According to Duke University’s Global Health Innovation Center, high-income countries have purchased more than half of the Covid-19 vaccine supply to date, while low-income countries have purchased only 9%. This is why a country like the United States is on the verge of vaccinating half of its population with a single dose, whereas the rate in Guinea is less than 1% and showing no signs of improvement.
If these glaring inequities in vaccine access persist, it will take at least two years for the world’s poorest countries to immunize the majority of their populations, as they cannot afford to compete for early doses of vaccines. And we are on track for a long period in which people in rich countries enjoy the benefits and safety of being fully immunized, while people in poorer countries continue to become ill and die from the coronavirus.
“That’s not just unconscionable, but it also is very much against the interests of high-income countries,” Georgetown global health law professor Lawrence Gostin said. With the virus still circulating and variants spreading around the world, outbreaks in the poorest countries will pose a threat to the rest of the world.
It’s no coincidence that many of the world’s first Covid-19 vaccines — from companies like Pfizer, AstraZeneca, and Moderna — were developed and distributed in high-income countries. As the pandemic spread last year, wealthier nations, including the United States, the United Kingdom, and the European Union, began making deals with pharmaceutical companies developing Covid-19 vaccines, which also happened to be headquartered within their borders.
Governments essentially gave the companies billions of dollars to accelerate research and development in exchange for priority access to vaccines if they proved effective. However, the agreements pushed poorer countries further down the access line because they lacked the resources to pre-purchase millions of doses of vaccines that might not even be approved for market.
The vaccine hoarding has occurred concurrently with Covax, an unprecedented multilateral effort to support the development and equitable distribution of 2 billion doses of Covid-19 vaccines to the world’s poorest countries by the end of 2021.
The initiative is divided into two parts: a purchasing pool for high-income countries and a fundraising campaign for low-income countries. Countries that join gain access to any vaccines approved in Covax’s portfolio by promising to buy a certain number of vaccine doses from manufacturers, while also creating a global market for the shots and driving down prices. Covax has only delivered about one in five of the doses that were expected by the end of May
More than 190 countries, including wealthy ones, have signed on. “Covax was attempting to make a reality — they appealed to the better angels of all countries,” said Saad Omer, director of Yale Institute for Global Health.
But the bilateral deals took a lot of power away from Covax. Rich countries “want to have it both ways,” Gostin said. “They join Covax so they could proclaim to be good global citizens, and at the same time rob Covax of its lifeblood, which is vaccine doses.”
As a result, Covax has only delivered about one-fifth of the doses that were expected by the end of May, according to Duke. Still, it’s not a given that it’ll take years to vaccinate the world from Covid-19. There are ways to speed up the process.
Rich countries, such as the United States and the United Kingdom, could simply begin investing more in assisting poorer countries in responding to the crisis. Omer advocated for a program similar to PEPFAR, America’s global health program aimed at combating AIDS around the world. It was established in 2003 by George W. Bush and has so far contributed $90 billion to the fight against AIDS.
