Vaccine Inequality & International Vaccine Diplomacy; What is The Solution?

Coronavirus Covid-19 Disease Control Emerging Infectious Diseases Global Health Global Pandemic immigration and government immunization Public health Policy SARS-CoV-2 SARS-CoV-2 Vaccine SARS-CoV-2 Variants Vaccine Inequality

In the past months with Covid-19 vaccines available in many countries, implementation programs are rolling out across the globe. The effectiveness of such programs is very important in curbing further spread of the pandemic. Vaccines will be key in reducing unnecessary loss of life and ushering us into a new normal way of life. In the US though, those who were most affected by the pandemic are lagging behind in access to vaccines. The infographic below from a publication by the Kaiser Family Foundation illustrates this disparity clearly. In several states across the nation the proportion of African Americans vaccinated fall far below their representation in the population and proportion of Covid deaths. At this time some are asking the question “vaccine inequality in the US and globally; what is the solution?”

Vaccine Inequality by Race and State in The US

For most states in the US African Americans lag behind whites in vaccine access. Source: Kaiser Family Foundation

The causes of this observed disparity in vaccine distribution by race and ethnicities in the US are difficult to determine with any certainty. As a physician with much experience with minority populations I believe one key problem may lie in information asymmetry. Health literacy, knowledge about vaccine sites, eligibility and prioritization as well as some of the mechanisms involved in obtaining appointments are unequally distributed. Our underprivileged groups may not have the time or resources to seek out these resources and take advantage of them. To address this problem many are suggesting mobile vaccine delivery in select under-privileged settings.

Global Vaccine Inequality; Is Covax The Solution?

Across the world the usual north south divide in access to resources is also evident once more. Unfortunately, in this case the situation may be more complex. Even countries like Canada are lagging behind because they have to rely on other countries for their supplies. Canada had tried to avoid relying on US sources on account of concerns with the Trump administration’s America first stance. Unfortunately their sources in Europe are struggling with meeting demand from EU nations and as such Canada‚Äôs supplies have become low priority.

When, public health experts look at these problems they see potential for disastrous consequences. Over the past year the value of coordinated and concerted efforts to address this global pandemic was clear. Unfortunately, what we all know must happen to keep us all safe does not always happen. The need for global diplomacy and equity in vaccine deployment cannot be over emphasized for both economic and epidemiological reasons. So, how do we tackle this situation? Can vaccine inequality be addressed with diplomacy, and are we ready for that? The Trump administration did not join the COVID-19 Vaccine Global Access (COVAX) Facility. This group formed under the World Health Organization (WHO) in June 2020 under GAVI was funded by the Bill and Melinda Gates Foundation to ensure equity in Covid-19 vaccine access. At this time the Biden administration has decided to join, reversing this Trump era decision.

A Video On The Covax Ideal of Global Vaccine Equity

The US has also agreed to send 4 million doses of Astra-Zeneca vaccines to Canada and Mexico in a loan deal. Even in the US with vast stockpiles and easy access to supplies many are struggling to find appointments. In many countries in Africa vaccines have only started arriving. Some of these nations do not have the capacity and finances to develop vaccination programs to distribute these vaccines. In many of these countries the implementation hurdle may result in many low resourced outlying communities remaining unvaccinated.

Vaccine Rollout in Africa

Countries like Tanzania and Madagascar have said they have no plans to acquire vaccines, and Burundi says that at the moment, they don’t need vaccines. Source: WHO, GAVI and BBC Research

Even in the US the one significant problem by far in the vaccine implementation is information management. This has been compounded by many rapid changes in how we receive information in the past 2 decades. The US is using a state level approach in vaccine deployment with different states using different guidelines for prioritization. The shift from a monolithic source of information to multiple channels and platforms to spread and share the information maybe a barrier in the US.

In lower income nations the age old resource problems may go beyond just vaccine supplies which could potentially be addressed by Covax. At this time though there are many countries in Africa that are yet to receive vaccine supplies. Some like Tanzania and Madagascar have said they have no plans to get vaccines. For Tanzania, hopefully this stance may change with the passing of President John Magufuli who publicly denied there was a pandemic, and is believed by many to have died from Covid-19. The efficiency of Covid-19 transmission and the rapid evolution of new strains including some that may have signs of reduced susceptibility to current vaccines makes rapid control very important.

Vaccine Products From China, Russia and Other Sources

Russia and China have also made promises to provide vaccines to some African countries but so far supplies have been meagre or are yet to emerge. India, the source of most of Covax supplies was recently reported to be halting international supplies in favor of local needs. At this time we can only hope that better allocation of vaccine supplies will allow a more effective implementation. In the absence of such effective coordination overall control of SARS-CoV-2 spread will be more costly and may take longer than we think.

Right from day 1, epidemiologist had stressed the importance of support and collaboration to address the public health issues related to the pandemic. The development of Covid-19 vaccines in record time was due to global collaboration. The current vaccines though adequate and effective have intrinsic implementation barriers for some nations with low capacity. The WHO, has mechanisms for such nations to use loan assistance to address such challenges. Technological solutions by way of vaccines that bypass implementation barriers such as oral vaccines are possible, and there are some in the pipeline. At this time though, we hope all nations take the resources available to address the loss of life and stabilize their economy. There are various solutions to these problems, but by far the most important ingredient is international co-operation.

By Dr. Leonard Sowah an internal medicine physician in Baltimore, Maryland


A physician providing primary medical care to patients across the lifespan