tag:theconversation.com,2011:/nz/topics/vaccine-inequity-112818/articlesvaccine inequity – The Conversation2022-09-15T02:28:33Ztag:theconversation.com,2011:article/1906582022-09-15T02:28:33Z2022-09-15T02:28:33ZWe were on a global panel looking at the staggering costs of COVID – 17.7m deaths and counting. Here are 11 ways to stop history repeating itself<p>A global report released <a href="https://www.thelancet.com/commissions/covid19">today</a> highlights massive global failures in the response to COVID-19.</p>
<p>The report, which was convened by The Lancet journal and to which we contributed, highlights widespread global failures of prevention and basic public health.</p>
<p>This resulted in an estimated 17.7 million excess deaths due to COVID-19 (including those not reported) to September 15.</p>
<p>The report also highlights that the pandemic has reversed progress made towards the United Nations <a href="https://sdgs.un.org/goals">Sustainable Development Goals</a> in many countries further impacting on health and wellbeing.</p>
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<p>The report, from <a href="https://covid19commission.org">The Lancet COVID-19 Commission</a>, found most governments were ill-prepared, too slow to act, paid too little attention to the most vulnerable in their societies, and were hampered by low public trust and an epidemic of misinformation.</p>
<p>However, countries of the Western Pacific – including East Asia, Australia and New Zealand – adopted <a href="https://theconversation.com/australias-response-to-covid-in-the-first-2-years-was-one-of-the-best-in-the-world-why-do-we-rank-so-poorly-now-187606">more successful</a> control strategies than most.</p>
<p>This had resulted in an estimated 300 deaths per million in the region
(around <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7EAUS">558 per million</a> in Australia and <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7ENZL">382 per million</a> in New Zealand to September 12). This is compared with more than 3,000 per million in the <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7EUSA">United States</a> and the <a href="https://ourworldindata.org/grapher/total-covid-cases-deaths-per-million?country=%7EGBR">United Kingdom</a>. </p>
<p>The report also sets out 11 key recommendations for ending the pandemic and preparing for the next one.</p>
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Read more:
<a href="https://theconversation.com/imagining-covid-is-like-the-flu-is-cutting-thousands-of-lives-short-its-time-to-wake-up-190545">Imagining COVID is 'like the flu' is cutting thousands of lives short. It's time to wake up</a>
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<h2>Co-operation lacking</h2>
<p>The report is the result of two years’ work from global experts in public policy, health, economics, social sciences and finance. We contributed to the public health component.</p>
<p>One of the report’s major criticisms is the failure of global cooperation for the financing and distribution of vaccines, medicines and personal protective equipment for low-income countries. </p>
<p>This is not only <a href="https://theconversation.com/wealthy-nations-starved-the-developing-world-of-vaccines-omicron-shows-the-cost-of-this-greed-172763">inequitable</a> but has raised the risk of <a href="https://theconversation.com/new-covid-variants-have-changed-the-game-and-vaccines-will-not-be-enough-we-need-global-maximum-suppression-157870">more dangerous variants</a>.</p>
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<p>The report highlighted the critical role of strong and equitable public health systems. These need to have: strong relationships with local communities; investment in behavioural and social science research to develop more effective interventions and health communication strategies; and continuously updated evidence.</p>
<h2>11 recommendations</h2>
<p>The report made 11 recommendations to end the pandemic and prepare for future ones.</p>
<p><strong>1. Vaccines plus other measures</strong> – establishing global and national “vaccination plus” strategies. This would combine mass immunisation in all countries, ensure availability of testing and treatment for new infections and long COVID, coupled with public health measures such as face masks, promotion of safe workplaces, and social and financial support for self-isolation.</p>
<p><strong>2. Viral origins</strong> – an unbiased, independent and rigorous investigation is needed to investigate the origins of SARS-CoV-2, the virus that causes COVID-19, including from a natural spillover from animals or a possible laboratory-related spillover. This is needed to prevent future pandemics and strengthen public trust in science and public authorities.</p>
<p><strong>3. Bolster the World Health Organization</strong> and maintain it as the lead organisation for <a href="https://theconversation.com/too-late-already-bolted-how-a-faster-who-response-could-have-slowed-covid-19s-spread-160860">responding to emerging infectious diseases</a>. Give WHO new regulatory authority, more backing by national political leaders, more contact with the global scientific community and a larger core budget.</p>
<p><strong>4. Establish a global pandemic agreement</strong> and strengthen <a href="https://theconversation.com/at-what-point-is-a-disease-deemed-to-be-a-global-threat-heres-the-answer-185547">international health regulations</a>. New pandemic arrangements should include bolstering WHO’s authority, creating a global surveillance and monitoring system for infectious disease outbreaks. It would also include regulations for processing international travellers and freight under global pandemic conditions, and the publication of an annual WHO report on global pandemic preparedness and response.</p>
<p><strong>5. Create a new WHO Global Health Board</strong> to support WHO decision-making especially on controversial matters. This would be composed of heads of government representing each of the six WHO regions and elected by the member states of those regions.</p>
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<p><strong>6. New regulations to prevent pandemics</strong> from natural spillovers and research-related activities and for investigating their origins. Prevention of <a href="https://theconversation.com/5-virus-families-that-could-cause-the-next-pandemic-according-to-the-experts-189622">natural spillovers</a> would require better regulation of domestic and wild-animal trade and enhancement of surveillance systems for pathogens (disease-causing micro-organisms) in domestic animals and humans. The <a href="https://globalhealth.org/programs/world-health-assembly/">World Health Assembly</a> should also adopt new global regulations on biosafety to regulate international research programs dealing with dangerous pathogens.</p>
