The Haves and Have-Nots: The geopolitical dilemma of COVID vaccine equity

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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.

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As the world races against time in a bid to outrun COVID-19, it appears the race is staggered in favour of the wealthy—the wealthy nations and the wealthiest people from the world’s poorest countries. The media is awash with images of world leaders, health workers and vulnerable people getting that long-awaited vaccine jab in their arms, and social proof campaigns like V for #Vaccinate encourage people to rush out and get vaccinated. Yet for many of the world’s poorest people there are no vaccines in the immediate future, and similar images from parts of Africa and South-East Asia could be a couple of years away.

Vaccines for ALL should be our mantra, and yes, until we are all safe none of us can be safe—yet that was easy to say before the vaccines were developed, trialled and approved. Plans, it is said, often crash and burn when they come into contact with reality, and this has certainly proven to be the case with vaccine rollout in even the world's most developed nations. From Europe to the United States of America, we are all witnessing first-hand and in real time the challenges of attempting to outrun a virus—which at times appears to be smarter than many world leaders—as it mutates and attempts to evade therapies and now vaccines.

The miracle of modern science, research and innovation brought vaccines to us much earlier than anticipated, the combination of high-level political will and massive financial incentives. Rare public-private partnerships and international co-operation became a dream scenario for scientists, as they pulled together in a heroic effort and brought several vaccine candidates to the world in record time.

It is perhaps that speed of development and production that has impeded equity and access for those of us in the low- and middle-income countries (LMICs) of the world. Confirmed purchases of COVID-19 vaccines amount to 7.2bn doses—and 5.3bn of them have been bought by high-income and upper middle-income countries. As of the end of the first week in February 2021, the United Kingdom has vaccinated almost 12 million people; in the United States this figure is 40 million, and on 6 February alone 2.1 million vaccine doses were administrated: more than have been distributed to most LMICs combined. To date in Africa, less than 100,000 people have been vaccinated. This is the definition of inequity.

Read more on the Fourm Network: Global Crisis, Unequal Problems: If vaccines and recovery remain a developed country luxury, we will remain locked in crisis by Jorge Moreira da Silva, Director of Development Co-operation, OECD

There is an economic imperative, a moral imperative and an ethical imperative that dictate we must vaccinate as many people all over the world as quickly as possible. The health imperative stands on its own: people are dying and infecting one another. This cannot be allowed to become a geopolitical issue. Global co-operation and solidarity are essential to health for all, and particularly now when it also becomes a matter of global health security. As COVID-19 is a global problem, the solutions must also be applied globally and in an equitable manner.

Already travel bans are being put in place to separate the haves from the have-nots, with much of Southern Africa and South America sealed off from the United Kingdom, Europe and North America as fears grow of the "South African" and “Brazilian” variants. Yet this is a catch-22 situation, as without vaccines the virus will continue to spread, replicate and mutate all over the world; soon perhaps we will have a Lagos variant, a Kinshasa variant and a Nairobi variant making their way back around the world if the vaccines and therapies don’t work against them. It is the way of viruses, and enlightened self-interest alone dictates that we all work together to ensure that new variants are not re-introduced into countries that have already achieved herd immunity to the initial virus strains.

As mortality drops for the haves, mortality rates surge for the have-nots. In the first few weeks of 2021, three African countries have collectively lost several cabinet ministers to COVID-19; in 2020, Nigeria lost several prominent political personalities to the virus with a significant impact on its day-to-day governance. The continuity of government is becoming a concern on a continent where the average age of leaders is about 72 years, and where peace and security are already elusive. In Africa, COVID-19 is becoming a matter of regional stability and global security.

In an interconnected 2021, it is impractical to maintain long-term travel restrictions, yet that is where we are headed if the world does not vaccinate in an equitable manner. Trade and development are inextricably linked with open borders. And yet, in a moment that calls for collective action and global solidarity, it appears to have been replaced with nationalistic fervour, vaccine nationalism and vaccine wars between neighbours. There have been some rays of hope: vaccine diplomacy from India as they gifted 500,000 vaccines to Sri Lanka for health workers, and 3 million doses to Bangladesh and Nepal.

