• Dr. Anna van Poucke, Leadership |

Last week, after participating in a number of World Economic Forum Davos Agenda virtual sessions, there was one quote, used several times, that to me brought home the situation in which we find ourselves: no one is safe, until we are all safe’ . Hearing that quote and listening to the “Vaccines for the world” session panelists, it reinforced what I already knew: vaccines need to be accessible and equitable to everyone to get the world on the quickest path to recovery. We cannot ignore the underserved communities within our own domestic borders, nor can high-income countries (HICs) be ‘vaccine nationalists’, ignoring the plight of low-and middle-income countries (LMICs) – on health, economic, and moral grounds.

COVID-19: The great divide

Early on, there was disproportionate COVID-19 impact on disadvantaged communities domestically in HICs – with higher rates of incidence, hospitalization, and mortality (in the US to be observed at 2.3 and 2.5 times higher for Black and Latinx people, respectively)1  − compounded by existing social inequities, including living in more confined housing conditions (enabling transmission), higher participation in ‘essential services’ (increasing exposure risk), and having higher prevalence of comorbidities which result in worse outcomes with COVID-19. HICs still struggle to provide vaccines to these vulnerable communities with traditional barriers of access and mistrust preventing better distribution and uptake.

In LMICs, where wealth, healthcare investment, and infrastructure are less available – a new health gap has emerged. The comparison of only 25 doses administered in one low-income country by January 18 versus the 39 million in HICs paints a stunning picture2. While vaccines are more broadly distributed to populations in HICs, frontline workers and vulnerable populations in LMICs continue to risk exposure and do not benefit from the potential life-saving vaccines.

Making the case: Why vaccinating the world is critical

The health and wealth case

With their willingness and ability to pay top dollar to secure access, current strategies of HICs have focused on accumulating vaccines to cover their populations. A recent study found more than half (51 percent) of pre-ordered COVID-19 vaccines will go to high-income countries, despite the fact those countries and territories only represent 14 percent of the world’s population.3

COVAX, the global initiative to ensure equitable access to COVID-19 vaccines with 190 participating economies, expects to make available 1.3 billion doses to LMICs by the end of 20214; but other estimates suggest vaccination efforts in low income countries may continue into 20245. The vaccine gap will create tensions as economies, trade, and travel will be limited by the ‘vaccinated’ and ‘unvaccinated’. A study from a leading philanthropic foundation found that in just 10 countries, the economic benefits of a globally equitable vaccine solution would create paybacks of $153 billion USD by 2021 (and $466 billion by 2025); with the modest ask of $38 billion for the COVAX facility, the return on investment is evident, and yet, there remains a funding gap6. By vaccinating the world, we can return to normalcy for economy, open borders, and reduce the risk of COVID-19 resurgence.

The humanitarian case

The case here seems intuitive at the human-level: helping thy neighbor makes sense from a moralistic perspective. In many situations we are powerless to influence outcomes or change the course of history, but with multiple vaccines developed and approved – we do have the power to make the right choice through our vaccine allocations. Beyond the humanitarian case, an equitable vaccination approach benefits the world’s progress and geopolitical stability – by allowing for the world to overcome the crisis together, putting us quickly back on the path to recovery. Further, we can address these moral dilemmas by doing as one of the Davos Agenda session panelists suggested in ‘following the epidemiology’, which can balance vaccine scarcity with highest-impact, by focusing on areas of most need – including hotspots of transmission and high-risk areas such as cities – where density increases risk of transmission.

How can we level the playing field?

The case above makes obvious as to why vaccine access and equity helps everyone – and as we’ve seen with all healthcare challenges, it takes investment, cooperation, and leadership to make it happen. We need to be courageous and change the course of things if we want to be successful in leveling the playing field:

  • Activating local capacity: The private sector and governments can work together by empowering production closer-to-home – resulting in a global supply chain with greater resiliency, deliveries that can be made more rapidly (less waiting in the global queue for vaccines), and the possibility to reduce costs. Capacity can also be driven at the knowledge-level by sharing best practices in vaccine delivery, the adoption and deployment of technology, and greater cooperation from production, to administration, to last-mile delivery. Global coordination is happening through COVAX task forces that have been mobilized to provide rapid guidance on common issues arising from participating jurisdictions, allowing vaccine programs to be more agile in their approach to deliver greater efficiency, more rapid deployment, and with less waste in the process.
  • Supporting funding and inventory access: If vaccine equity is a true imperative of HICs, we should put our money where our mouths are. While most developed nations have made investments into COVAX, there is a funding gap of $27 billion USD that remains7, putting the program in peril. As I’ve learned from anything in healthcare – whether it be a hospital turnaround or a health system transformation: investment is required to make things happen, for infrastructure to be setup, and for outcomes to be delivered. We have to invest to be successful. During the Davos Agenda session, it was encouraging to hear the private sector step up to the challenge where one of the corporate representatives, offered theirs and other partners’ help with supply, delivery, logistics, and other support; it could work − we’ve seen much success in the public private-partnership model in bringing new capacity, investment, and talents together in healthcare.
  • Investing in trust: ‘Vaccine hesitancy’ is apparent as underserved communities have a tenuous relationship with healthcare access, equity, and communication. COVID vaccines can be an inflection point for resetting that trust – taking an urgent issue, with the right communications strategy, and by linking them into our healthcare systems, we can build trust and change the future trajectory of these relationships. As suggested in the session, by engaging and activating the community - ranging from religious leaders, to social media influencers, to respected medical professionals – trust can be established rapidly and communities will feel more engaged, listened to, and empowered to make decisions rooted in trust.

As one Davos Agenda panelist put it, “history is being written for approaches in the future,” you begin to realize there’s a silver lining to the crisis − that despite people in many places being forced into social distancing, living in bubbles, and keeping 6 feet apart - a global pandemic like COVID-19 has made us more connected than ever. We need to learn from the partnerships, calls-to-action, and progress that we’ve made. COVID-19 vaccines have been celebrated as the greatest achievement in modern-era medicine; but more importantly – can we make vaccine access and equity the greatest triumph, a modern-era marriage of health and wealth? We have to give it our best shot.


1 APM Research Lab. (2021, January 7). The color of coronavirus: covid-19 deaths by race and ethnicity in the U.S. https://www.apmresearchlab.org/covid/deaths-by-race

2 Soy, A. (2021, January 22). Africa’s long wait for the COVID-19 Vaccine. BBC News. https://www.bbc.com/news/world-africa- 55751714

3 So, A. and Woo, J. (2020). Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis. BMJ, 371. doi: https://doi.org/10.1136/bmj.m4750

4 World Health Organization. (2021, January 22). COVAX announces new agreement, plans for first deliveries. https://www.who.int/news/item/22-01-2021-covax-announces-new-agreement-plans-for-first-deliveries

5 Duke Global Health Institute. (2020, November 9). Will low income countries be left behind when COVID-19 vaccines arrive? https://globalhealth.duke.edu/news/will-low-income-countries-be-left-behind-when-covid-19-vaccines-arrive

6 Elks, S. (2020, December 3). Ensuring global COVID-19 vaccine access seen worth billions to rich nations. Reuters. https://www.reuters.com/article/health-coronavirus-vaccine-gdp/ ensuring-global-covid-19-vaccine-access-seen-worth-billions-to-rich-nations-idUSL8N2IJ3AR

7 Farge, E. (2021, January 22). U.S. alone won't fill COVAX funding gap, lead official says. Reuters. https://financialpost.com/pmn/business-pmn/u-s-alone-wont-fill-covax-funding-gap-lead-official-says

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