<p><strong>7. A ten-year global strategy</strong> by <a href="https://www.dfat.gov.au/trade/organisations/g20">G20 (Group of Twenty)</a> nations, with accompanying finance, to ensure all WHO regions, including the world’s poorer regions, can produce, distribute, research and develop vaccines, treatments and other critical pandemic control tools. </p>
<p><strong>8. Strengthen national health systems</strong> based on the foundations of public health and universal health coverage and grounded in human rights and gender equality.</p>
<p><strong>9. Adopt national pandemic preparedness plans</strong>, which include scaling up community-based public health systems, investment in a skilled workforce, investment in public health and scientific literacy to “immunise” the public against dis-information, investment in behavioural and social sciences research to develop more effective interventions, protection of vulnerable groups, establishment of safe schools and workplaces, and actions to improve coordinated surveillance and monitoring for new variants.</p>
<p><strong>10. Establishment of a new Global Health Fund</strong> where – with the support of WHO – there is increased and effective investment for both pandemic preparedness and health systems in developing countries, with a focus on primary care. </p>
<p><strong>11. Sustainable development and green recovery plans</strong>. The pandemic has been a setback for sustainable development so bolstering funding to meet sustainability goals is needed.</p>
<h2>Unlock a new approach</h2>
<p>To improve the world’s ability to respond to pandemics we need to unlock a new approach. The key component to any meaningful transformation is to collaborate and work towards a new era of multilateral cooperation. </p>
<p>Governments in Australia, Aotearoa New Zealand and elsewhere have talked about “building back better”. We need to take the lessons learnt from the failures of the past few years and build a stronger framework. This will not only help reduce the dangers of COVID-19 but also forestall the next pandemic and any future global crisis. </p>
<p>By reassessing and strengthening global institutions and co-operation, we can build and define a more resilient future.</p>
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<p><em>Chris Bullen, Professor of Public Health, University of Auckland, co-authored this article and The Lancet COVID-19 Commission report on which it was based.</em></p><img src="https://counter.theconversation.com/content/190658/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Thwaites is Chair of Monash Sustainable Development Institute and ClimateWorks Australia which receive funding for research, education and action projects from the Australian and state governments as well as from philanthropy and industry. He is former Deputy Premier of Victoria and a member of the Australian Labor Party.</span></em></p><p class="fine-print"><em><span>Liam Smith receives funding from a number of government schemes, government bodies and private sector funders. </span></em></p><p class="fine-print"><em><span>Margaret Hellard receives funding from a number of government funding schemes and government bodies and philanthropic organisations for work on COVID-19.
Margaret Hellard also receives funding from Gilead Sciences and Abbvie for research unrelated to COVID-19.</span></em></p>We found most governments were ill-prepared, too slow to act, paid too little attention to the most vulnerable, and were hampered by low public trust and an epidemic of misinformation.John Thwaites, Chair, Monash Sustainable Development Institute & ClimateWorks Australia, Monash UniversityLiam Smith, Director, BehaviourWorks, Monash Sustainable Development Institute, Monash UniversityMargaret Hellard, Adjunct Professor, Monash University; Associate Director and Head, Centre for Population Health, Burnet InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1734002021-12-21T18:22:01Z2021-12-21T18:22:01ZIncome inequality and COVID-19: We are in the same storm, but not in the same boat<figure><img src="https://images.theconversation.com/files/438569/original/file-20211220-15-1fp6ske.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4992%2C3325&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Last May, churches in low income communities across New York offered COVID-19 testing to residents in conjunction with Northwell Health and New York State, where COVID-19 hit residents the hardest.</span> <span class="attribution"><span class="source">(AP Photo/Mary Altaffer) </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/income-inequality-and-covid-19--we-are-in-the-same-storm--but-not-in-the-same-boat" width="100%" height="400"></iframe>
<p>By now, many are aware that the pandemic has affected lower-income groups the most within countries, <a href="https://health-infobase.canada.ca/covid-19/inequalities-deaths/index.html">including in Canada</a>. But what most do not know is that income inequality — the economic distance between higher and lower-income groups within individual countries — is also driving national COVID-19 infection and death rates.</p>
<p>The specific impacts are only just becoming clear. As researchers in economics and epidemiology, we are interested in how economic inequality has impacted COVID-19 outcomes. The pandemic has given researchers like us a unique opportunity to study the relationship between inequality and health across various countries.</p>
<p>Working independently to study the pre-vaccine phase of the pandemic, our teams approached the research question from different perspectives. We brought together economists who are concerned with the analysis and economic impact of income inequality, and epidemiologists who study how social factors influence health.</p>
<p>Taking into account pre-pandemic inequality and other structural variables, we found that higher income inequality was associated with worse COVID-19 outcomes within countries.</p>
<h2>Studies show link between inequality and COVID-19</h2>
<p>The first study, conducted by <a href="https://doi.org/10.1016/j.ssmph.2021.100904">Edgardo Sepulveda of Ryerson University and Ann-Sylvia Brooker of the University Health Network in Toronto</a>, an economics-epidemiology team, focused on 22 high-income countries that are members of the Organisation for Economic Co-operation and Development (OECD), an intergovernmental economic organization. Given that <a href="https://doi.org/10.3390/ijerph17165974">age is one of the most significant COVID-19 risk factors</a>, their analysis broke the population into four age groups: 15–44, 45–64, 65–79 and above 80 years. They accounted for economic and other known risk factors, such as national poverty and the number of residents in long-term care homes in each country.</p>