The most hopeful gesture of global solidarity, however, has been the emergence of the WHO, GAVI and CEPI led COVAX mechanism. It has sought to bridge the equity gap, and last week announced the roll out in Africa of an initial phase of 90 million doses to support countries to immunise 3% of the African population most in need of protection, including health workers and other vulnerable groups. Three percent is better than nothing, but is nowhere near enough to achieve the levels of vaccination required to enable us restart our economies safely and ensure that children can safely return to school. In view of major vaccine shortages and delivery delays due to lags in production, the ravenous gobbling up of most available stocks by the wealthiest countries is making the COVAX task difficult. An honest and transparent conversation is needed around the co-ordination of vaccine distribution and the broader impact of COVID-19 around the world. In the immediate aftermath of the emergence of the HIV virus, the world got together and established UNAIDS a multi-sectoral collaboration to help eradicate AIDs and mitigate its effects. Perhaps it is again time for that level of global co-operation and collaboration. Generosity is often mistaken for solidarity, but what most people in LMICs ask is for true inclusion, not for charity. We cannot talk of global solidarity until we all have not just a seat at the table, but also a voice in the process.

Find out more about COVAX

Africa has recognised that she must help herself, and there are admirable efforts being made by the Africa Vaccine Acquisition Task Team under the leadership of President of South Africa H.E Cyril Ramaphosa, Strive Masiyiwa and Dr. John Nkengasong of Africa CDC. They have ensured that there is at least a chance that the poorest of nations will have a shot at a vaccine, securing an initial 670 million doses for all African nations. Delivery of these will be an even greater challenge, and to that end the African Delivery Vaccine Alliance has been established, an alliance I am proud to serve on as we quite literally scour the earth in search of vaccines. In this moment, it would appear that our friends and allies—who jostle to influence policy and trade with us—have forgotten that our lives and livelihoods matter, too. The far-reaching economic consequences of the pandemic mean that this global co-operation and solidarity needs to be wide ranging, going beyond equitable access to vaccines as food security and girls' education are also being threatened by the virus. We must act together and act now.

A final word: as the global health community grapples with the challenges of vaccinating the world’s population, it would be wise also to begin to prepare the world’s most vulnerable nations for the inevitable next pandemic. Environmental awareness, pandemic preparedness, early warning systems and scientific research might be as worthwhile an investment as the vaccines themselves.

Read the OECD's Development Co-operation Report 2020: Learning from Crises, Building Resilience

Related Topics

Tackling COVID-19 Health Vaccines Sustainable Development Goals

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Dr. Ayoade Olatunbosun-Alakija

Member, Africa Union Africa Vaccine Delivery Alliance; Global Advisory Board Member for WomenLift Health; Chief Strategist, CONVINCE Africa

Dr. Ayoade Olatunbosun-Alakija is Chief Strategist for CONVINCE Africa, a member of the Africa Union Africa Vaccine Delivery Alliance and Global Advisory Board Member for WomenLift Health. She is the former Chief Humanitarian Coordinator (CHC) at the helm of the Nigerian Emergency Coordination Centre, she was a high-level interlocutor between state and non-state actors at governmental and intergovernmental levels. Previously, she served with the United Nations. She has also advised on achievement of the Millennium Development Goals (MDGs) and the post 2015 development agenda in the areas of health, education and life-skills in Africa (Rwanda, Kenya and Malawi to name but a few), the Caribbean and the Pacific where her input was integral to MDG achievement in certain quarters. A graduate of the London School of Hygiene and Tropical Medicine (University of London) with a Master of Science Degree in International Development and Public Health, Dr. Alakija is also a published researcher. She has collaborated as lead researcher with the World Health Organisation in the design, coordination and implementation of national health and behavioural surveys across nations.

1 Comment

Go to the profile of Afolabi Imoukhuede
Afolabi Imoukhuede 17 days ago

Awesome write up Dr. Alakija. The world watched the transmission of the virus across borders thus signifying to us all that the world is truly now a “global village.” This is the same concept that must be brought to bear in the acquisition and distribution of the COVID19 vaccines. No one should be left behind. AI