catton, RN, chief executive officer of the International Council of Nurses (ICN), which is made up of 130 national nurses associations representing more than 27 million nurses. Hundreds of thousands of health care workers have become sick or died from the virus, and those who remain are experiencing burnout, fear, and depression, notes Catton. "We are not OK."


As early as the start of 2021, Catton says, the ICN found that nurses and health care workers in high-income countries were receiving vaccines, but there was little evidence of this occurring in low- and middle-income countries.



The UN defines vaccine equity as the allocation of vaccines "across all countries based on needs and regardless of their economic status." A report based on a September 2021 survey by the Partnership for Evidence-Based Response to COVID-19, Responding to COVID-19 in Africa, notes that health service delivery has been disrupted by the ongoing crisis. Barriers to care access, according to the report, are adversely affecting public health efforts in Africa and reversing gains that have been made in recent decades. In addition, the report notes that "low vaccination coverage may contribute to high transmission rates, impacting essential health services and increasing the risk that new variants of concern may emerge."


Only about one in four health care workers in Africa are vaccinated, and in some countries, it's as low as 8%, according to Catton. "It's not only a health crisis but a human rights crisis as well." He believes the world has "lost its moral compass on this one."


In a virtual press conference in late November, the WHO's Regional Office for Africa estimated that only 27% of Africa's health care workers were fully vaccinated, compared with more than 80% in high-income countries. At that time, an estimated 300,000 health care workers in Nigeria-18% of the workforce-were vaccinated, and less than half of Ethiopia's health care workers had indicated they would get vaccinated. The WHO's regional office attributed low vaccination rates among health care workers to the lack of availability of vaccines as well as vaccine hesitancy focused on concerns about safety and adverse effects.


The challenge is to distribute vaccines as fast as the virus is moving across the globe. The COVID-19 Vaccines Global Access (COVAX) project is a global partnership involving the WHO that had intended to provide enough vaccines in 2021 to vaccinate 20% of the population of every country. It was estimated this would require 2 billion vaccine doses. According to a December 2021 report from COVAX, it only obtained about 1.4 billion doses to distribute last year but hoped to have nearly 2.4 billion available by March.


"At the current pace of vaccine rollout, 109 countries would miss out on fully vaccinating 70% of their populations by the start of July 2022," said WHO director-general Tedros Adhanom Ghebreyesus during a January 6 media briefing. "The essence of the disparity is that some countries are moving toward vaccinating citizens a fourth time, while others haven't even had enough regular supply to vaccinate their health workers and those at most risk."


Thomas Kenyon, MD, MPH, director of Project HOPE and former director of the Center for Global Health at the Centers for Disease Control and Prevention, says the world needs to do more about the gaps in vaccination. Health care workers around the globe need to know they are protected and supported, and this needs to be reinforced with resources, education, protective equipment, and the tools necessary to safely perform their jobs, according to Kenyon. "In addition to infrastructure, supply chain, and distribution challenges, we also need to invest more in the health care workforce in these countries, in particular, nursing," Kenyon says. He observes that more public health education is also needed to overcome vaccine hesitancy.



The United States recently announced a $315 million investment in its Initiative for Global Vaccine Access, known as Global VAX, which aims to facilitate assistance and coordination of global vaccination efforts, with a focus on supporting such work in sub-Saharan Africa. This funding, which is intended to ensure more people in low- and middle-income countries are vaccinated, provides for investment in storage and delivery solutions and supports mobile vaccination sites and countrywide vaccination campaigns.


Another positive development was the late-December emergency use authorization for CORBEVAX by the government of India. Developed by Texas Children's Hospital and Baylor College of Medicine, this vaccine uses a traditional technology that allows for large-scale production and thus improved access for populations still awaiting vaccine supplies.


It's common sense that providing more people around the world with COVID vaccines offers the best hope for slowing the coronavirus pandemic, saving lives, and securing a global economic recovery, Catton points out. "Nobody is safe until everyone is safe."-Liz Seegert