<p>They found that higher income inequality in a country was associated with more COVID-19 deaths across all age groups. There are a number of possible explanations for this association, such as a larger proportion of the population being more at risk. This may be due to higher exposure, more comorbidities or poorer access to treatment.</p>
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<img alt="A man wearing an oxygen mask rests his head on a woman's lap. Both are in the backseat of a car." src="https://images.theconversation.com/files/438284/original/file-20211217-15-ld3i1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438284/original/file-20211217-15-ld3i1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438284/original/file-20211217-15-ld3i1s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438284/original/file-20211217-15-ld3i1s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438284/original/file-20211217-15-ld3i1s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438284/original/file-20211217-15-ld3i1s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438284/original/file-20211217-15-ld3i1s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A patient breathes with the help of oxygen provided by a gurdwara, a Sikh place of worship, inside a car in New Delhi, India. India’s medical oxygen shortage has become so dire that a gurdwara began offering free breathing sessions with shared tanks to COVID-19 patients waiting for a hospital bed.</span>
<span class="attribution"><span class="source">(AP Photo/Altaf Qadri)</span></span>
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<p><a href="https://doi.org/10.3138/cpp.2021-033">The second study</a>, conducted by James Davies of Western University, looked at COVID-19 severity in 127 high-, medium- and low-income countries. Taking into account a number of variables — including national poverty, geography, the number of hospital beds and the level of democracy — he found a strong association of COVID-19 cases, deaths and inequality.</p>
<p>For example, during the first wave of the pandemic, the U.S. had <a href="https://www.cbc.ca/news/world/covid-19-us-canada-death-rates-1.5553168">60 per cent more deaths</a> and 150 per cent more cases per capita than Canada. Davies estimates that one third of these gaps could be explained by higher U.S. inequality. </p>
<p>But Canada should not be smug. There are <a href="https://data.worldbank.org/indicator/SI.POV.GINI?locations=OE">20 OECD countries with lower inequality than Canada</a>, meaning that there are 20 countries who are dealing with inequality better than Canada is. Davies’ results suggest that if Canada’s income inequality gap was smaller, it could have had 34 per cent fewer COVID-19 cases in the first wave.</p>
<h2>Inequality has widespread effects</h2>
<p>Not only is inequality within countries socially and economically undesirable and politically corrosive, but it is also wasteful. Reducing inequality can increase the overall welfare in society. While it’s true that too much redistribution can potentially reduce the size of any future “economic pie,” it is unlikely that Canada, and most other OECD countries, are close to reaching that point.</p>
<p>It’s clear that inequality has a negative effect on health, and has worsened the severity of the ongoing pandemic. Lower-income groups within OECD countries, <a href="https://www.cbc.ca/news/canada/toronto/toronto-covid-19-vaccines-1.5978107">including in Canada</a>, tend to have lower vaccination rates.</p>
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<img alt="Nurse giving a man a vaccination shot in the arm" src="https://images.theconversation.com/files/438571/original/file-20211220-50043-ykgm56.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438571/original/file-20211220-50043-ykgm56.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438571/original/file-20211220-50043-ykgm56.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438571/original/file-20211220-50043-ykgm56.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438571/original/file-20211220-50043-ykgm56.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438571/original/file-20211220-50043-ykgm56.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438571/original/file-20211220-50043-ykgm56.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A nurse gives a man a shot at a vaccine clinic for the homeless in Calgary Alberta. people experiencing homelessness are disproportionately impacted by COVID-19.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/Jeff McIntosh)</span></span>
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<h2>Towards more economic equality</h2>
<p>Looking only at the United States for comparison, some Canadians may think that ours is a relatively equal society, <a href="https://www.cbc.ca/news/politics/pandemic-covid-coronavirus-cerb-unemployment-1.5610404">but it is not</a>. We are just the middle of the pack — we can and should do better.</p>
<p>If Canada is truly interested in achieving greater equality, we need to focus on the systems and policies that exacerbate inequality, to improve our pre-distribution policies and our redistributive effort. We can increase investments in people, enrich our social programs and have a fairer tax system where the rich contribute more. </p>
<p>If such measures are taken, we can expect that both economic performance and public health would improve, and that more Canadians would be in the same boat and paddling in the same direction.</p>
<p><em>Ann-Sylvia Brooker is a health researcher in Toronto and co-authored this article.</em></p><img src="https://counter.theconversation.com/content/173400/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>How two Canadian teams of economists and epidemiologists studied COVID-19 from a social science perspective to show that higher national income inequality is associated with worse COVID outcomes.James Davies, Emeritus Professor of Economics, Western UniversityEdgardo Sepulveda, Associate Fellow (National Institute on Ageing), Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733612021-12-14T16:01:04Z2021-12-14T16:01:04ZCOVID-19 vaccine inequity allowed Omicron to emerge<figure><img src="https://images.theconversation.com/files/437133/original/file-20211213-17-15ypeah.png?ixlib=rb-1.1.0&rect=56%2C44%2C1940%2C1197&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While people in the wealthy West have had preferred access to multiple rounds of vaccines, vast numbers of people, especially in Africa and on the Indian subcontinent, haven’t received a single dose.</span> <span class="attribution"><span class="source">(Pixabay/Canva)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/covid-19-vaccine-inequity-allowed-omicron-to-emerge" width="100%" height="400"></iframe>
<p><a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">Canada’s COVID-19 vaccination rate</a> is 76 per cent — <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=total_vaccinations_per_hundred&Metric=Vaccine+doses&Interval=Cumulative&Relative+to+Population=true&Align+outbreaks=false&country=Africa%7ECAN">10 times higher</a> than it is across the continent of Africa.</p>
