What does vaccine equity look like? How do we stop COVID-19 becoming a disease of poverty? How can everyone be ‘free’ when freedom is dictated by equitable access to vaccines?
As part of In Perspective, a conversation series hosted by UNSW School of Population Health, on September 14 we welcomed an esteemed panel of vaccine experts to explore not only the complexities in answering these questions, but also the imperative to shift perception of vaccine equity from a moral issue to one of global survival.
Included on the panel were Dr Catherine Kyobutungi - Executive Director of the African Population and Health Research Center, Professor Vivekanand Jha - Executive Director of The George Institute India and Chair of Global Kidney Health in the Faculty of Medicine at Imperial College in London, UK, Professor Hasbullah Thabrany – Chief of Party, USAID-Ministry of Health (MOH), Health Financing Activity in Indonesia and Chairman of the Indonesian Health Economics Association, and Professor William Pomat - Director of the Papua New Guinea Institute of Medical Research.
The panel was chaired by Dr Augustine Asante, Director of the Master of Global Health program at UNSW and moderated by Associate Professor Anita Heywood, infectious diseases epidemiologist at the School of Population Health at UNSW Sydney.
Professor Rebecca Ivers, Head of School of Population Health at UNSW Sydney, opened the discussion, saying:
“As we stumble though this COVID ridden landscape and find a pathway out, there are many people who have been left behind. Today we will seek to explore how we better address this and develop pathways to health for everyone.”
Dr Asante, a health economist with years of experience researching in the areas of health financing equity and health systems in low-and middle-income countries invited the panel to share their perspectives on the Covid-19 vaccine rollout, and the implications of a global failure to achieve vaccine equity.
“Covid-19 continues to wreak havoc across the globe. The Delta variant has become entrenched in many communities, and poses significant challenge to our health, our health systems, and the global economy. After more than one and half years of battling this virus, it has become abundantly clear that vaccination provides the only path back to a normal life.”
Dr Kyobutungi responded: “The way I see it, speaking from an African country, we think that the inequity is so gross that there's a thin line between inequity and vaccine apartheid.”
Dr Kyobutungi went on to show the alarming inequity in numbers of those who have been vaccinated for COVID-19 in selected African countries as compared to those administered globally. Africa accounts for approximately 16% of the world’s population, yet less than 2% of the population have received at least one dose.
“The current world order does not support equity, because the goal of any society should be justice and fixing the system to offer equal access to tools and opportunities. So, equity has failed,” said Dr Kyobutungi.
Professor Jha continued the discussion, adding: “This is a quote that we have heard again, and again many times: it is not over until it is over everywhere. It would take only 10% of the world population to remain unvaccinated to provide a big enough pool for the virus to circulate. And if this virus continues to circulate and spread like wildfire in the global south, it will mutate again and again, it is bound to happen, viruses will be viruses. There is no way that we can escape from this fact – and this is a medical fact, not a moral issue.”
Professor Jha went on to explain that vaccine inequity is undermining economic recovery. He said: “Rich countries are monopolising vaccine supplies. Mutual trust needs to be established to promote vaccine awareness and uptake. We know that vaccines work against poverty and conflict so what we need is acceleration in scaling up manufacturing and sharing enough vaccine dosage.”
Professor Thabrany spoke of the negative economic impact COVID-19 has had in Indonesia and the Philippines but noted that revenue has picked up in recent months and there is still hope of reaching a vaccination rate of 70% by the end of the year. Indonesia also has a domestic COVID-19 Vaccine in development, with hopes of free vaccinations available for everyone.
Professor Thabrany highlighted challenges with vaccine hesitancy in Indonesia. “People do not want to be vaccinated for various reasons. Some do not believe the products are good, some say that it is not halal, and others feel it will worsen existing health conditions,” he said.
Professor Pomat of Papua New Guinea also cited vaccine hesitancy as a primary challenge, stating that much of the misinformation was being perpetrated by trusted health professionals, many who do not believe that COVID-19 is real. “If the health workers themselves are not going and getting vaccinated, then how do we convince others to go and get vaccinated?” he said.
Papua New Guinea also faces problems with vaccine availability and distribution. Of the population, 80% live in rural areas and simply do not have the infrastructure or revenue to transport or store vaccine. Vaccines must be refrigerated, and many areas are without electricity.
Professor Jha added: “The world is following a vaccination strategy that doesn't combat inequity, and as a result, it is further entrenching inequities, and that's something that should concern the global health community.”
According to the World Health Organization, to end the pandemic at least 40% of people in every country need to be vaccinated by end of 2021 and at least 70% by the first half of 2022. While over 6 billion doses of COVID-19 vaccines have been administered globally, low-income countries account for just 2% of the total doses.
Dr Kyobutungi concluded the conversation, expressing: “I don't think vaccine inequity is going to end unless the TRIPs waivers are implemented, and the vaccines can be manufactured in many geographies by different entities in different parts of the world. I think we can only address inequity if we all wake up and realise that we are human beings, and we all need each other, you know. We all owe each other justice and equity.”
Achieving vaccine equity is not limited to vaccine availability, but also to the absence and inadequacy of accessible methods of production, preservation, transportation, distribution, and administration. As concluded by the panel, vaccine equity is only possible when it is seen as a global crisis and not a moral issue.
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