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Published on 28 March 2022

Why is it that nearly everyone who needs or wants a Covid-19 vaccine has had one if they live in a rich country but only 15% of those in low-income countries have had a first dose?

Christian Aid and our friends in the People’s Vaccine Alliance, today publish a Covid vaccine equity index which shows that no big, rich country is doing nearly enough to promote global vaccine equity. Governments of lower income countries, the World Health Organization and numerous civil society organisations have called for global vaccine equity since the development of Covid-19 vaccines. Yet, despite repeating the mantra of ‘no-one is safe until everyone is safe’, governments in rich countries have chosen not only to prioritise their own populations but to actively undermine the prospects of internationally agreed targets to vaccinate 70% of adults in all countries by September 2022.

Our Covid vaccine inequality index ranks countries in the G20 in three areas: how much these governments are financing vaccines globally; how far their own procurement of vaccines has helped or hindered global distribution of vaccine doses; and whether they are supportive of fundamental trade and manufacturing policies which could unlock much greater and fairer supply of vaccines globally. Working with colleagues at the ODI, we identified relevant variables in these three areas, and used a range of publicly available data sources to develop a database and track how much each G20 country has done. Drawing on this data, the CA and PVA  index brings together the most important factors which can make or break global vaccine equity.

We decided to ascribe double weight in our index to the last pillar since we think that global policy changes such as a TRIPS waiver on vaccine production and political support to require pharmaceutical companies to share their recipes with vaccine manufacturers would have game-changing significance, particularly for poorer countries. From its inception, the People’s Vaccine Alliance has prioritized campaigning for a waiver on certain intellectual property rules at the World Trade Organization as the most key policy change to unblock vaccine production, allowing many more qualified vaccine producers to manufacture vaccines without fear of legal repercussions. Recent news of a ‘breakthrough compromise’ on a possible change in WTO rules should be viewed extremely cautiously – even negatively – by vaccine equity advocates.

Of the G20 club of large economies, South Africa is at the top of a not very impressive class: their scores are barely 70% of what we might expect a fully committed government to do to support vaccine equity. Only five countries score above 50 percent; thirteen cluster between 37 and 49 percent, with South Korea a clear laggard on just 30% of the potential of an archetypal globally-minded government. These results show that there is much for each G20 government to do individually – and that if they coordinated properly – they could collectively spur significant changes globally. Notably, the USA is the only high-income country scoring above 50 percent, given some benefit of the doubt over its purported support for the TRIPS waiver proposed by South Africa and India.

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vaccine index score Credit: Christian Aid
vaccine index score

Indeed, some areas require international cooperation to make significant progress. The most obvious of these is the need for an emergency TRIPS waiver on vaccines so that the intellectual property can be used by many companies and manufacturers to vastly increase the speed, number and spread of vaccines around the world. The world has wasted more than a year living on a COVAX chimera that too many hoped would solve problems inherent in the selfish actions of rich countries.  

It is no accident that rich countries elbowed their way to the front of the vaccine order queue, placed far more orders than they would ever need, and insisted that their orders should be prioritized over countries relying on COVAX. This trend persists despite most rich countries attaining levels of vaccine coverage beyond hopes and expectations. In fact, millions of vaccines have been wasted as rich countries have hoarded their supplies, only agreeing to share a small fraction of their surplus – and doing so in such a piecemeal way that countries receiving these leftovers have seldom had the opportunity to properly plan to use doses often nearing expiry.

We account for these behaviour patterns in the index by penalizing countries which ordered vastly more vaccines than they would need, and for hoarding the surplus. Countries which have delivered on promises to redistribute surplus doses are rewarded in line on a proportionate basis. But whilst headlines about vaccine donations have garnered headlines, these actions have only led to a modest redistribution of vaccine doses.

Many countries – both high and middle income ones in the G20 – should have contributed more financial support to the WHO-led ACT Accelerator programme which aimed to provide vaccines, tests and treatments for Covid-19 to countries around the world. Even with the vaccine part of this initiative (COVAX) almost fully funded, huge vaccine inequity remains. This experience provides a grim portend of emerging disparities in treatments for those with Covid-19; once again rich countries are using their financial muscle to ensure their populations can have the latest medicines whilst not contributing anything like their fair share to global funds to ensure the same for those in poorer countries.   

As many people across G20 countries start thinking of Covid-19 in the past tense, the stark reality of vaccine inequality should jolt us from this apparently comforting thought. It is in all our interests to ensure that Covid-19 vaccines are available now for everyone who needs one. G20 governments need to lead the agreement of a TRIPS waiver at the World Trade Organization, and they need to support technology transfer so vaccines can be produced quickly and easily in more places. They need to see their own vaccine plans in the global context and step up their funding to reflect the continuing impacts of the pandemic – particularly in countries where vaccine rates are low. We may have ‘long vaccine inequity’ symptoms, hoping that problems we’ve known about somehow right themselves, but the reality is that our governments are still not responding adequately to what is a crisis for too many people.

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The People's Vaccine

The People’s Vaccine Alliance is a coalition of over 90 organisations working together to end vaccine apartheid.