<p>While people in the wealthy West have had preferred access to multiple rounds of vaccines, vast numbers of people, especially in Africa and on the Indian subcontinent, <a href="https://ourworldindata.org/covid-vaccinations">haven’t received a single dose</a>. This has permitted the virus to thrive and <a href="https://www.oxfam.org/en/press-releases/two-thirds-epidemiologists-warn-mutations-could-render-current-covid-vaccines">accelerated the process of mutation</a>, adding months and perhaps years to the pandemic.</p>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>Wherever COVID-19 has the chance to linger, <a href="https://www.theguardian.com/commentisfree/2021/nov/26/new-covid-variant-rich-countries-hoarding-vaccines">variants develop and travel</a>. This entirely predictable pattern is destined to repeat itself unless countries with resources <a href="https://news.un.org/en/story/2021/08/1098882">share vaccines</a> with others that cannot afford them. </p>
<p><a href="https://www.cbc.ca/radio/asithappens/as-it-happens-thursday-edition-1.6219522/rich-countries-only-shared-14-of-covid-19-vaccine-doses-promised-to-poorer-nations-report-1.6219969">Wealthy countries have yet to meet their pledges</a> to provide equitable global access to vaccines via <a href="https://www.unicef.ca/en/covax-ensuring-global-access-covid-19-vaccines?ea.tracking.id=20DIAQ01OTE&19DIAQ02OTE=&gclid=Cj0KCQiAzMGNBhCyARIsANpUkzP5fE37OazUDpzB8MnRHS-_hAe1K8l08m_x1dIRTGPh5YjyjSxW7QoaAjQMEALw_wcB">COVAX</a> (an international collaboration to procure and distribute COVID-19 vaccines) and other initiatives. The resulting lack of broad global vaccine coverage made the rise of another variant like Omicron inevitable. </p>
<p>For Canada, it is more critical than ever to carefully balance the supply of vaccines available for domestic use while prioritizing international sharing — and encouraging regional manufacturing. </p>
<h2>Millions of pre-ordered vaccine doses</h2>
<p>When the COVID-19 crisis started, major manufacturers pre-sold their vaccines to governments as they were being developed but before they were tested, as a way of funding their work, including clinical trials. </p>
<p><a href="https://theconversation.com/canadas-me-first-covid-19-vaccine-strategy-may-come-at-the-cost-of-global-health-146908">Canada and other developed countries ordered millions of doses</a>, enough to cover their populations many times over, with promises to share their excess vaccines with other countries. That has not happened quickly enough. While logistical, legal and other barriers did impede the wider distribution of vaccines, there appears to be <a href="https://globalnews.ca/news/8243635/bolivian-minister-canada-covid-vaccine-waiver/">a lack of will</a> to overcome them. </p>
<p>The momentum gained by accelerating the development of vaccinations has now been lost. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hundreds of vials with red lids on a conveyor belt" src="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vials waiting to be filled with Pfizer’s COVID-19 vaccine at a production plant in France. Developed countries pre-purchased millions of doses of COVID-19 vaccines while they were still in development.</span>
<span class="attribution"><span class="source">(AP Photo/Christophe Ena)</span></span>
</figcaption>
</figure>
<p><a href="https://www.wsj.com/articles/pfizer-biontech-covid-19-vaccine-loses-significant-effectiveness-against-omicron-in-early-study-companies-say-11638964121">Third doses and booster shots</a> will be important to controlling both the ongoing threat of Delta and the spread of Omicron. Canadians should certainly heed public health guidance and get their shots when they are recommended. Once vaccine doses are in Canadian freezers and fridges they aren’t going anywhere, and declining a dose won’t mean that it is redistributed to other parts of the world that need them. </p>
<p>On a federal level, Canada should only buy what is needed domestically and commit to accelerating the distribution of vaccines elsewhere. The same is true for all wealthy countries.</p>
<h2>The rise of Omicron</h2>
<p>Watching the rise of Omicron is particularly frustrating. It has been apparent since the outset that the spread of COVID-19 needed to be slowed globally, precisely to prevent variants from emerging. That message should have been clearer after the spread of the agile <a href="https://www.ox.ac.uk/news/2021-07-23-alpha-variant-spread-super-seeding-event-warning-over-covid-19-variants">Alpha variant</a>. It should have been clearer still from the swift attack of the <a href="https://theconversation.com/why-is-delta-such-a-worry-its-more-infectious-probably-causes-more-severe-disease-and-challenges-our-vaccines-163579">Delta variant</a>.</p>
<p>Variants like Delta and Omicron will arise when the burden of infection is high and vaccination rates are low, as is the case with many countries in the Global South. <a href="https://theconversation.com/coronavirus-variants-have-new-names-we-can-finally-stop-stigmatising-countries-159652">Identifying variants by their country of origin</a> perpetuates a long legacy of <a href="https://theconversation.com/calling-covid-19-a-chinese-virus-is-wrong-and-dangerous-the-pandemic-is-global-134307">representing racialized people as originators or carriers of disease</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people in lab coats, gloves and masks in a laboratory" src="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scientists at the Ndlovu Research Center in Elandsdoorn, South Africa, part of the Network for Genomic Surveillance in South Africa, which discovered the Omicron variant.</span>
<span class="attribution"><span class="source">(AP Photo/Jerome Delay)</span></span>
</figcaption>
</figure>
<p>In fact, the world has been served well by South Africa’s admirable investments in disease surveillance that turned up the newest COVID-19 threat.</p>
<p>There is no way to know where in the world the Omicron variant actually emerged, even though it was first detected in South Africa. South Africa has been down this road before with HIV, and had a <a href="https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/sars-cov-2-genomic-surveillance-update/">well-developed pandemic surveillance system that allowed it to detect this variant</a>. </p>
<h2>Investing in global health</h2>
<p>Canada has not historically invested in global health, infectious disease research or in vaccine innovation and manufacturing. </p>
<figure class="align-right ">
