A novel coronavirus was identified in the Chinese city of Wuhan on 31 December 2019 and this week it was declared that private pharmaceutical companies, Pfizer and BioNTech, have created a vaccine that appears to be more than 90% effective. The long-awaited good news regarding a vaccine is being welcomed by communities around the world.
However, the distribution of the vaccine is likely to take a long time to reach lower-income countries. Researchers at Duke University have predicted that billions of people in poor and middle-income countries might not be immunised until 2023 or 2024.
Karl Blanchet, Professor in Humanitarian Health at the University of Geneva, told Al Bawaba that the vaccine will reach the world’s wealthiest first. “By the time the vaccines reach low-income countries, the vaccination campaigns will be finished in high-income countries. Who will be able to regulate the fair distribution? I don’t think WHO has enough power considering the influence of the private sector in this area. I am afraid the rule of fiercest will be the one applied,” Blanchet said.
“By the time the vaccines reach low-income countries, the vaccination campaigns will be finished in high-income countries. Who will be able to regulate the fair distribution?
In the Middle East, some governments are busy making bilateral agreements with Russian researchers who appear to be working on a promising vaccine. Egypt, Saudi Arabia and Syria’s Assad regime have all made public their interest in the Russian vaccine unveiled in August, known as Sputnik V, which is currently undergoing the third stage of trials in line with WHO guidelines. Bashar al-Assad has told the Russian news organisation Sputnik that “everybody in Syria is asking about the Russian vaccine and when it's going to be available." Egypt has reportedly ordered 25 million doses for the near future.
Dr Sara Nam, who has worked as a Nurse and Midwife on vaccination programmes in Afghanistan, Liberia, the DRC, and South Sudan, told Al Bawaba that “no one will be ‘safe’ from COVID until everyone is safe.” However, she insists that past experiences and current structures are available to help vaccines reach populations in low-income regions.
“everybody in Syria is asking about the Russian vaccine and when it's going to be available."
“There are many good examples in crises settings that we can learn from in terms of getting vaccines to those who need them most. We can learn from the expanded programme of immunisation programmes that have been very successful in providing vaccines and making sure that the coverage of vaccines is good enough to prevent disease outbreaks,” Nam told Al Bawaba.
One problem will be distributing vaccines in a way that is effective and equitable. “We will need to look to the ACT Accelerator,” Nam said, “a collaboration launched by WHO and partners in June that aims to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines.”
The WHO has launched a programme known as COVAX that aims to pool funds from high-income countries who are independently purchasing vaccines. The idea is that the pooled funds can be invested in greater production facilities that will create a more cost-efficient vaccine which can then be distributed at zero cost to lower-income nations.
However, Duke University researchers have found that nearly four billion doses have been purchased in bilateral deals, mainly with high-income countries, with another 5 billion doses currently under negotiation with the same nations. In comparison, COVAX has only managed to secure 250 million doses.
Once a vaccine is available, it then needs to be distributed properly. Nam said, “there will need to be careful planning about how to distribute the vaccines as they become available, to make sure they are rolled out in a way that ensures they offer population-level protection including those who live remotely and are poorer or are otherwise marginalised.”
Nam adds that it’s not merely a matter of delivering the vaccines, systems need to be in place to ensure they are administered effectively. “Policies and operational guidelines need to be developed; health staff need to be trained; procurement and supply systems must be able to cope and this includes having the right storage facilities in place, and all the relevant equipment must be available in the right places and there must be systems in place to track who is vaccinated, where and when; and systems to identify where there are shortfalls in any of these areas.”
“there will need to be careful planning about how to distribute the vaccines as they become available, to make sure they are rolled out in a way that ensures they offer population-level protection including those who live remotely and are poorer or are otherwise marginalised.”
Blanchet suggests that frontline workers, healthcare workers, older persons, pregnant women and people with certain chronic conditions should receive the vaccine first, followed by the rest of the population. “I am not sure, however, that this can be organised the right way even in high-income countries,” he told Al Bawaba.
14% of respondents said they would refuse the vaccine, whilst another 14% said they would hesitate to take it.
Even if all the vaccines can be produced and delivered properly, there is still the problem of vaccine hesitancy. A recent survey conducted in 19 countries, including Nigeria and South Africa who have been heavily affected by Covid-19, found that 14% of respondents said they would refuse the vaccine, whilst another 14% said they would hesitate to take it.
As with every aspect of the Covid-19 pandemic, structural inequalities on global, national and local levels have negatively affected the world’s most marginalised groups. Whilst updates of vaccines will continue to take up hours and inches in the media over the coming months, billions around the world could be waiting years to hear the good news.
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