According to WHO globally, as of today 28 January 2021, there have been 99,864,391 confirmed cases of COVID-19, including 2,149,700 deaths.

As COVID -19 continues its deadly path and the world stands in awe before the human cost, many are the countries that already struggle to deal with the immediate socio-economic effects and the aggravated inequalities the pandemic has caused.

Based on a recent study from the World bank, the COVID-19 pandemic is estimated to have increased extreme poverty by 88-93 million in 2020 (Figure 1) while the new 2021 forecast predicts between 119-124 million additional poor globally with around 60% living in South Asia.

During the last months, there has been an impatient race for the development of the COVID-19 vaccine. Thankfully the vaccine is ready, and the world now focuses on its most effective rollout.

As it seems, availability, accessibility, affordability and international cooperation are paramount conditions for a fair rollout and distribution of the vaccine globally.

Like other infectious diseases, Covid-19 can spread rapidly across borders and universal and equitable access to a safe and effective Covid-19 vaccine is critical to curb the spread of the pandemic at a global level.

The right to life and the right to the highest attainable standard of health for all, are fundamental human rights that all stakeholders in this equation are equally responsible to protect and fulfil.

In this direction, in November 2020, the UN Office of the High Commissioner of Human Rights published a statement written by UN Human Rights experts that aims at raising some of the critical human rights aspects that are intertwined with regard to the rights to life, to health and to international cooperation and assistance in relation to the COVID-19:

“In order to mitigate and contain the spread of the pandemic globally and to support national and international economic and financial recovery, it is imperative that COVID-19 diagnosis and treatment goods, including any potential vaccine, are fully available, accessible and affordable to all on this planet. In our capacity as UN human rights experts, we emphasize that a global pandemic of this scale and human cost, with no clear end in sight, requires a concerted, principled and courageous response. All efforts to prevent, treat and contain COVID-19 must be based on the bedrock human-rights based principles of international solidarity, cooperation and assistance. There is no room for nationalism or profitability in decision-making about access to vaccines, essential tests and treatments, and all other medical goods, services and supplies that are at the heart of the right to the highest attainable standard of health for all”.

The statement further reads:

“Epidemiologists fear that, due to the limited capacity of production of the vaccine, countries that are striking deals to secure vaccines for their own population – instead of engaging in a coordinated global effort to share them across borders– will not achieve their intended purpose. The pandemic will continue and will come back to impact those countries sooner or later, including through further economic disruption”

,and concludes with an essential message often repeated in 2020: 

“NO ONE IS SECURE UNTIL ALL OF US ARE SECURE”

The Responsibility of Governments for Universal and Equitable Access to COVID-19 vaccine

Last August, the chief of WHO Tedros Adhanom Ghebreyesus warned against vaccine nationalism and addressed the importance of global solidarity to handle the crisis.

“While there is a wish amongst leaders to protect their own people first, the response to this pandemic has to be collective,”

he said.

Unfortunately, contrary to above recommendations and to the international human rights standards, it appears that several Governments have been striving to secure large vaccine quantities for their citizens, disregarding the call for international cooperation to enhance global availability and accessibility. In September 2020, Oxfam International reported that high-income countries representing no more than 13 percent of the world’s population, had already reserved 51 percent of the doses of several leading vaccine candidates. A recent report from “The People’s Vaccine Alliance” a coalition of organisations and activists confirms that:

“rich nations representing just 14% of the world’s population had bought up more than half (53%) of all the most promising vaccines”.

That included all of Moderna’s vaccines for 2021 and 96% of Pfizer’s expected production. These deals, in most of the cases bilateral between the governments and the vaccine companies, could severely undermine the effort for universal and equitable access especially for the low- and middle-income countries. Moreover, the limited or lack of transparency would create doubt on the proper and ethical use of public money.

Last week, on the 21 January 2021, we read in BBC news that whereas close to 40 million doses have been administered in at least 49 higher-income countries, just 25 single doses were given in just one of the lowest-income countries. According to WHO chief Dr. Tedros Ghebreyesus, the irresponsibility of the wealthy nations together with other setbacks as the insufficient funding, tough local regulations and cold chain requirements are the main reasons why:

“The world is on the brink of a catastrophic moral failure and the price will be paid with lives and livelihoods in the poorest countries”.

An example of vaccine nationalism, amongst others, is that of Israel. On January 7, 2021, the Israeli government communicated that just three weeks after the first Israeli citizen received the Pfizer vaccine, the country has raced ahead of the rest of world with vaccinations, covering approximately 20 %of its population.