<img alt="A collage of world flags in the shape of a coronavirus" src="https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=755&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=755&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=755&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Regional manufacturing in Canada and abroad could enable quicker worldwide vaccine distribution.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>As a result, our country is <a href="https://www.cbc.ca/news/politics/domestic-vaccine-manufacturing-canada-1.6004427">a consumer of COVID-19 vaccines rather than a contributor to the global supply</a>. Despite having small manufacturing facilities that had capacity to contribute a few million doses, Canada lacked the political will to repurpose these facilities to assist with the global vaccine effort. </p>
<p>Regional manufacturing here and abroad could enable quicker worldwide vaccination. Vaccine manufacturers are already contracting local manufacturers in <a href="https://caravanmagazine.in/health/will-600-million-india-made-doses-of-johnson-and-johnson-vaccine-be-exported-to-rich-western-countries">India</a> and <a href="https://www.nytimes.com/2021/08/16/business/johnson-johnson-vaccine-africa-exported-europe.html">Africa</a> to make vaccine doses, but these doses are being shipped to the West instead of being available locally. Sharing knowledge and technology that can help countries in the Global South develop vaccines and vaccinate their own populations will have a greater long-term benefit for the world than trying to stop variants by closing borders.</p>
<p>As the crisis has worn on, we have <a href="https://www.ic.gc.ca/eic/site/151.nsf/eng/00006.html">invested in domestic manufacturing in Canada</a>, but it will take years to staff these plants with trained personnel, let alone create innovative vaccines that are more suitable for distribution to the Global South. </p>
<p>Rather than being consumers who contribute to inequitable vaccine distribution, we have an opportunity to weave vaccine equity into these investments. </p>
<p>We can commit to training people from countries where vaccines are needed most to equalize access to expertise. We can commit to global partnerships to distribute manufacturing equitably and we can be advocates for change. </p>
<p>As we rebuild and invest in vaccine development and production, we have an opportunity to become leaders in vaccine equity and reduce the burden of infectious disease now and in the future. </p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/173361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dawn ME Bowdish receives funding from the COVID-19 Immunity Task Force, the Canadian Institutes for Health Research and the National Sciences and Engineering Research Council. She is on the Board of Directors for the Lung Health Foundation and has occasionally consulted with vaccine manufacturers. </span></em></p><p class="fine-print"><em><span>Chandrima Chakraborty receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p>In places with low vaccination rates, COVID-19 has the chance to linger, and variants develop and travel. Without global vaccine equity, this entirely predictable pattern will repeat itself.Dawn ME Bowdish, Canada Research Chair in Aging & Immunity, McMaster UniversityChandrima Chakraborty, Professor, English and Cultural Studies; Director, Centre for Peace Studies, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1727632021-11-30T04:26:55Z2021-11-30T04:26:55ZWealthy nations starved the developing world of vaccines. Omicron shows the cost of this greed<figure><img src="https://images.theconversation.com/files/434628/original/file-20211130-25-1dor8ed.jpg?ixlib=rb-1.1.0&rect=141%2C14%2C2676%2C2256&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Themba Hadebe/AP</span></span></figcaption></figure><p>We don’t yet know how dangerous the new Omicron variant of SARS-CoV-2 will turn out to be. <a href="https://www.who.int/news/item/28-11-2021-update-on-omicron">Early evidence suggests it may be more transmissible</a> than other variants, and the <a href="https://www.theguardian.com/world/2021/nov/29/omicron-covid-variant-poses-very-high-global-risk-says-who">World Health Organization has raised concerns</a> about its potential to spark another global surge in infections.</p>
<p>If currently available vaccines continue to protect us from severe disease and death, which seems likely at this stage, vaccinated people in developed countries should be able to breathe a sigh of relief.</p>
<p>But with a yawning gap between vaccination rates in high- and low-income nations, Omicron could present a major problem for the world. It could cause a further wave of preventable disease and premature death in developing countries, and exacerbate poverty in parts of the world that are already struggling with the pandemic. </p>
<p>And unless governments take urgent action to correct these inequities, we risk the emergence of further variants, some of which may evade vaccines.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-best-hope-for-fairly-distributing-covid-19-vaccines-globally-is-at-risk-of-failing-heres-how-to-save-it-158779">The best hope for fairly distributing COVID-19 vaccines globally is at risk of failing. Here's how to save it</a>
</strong>
</em>
</p>
<hr>
<h2>Inequities in access to COVID-19 vaccines</h2>
<p>By the end of November, around 54.2% of the global population had received at least one COVID-19 vaccine dose. For low-income countries, however, the <a href="https://ourworldindata.org/covid-vaccinations#what-share-of-the-population-has-received-at-least-one-dose-of-the-covid-19-vaccine">rate was just 5.8%</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/434617/original/file-20211130-17-onhj01.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434617/original/file-20211130-17-onhj01.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434617/original/file-20211130-17-onhj01.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434617/original/file-20211130-17-onhj01.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434617/original/file-20211130-17-onhj01.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434617/original/file-20211130-17-onhj01.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434617/original/file-20211130-17-onhj01.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID vaccination doses, per capita.</span>
<span class="attribution"><span class="source">Our World in Data</span></span>
</figcaption>
</figure>
<p>The gap in vaccination coverage between high-income and upper-middle-income countries on one hand, and low-income countries on the other, is particularly stark.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/434619/original/file-20211130-17-j8dr4c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434619/original/file-20211130-17-j8dr4c.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434619/original/file-20211130-17-j8dr4c.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434619/original/file-20211130-17-j8dr4c.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434619/original/file-20211130-17-j8dr4c.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434619/original/file-20211130-17-j8dr4c.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434619/original/file-20211130-17-j8dr4c.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 vaccine doses administered per 100 people, by income group.</span>
<span class="attribution"><span class="source">Our World in Data</span></span>
</figcaption>
</figure>
<p>Vaccination rates in Africa are particularly concerning. About 40 or so countries still <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">have less than 10% of their populations</a> fully vaccinated, the vast majority of which are in Africa.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/434631/original/file-20211130-19-1q98puh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434631/original/file-20211130-19-1q98puh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434631/original/file-20211130-19-1q98puh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434631/original/file-20211130-19-1q98puh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434631/original/file-20211130-19-1q98puh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434631/original/file-20211130-19-1q98puh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434631/original/file-20211130-19-1q98puh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Comparisons between highly vaccinated nations and those at the bottom, most of which are in Africa.</span>
<span class="attribution"><span class="source">Our World in Data</span></span>
</figcaption>
</figure>
<p>Experts have warned about the inequitable distribution of COVID-19 vaccines since the beginning of the pandemic, so why is there still a problem?</p>
<h2>Failure of COVAX to realise its promise</h2>
<p>First, COVAX, the global program for purchasing and distributing COVID-19 vaccines, has <a href="https://theconversation.com/the-best-hope-for-fairly-distributing-covid-19-vaccines-globally-is-at-risk-of-failing-heres-how-to-save-it-158779">struggled to secure enough vaccine doses since its inception.</a>. </p>
<p>Nearly 100 low-income nations are relying on the program for vaccines. COVAX was initially aiming to deliver 2 billion doses by the end of 2021, enough to vaccinate only the most high-risk groups in developing countries. However, its delivery forecast was <a href="https://www.who.int/news/item/08-09-2021-joint-covax-statement-on-supply-forecast-for-2021-and-early-2022">wound back in September</a> to only 1.425 billion doses by the end of the year. </p>
<figure class="align-center ">
<img alt="A shipment of COVAX vaccines arrives in May in Madagascar." src="https://images.theconversation.com/files/434634/original/file-20211130-13-unsbg6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434634/original/file-20211130-13-unsbg6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434634/original/file-20211130-13-unsbg6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434634/original/file-20211130-13-unsbg6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434634/original/file-20211130-13-unsbg6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434634/original/file-20211130-13-unsbg6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434634/original/file-20211130-13-unsbg6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A shipment of COVAX vaccines arrives in Madagascar, which still remains one of the least-vaccinated countries in the world.</span>
<span class="attribution"><span class="source">Alexander Joe/AP</span></span>
</figcaption>
</figure>
<p>And by the end of November, <a href="https://www.unicef.org/supply/covid-19-vaccine-market-dashboard">less than 576 million doses</a> had actually been delivered.</p>
<p>This predictable failure is largely due to wealthy countries <a href="https://www.bmj.com/content/371/bmj.m4750">mopping up more than half of the first 7.5 billion vaccine doses</a> developed through pre-purchase agreements, leaving only crumbs for COVAX. </p>
<p>Chronic under-investment in COVAX (in terms of both doses and funds), and further hoarding of vaccine doses in wealthy nations for boosters, have continued to starve COVAX of supplies to distribute to those most in need.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-new-covid-variants-like-omicron-linked-to-low-vaccine-coverage-heres-what-the-science-says-170262">Are new COVID variants like Omicron linked to low vaccine coverage? Here's what the science says</a>
</strong>
</em>
</p>
<hr>
<h2>Failure to deliver on promised vaccine donations</h2>
<p>Wealthy countries have been shamed into making pledges to donate large numbers of doses to low- and middle-income countries. But few of these pledges have yet translated into vaccines in arms.</p>
<p>By October 25, more than 1.3 billion vaccine doses had been pledged, but <a href="https://healthpolicy-watch.news/less-than-10-of-covax-donation/">only around 10% had been delivered</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/434623/original/file-20211130-25-j5tl48.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434623/original/file-20211130-25-j5tl48.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434623/original/file-20211130-25-j5tl48.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434623/original/file-20211130-25-j5tl48.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434623/original/file-20211130-25-j5tl48.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434623/original/file-20211130-25-j5tl48.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434623/original/file-20211130-25-j5tl48.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 vaccines donated to COVAX.</span>
<span class="attribution"><span class="source">Our World in Data</span></span>
</figcaption>
</figure>
<p>Meanwhile, many high-income countries have ignored <a href="https://time.com/6089974/who-moratorium-covid-19-vaccine-boosters/">pleas from the WHO</a> to hold off on providing booster vaccinations until the rest of the world catches up. Even after boosters have been administered, Médecins Sans Frontières estimates that ten high-income countries will be sitting on <a href="https://msfaccess.org/covid-19-vaccine-redistribution-save-lives-now">more than 870 million excess doses</a> by the end of the year. </p>
<p>Take Australia as one example. It has pledged 60 million doses for developing countries in the Indo-Pacific region, but so far, <a href="https://indopacifichealthsecurity.dfat.gov.au/vaccine-access">less than 9.3 million have been delivered</a>. None of these doses are slated for equitable distribution through COVAX, however, and none are currently committed for Africa.</p>