The Israeli government announced that they struck an agreement with Pfizer to exchange citizens’ data for 10 million doses of the coronavirus vaccine, including a promise of weekly shipments of 400,000-700,000 doses. Under this agreement, Israel will provide details to Pfizer about the age, gender and medical history of those receiving the vaccine as well as its side effects and efficacy. In addition, Israeli government paid a premium of more than 50% per vaccine dose to Pfizer, in order to get priority over the other countries. (politico.eu “The secrets to Israel’s coronavirus vaccination success”)

At the same time, Africa will have to wait “weeks if not months” before receiving Covid-19 vaccines (who.int)

In the following graphic representations, we can see the Cumulative COVID-19 vaccination doses administered per 100 people up to date, for the leading countries in vaccination doses.

The Responsibility of Businesses to increase Accessibility, Availability and Affordability

Related to the Responsibility to universal and equitable access to a safe and effective Covid-19 vaccine, the role of business is equally important.

The call for availability and accessibility means that vaccine companies, during the pandemic should make the scientific know-how accessible in order to expand the vaccine manufacturing capacity globally. In order to meet the increasing global demand for the vaccine, companies are encouraged to make special agreements and if necessary, to waive some provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS).

According to a Statement on the Covid-19 Pandemic by the UN Committee on Economic, Social and Cultural Rights:

“The Covid-19 pandemic is a global crisis, which highlights the crucial importance of international assistance and co-operation, a core principle enshrined in the Covenant.9. Such international assistance and co-operation includes the sharing of research, medical equipment and supplies, and best practices in combating the virus; […]“The needs of vulnerable and disadvantaged groups as well as fragile countries, including least developed countries, and countries in conflict and post-conflict situations should be at the centre of such international endeavours”.

When it comes to pricing, businesses and also governments should bear in mind that the primary objective is to maximize affordability of the vaccine so that more countries, also middle and low income, will be able to procure it. This recommendation does not mean that vaccine companies should not be compensated or make profit, but it clearly emphasizes that, especially during the pandemic, affordability should be prioritized over profitability.

International Cooperation Best Practices 

I wanted to conclude this article with a tone of optimism and present to you an example of International Cooperation, the COVAX initiative. COVAX is the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator.  The ACT Accelerator is a ground-breaking global collaboration launched by WHO and partners, bringing together governments, global health organisations, manufacturers, scientists, private sector, civil society and philanthropy, with the aim to accelerate the development, production and equitable access to COVID-19 diagnostics, treatments and vaccines.(www.who.int)

COVAX is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO that aims to accelerate the development and manufacture of COVID-19 vaccines and to ensure that every country regardless of their ability to pay gets fair and equitable access to COVID vaccines. It acts as an insurance policy with the largest portfolio of vaccine candidates in the world. Since wealthier countries have a bigger chance of gaining access to vaccines, COVAX is pooling their funds to enable investments in supporting the building of manufacturing capabilities and buying supply ahead of time so that 2 billion doses can be fairly distributed by the end of 2021.

So far, ACT-Accelerator funding commitments total US$ 6.0 billion out of which US$ 3.9 billion are committed to COVAX initiative. The scheme says it needs at least another US$ 2billion more to meet its global vaccination target for 2021.

The UK is the leading government that has contributed US$ 1.0 billion, to COVAX initiative, followed by Canada, Germany and Norway that contributed close to US$ 700 million each.

In this link you can access the ACT-Accelerator Commitment Tracker that provides transparent reporting on funding commitments made by public and private donors against ACT-Accelerator Pillar budgets. https://www.who.int/publications/m/item/access-to-covid-19-tools-tracker

The  COVAX initiative is expected to start distributing vaccines in February 2021, with priority to low and middle-income countries that will receive the biggest part. COVAX hopes that, by the end of 2021, more than 2 billion doses will have been delivered to countries across the world. Of those, about 1.8 billion doses will be delivered to the 92 poorer countries involved in the scheme, covering around 20% of their populations.

Important to mention at this point that according to WHO, stopping Covid-19 will require that at least 70% of the global population is vaccinated. At a rate of 2 billion doses per year, it could take almost 3 years to vaccinate 70% of the world’s estimated 7.8 billion people.

However, the COVAX initiative goal for 2021 is a start and these 2 billion doses would give protection to those who are first in line, such as health workers, the elderly and the vulnerable.

This is a call for action for all parties involved, public and private, to intensify their efforts so that the project of universal and equitable access to COVID vaccine is accelerated and the spread of the pandemic is curbed at a global level.

This is a bet that by all means should be won.