<p>Meanwhile, the Australian government has invested more than A$8 billion (US$5.7 billion) in <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/about-rollout/vaccine-agreements">pre-purchase agreements for 280.8 million vaccine doses</a> for Australians. This is equivalent to more than 10 doses per person.</p>
<h2>Failure to agree on temporary changes to trade rules</h2>
<p>Some wealthy countries have also continued to oppose a proposal to temporarily suspend trade rules that protect the monopolies of pharmaceutical companies on COVID-19 health products and technologies. </p>
<p>Initially <a href="https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W669.pdf&Open=True">proposed by India and South Africa</a> in October 2020, the so-called TRIPS waiver would enable companies around the world to freely produce COVID-19 products and technologies without fear of litigation over possible infringements of intellectual property rights.</p>
<p>It is now co-sponsored by 63 countries and supported by well over <a href="https://www.devex.com/news/where-are-we-on-covid-19-after-a-year-of-trips-waiver-negotiations-101795">100 of the World Trade Organization’s 164 member states</a>. The US signalled its support for a waiver in May (limited to vaccines), but it hasn’t formally co-sponsored the proposal. The European Union, the UK and Switzerland continue to oppose it, with Germany a particularly staunch opponent. </p>
<figure class="align-center ">
<img alt="A BioNTech vaccine production facility in Germany." src="https://images.theconversation.com/files/434644/original/file-20211130-20-1f05pby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434644/original/file-20211130-20-1f05pby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434644/original/file-20211130-20-1f05pby.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434644/original/file-20211130-20-1f05pby.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434644/original/file-20211130-20-1f05pby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434644/original/file-20211130-20-1f05pby.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434644/original/file-20211130-20-1f05pby.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A BioNTech vaccine production facility in Marburg, Germany.</span>
<span class="attribution"><span class="source">Michael Probst/AP</span></span>
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</figure>
<p>The TRIPS waiver, if adopted in <a href="https://docs.wto.org/dol2fe/Pages/SS/directdoc.aspx?filename=q:/IP/C/W669R1.pdf&Open=True">the form sponsored by the 63 countries</a>, would cover all health products and technologies needed for preventing, treating and containing COVID-19, including vaccines, treatments, diagnostic tests, medical devices and personal protective equipment. </p>
<p>It would waive rules in the WTO’s <a href="https://www.wto.org/english/docs_e/legal_e/27-trips_01_e.htm">Agreement on Trade-Related Aspects of Intellectual Property Rights</a> (TRIPS) that apply to patents, undisclosed information (such as information submitted to regulatory agencies or protected as trade secrets), copyright and industrial designs. And it would last for at least three years from the date the waiver is adopted, and then be reviewed annually.</p>
<p>However, more than a year after the waiver was proposed, discussions at the WTO remain deadlocked.</p>
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Read more:
<a href="https://theconversation.com/us-support-for-waiving-covid-vaccine-ip-is-a-huge-step-160443">US support for waiving COVID vaccine IP is a huge step</a>
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<p>The EU insists it will be sufficient to tweak existing provisions in the TRIPS Agreement that allow for compulsory licensing - exploitation of the subject matter of a patent without the permission of the patent holder. This, however, doesn’t cover undisclosed information, which is needed for manufacturing vaccines.</p>
<p>Many countries, including the UK, EU, China and Australia, are now <a href="https://www.hketogeneva.gov.hk/doc/WT_GC_W_823_Rev.2.pdf">supporting a separate proposal</a> at the WTO which addresses other trade-related issues, such as export restrictions and customs procedures. However, it fails to lift the intellectual property rights that maintain monopolies on COVID-19 products. </p>
<p>To delay matters even further, the emergence of the Omicron variant has resulted in postponement of the WTO ministerial council meeting this week, where these proposals were to be discussed. While debate will continue in the TRIPS Council in December, momentum to reach a decision in the near-term may have been lost.</p>
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<h2>Urgent action is needed</h2>
<p>Wealthy countries have hoarded vaccines, starved COVAX of funds and doses, released promised donations at a slow dribble, and stalled agreement on a global agreement to lift barriers to wider manufacturing of vaccines in the developing world.</p>
<p>We must do better. The Omicron variant illustrates that clearly the world can’t afford to wait any longer.</p><img src="https://counter.theconversation.com/content/172763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Gleeson has received funding in the past from the Australian Research Council. She has received funding from various national and international non-government organisations to attend speaking engagements related to trade agreements and health. She has represented the Public Health Association of Australia on matters related to trade agreements and public health</span></em></p>The new variant is a warning: unless we take urgent action to correct global vaccine inequities, we risk the emergence of further variants, some of which may evade vaccines.Deborah Gleeson, Associate Professor in Public Health, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1715032021-11-14T06:56:02Z2021-11-14T06:56:02ZThe number that matters in the COVID pandemic is a relative one: vaccine inequity<figure><img src="https://images.theconversation.com/files/431525/original/file-20211111-13-75raot.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When some stockpile valuable resources to the detriment of others, everyone loses</span> <span class="attribution"><span class="source">Emmanuel Osodi/Majority World/Universal Images Group via Getty Images</span></span></figcaption></figure><p>Numbers are extremely useful for succinctly conveying important information. Of course, all quantification, including statistics, has its limitations but it also has valuable advantages. The key is to make sure that the most relevant numbers are being used and prioritised appropriately. </p>
<p>It is straightforward to obtain statistics about the percentage of people vaccinated in any particular country or region as well as the number of deaths or tests there have been. US president Joe Biden reports being proud at having donated <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/09/09/remarks-by-president-biden-on-fighting-the-covid-19-pandemic-3/">nearly 140 million vaccines to over 90 countries</a>.</p>
<p>What matters most, though, is not the absolute number of vaccines that have been distributed or how countries are positioned on the global vaccination league ladder. It is the number of vaccines relative to need that have been made available and the number of vaccinations in the most vaccinated country relative to the number of vaccinations in the least vaccinated country. </p>
<p>The COVID war will be won or lost on the equity battlefield. And equity is a relative, not an absolute, matter. </p>
<p>Income inequity is a great illustration of the importance of relativity when inequity is being considered. Income inequity, for example, is not about the total wealth of a nation, but how that wealth is distributed. It is about the gap between those with the most and those with the least. The <a href="https://corporatefinanceinstitute.com/resources/knowledge/economics/gini-coefficient/">Gini coefficient</a> is a metric from economics that represents the income inequality in a nation or region. Gini ranges from 0 (perfect equality; everyone has the same income) to 1 (perfect inequality; one person has all the income). Like any metric, the Gini coefficient <a href="https://www.palgrave.com/gp/book/9783030680527">has its limitations</a>. But it’s able to provide some information about the haves and the have-nots with regard to income in a particular jurisdiction.</p>
<p>As with income inequity, it is the gap that needs to be the primary focus of the COVID war. It is of very little comfort, for example, that Canada has a <a href="https://ourworldindata.org/covid-cases">total vaccination rate</a> per 100 people of 155.67 while Tanzania has a rate of 1.63. Nobody will be safe from COVID while <a href="https://www.unicef.org/coronavirus/donate-doses-now?gclid=Cj0KCQiA-K2MBhC-ARIsAMtLKRtxs1u0LPmay1ADdStuqgsXyKT1qm0E4NWzqeTig_0EldoDvIGWxSQaAs4cEALw_wcB">vaccine inequity gaps</a> of this magnitude exist. Where vaccine rates are low, the virus can continue to spread and proliferate. This increases the risk of more deadly and contagious variants appearing.</p>
<p>This is why the world needs something like a Gini coefficient to measure vaccine inequity. It can help identify the best places to direct efforts for the most prudent use of limited resources to ensure the global community has the vaccination coverage it needs to control COVID. </p>
<h2>Illustrating the gap</h2>
<p>In September 2021, I collected data on the <a href="https://ourworldindata.org/covid-cases">total vaccinations per 100 people</a> for <a href="https://www.worldometers.info/geography/how-many-countries-in-europe/#:%7E:text=There%20are%2044%20countries%20in,according%20to%20the%20United%20Nations.">10 of the 44 countries of Europe</a> and <a href="https://www.worldometers.info/geography/how-many-countries-in-africa/">12 of the 54 countries of Africa</a>. I wanted to illustrate the value that a coefficient quantifying the gap might bring to our global deliberations. The countries were selected randomly. The slight difference in the number of countries selected was to keep the proportions approximately the same.</p>
<p>The data were illuminating and instructive. </p>
<p>The range for the European countries was from 32.49 total vaccinations per 100 people (Bosnia and Herzegovina) to 149.46 total vaccinations per 100 people (Spain). The median for these European representatives was 78.585 total vaccinations per 100 people. </p>
<p>For Africa, the range was from 0.57 total vaccinations per 100 people (Tanzania) to 150.04 total vaccinations per 100 people (Seychelles). The Seychelles is a spectacular outlier. The next highest African country had 26.34 total vaccinations per 100 people (Equatorial Guinea). </p>
<p>There are, no doubt, more sophisticated ways of quantifying a global vaccine disparity with a single metric. But it is a metric such as this that needs to be front and centre of the COVID battle strategy. Other metrics will then be helpful in a supplementary way, to identify where resources need to be concentrated to shift the gap metric in the direction we want.</p>
<p>The <a href="https://www.euro.who.int/en/health-topics/health-emergencies/pages/news/news/2021/05/q-and-a-covid-19-variants-and-what-they-mean-for-countries-and-individuals">effectiveness of vaccination</a> as a public health strategy will continue to be compromised while large numbers of the global community remain unvaccinated. The WHO strongly recommends that people “<a href="https://www.euro.who.int/en/health-topics/health-emergencies/pages/news/news/2021/05/q-and-a-covid-19-variants-and-what-they-mean-for-countries-and-individuals">take up their offer of a vaccine when their turn comes</a>”. Unfortunately, too few people’s turns are coming up fast enough. A ponderous approach to organising and arranging vaccine distribution is no match for SARS-CoV-2 and its rapidly expanding band of variants.</p>
<p>So, while the citizens of countries like Spain and the Seychelles might feel some comfort about the vaccination rates in their countries, it is a comfort of exquisite fragility while the current enormous disparity exists. A gap metric that represents the disparity might provide a more sobering message that could add extra incentive to overcome global inequity inertia.</p>
<p>A metric such as this might not be particularly complex. In <a href="https://psycnet.apa.org/record/2013-45032-006">previous research</a>, I created an “efficiency coefficient” in psychotherapy research to complement the voluminous effectiveness metrification that occurs. The efficiency coefficient was simply the ratio of effect size to average number of sessions. In principle, it should be relatively straightforward to create an analogue of the Gini Coefficient that quantifies vaccine inequity from 0 (every region or country has their entire eligible population vaccinated) to 1 (1 region or country has their entire eligible population vaccinated and every other country or region has none of their eligible population vaccinated). </p>
<p>The most important war might not be with COVID at all. Perhaps the greatest conflict is coming to terms with the fact that when some stockpile valuable resources to the detriment of others, everyone loses. The number to monitor is the vaccine inequity gap.</p><img src="https://counter.theconversation.com/content/171503/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Timothy A. Carey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The effectiveness of vaccination as a public health strategy will continue to be compromised while large numbers of the global community remain unvaccinated.Timothy A. Carey, Director: Institute of Global Health Equity Research, Andrew Weiss Chair of Research in Global Health, University of Global Health EquityLicensed as Creative Commons – attribution, no derivatives.