The Covid-19 pandemic has highlighted the importance of managing infection outbreaks as a global community. Many great advancements have been achieved by countries together, not least of which is a range of vaccines with high efficacy to prevent severe disease and death.
But the sheer extent of the inequity in countries’ access to vaccine lies sits in stark contrast to these achievements, and will likely be looked upon as the single largest failure of the Covid-19 pandemic response. This was the clear message from United Nations secretary general António Guterres, who told the UN General Assembly this week: “We passed the science test, but we get an F in ethics.”
Ireland is one of the lucky ones. It has achieved an impressive level of vaccination coverage (90 per cent of the eligible population). However, only 30 per cent of the world’s 7.9 billion people are fully vaccinated. This figure falls to just 3 per cent when you consider the 648 million people living in low-income countries.
Leaving a large proportion of the world's population unvaccinated [...] creates ideal circumstances for the generation of viral mutations
The World Health Organisation (WHO) has set a global vaccination targets, starting with 10 per cent coverage by the end of September 2021. This is the level required to protect the most vulnerable people in populations – these groups that we worried about in Ireland at the start of the pandemic such as the elderly. In low-income countries alone, achieving even this first critical target requires the administration of about 52 million vaccine courses.
In Ireland we have learned that delays can markedly alter the trajectory of virus case numbers and deaths. Those of us working in infection specialities have seen this before. Hesitancy in the rollout of HIV treatment to Africa in the early 2000s led to millions of extra infections and associated deaths, the legacy of which we are still dealing with today. History is repeating itself with Covid-19, where we now have an intervention that is extremely effective at preventing death but is not accessible in low-income countries.
Healthcare workers – already a scarce resource in the Global South – are risking their own health going to work each day, in the knowledge that their colleagues in richer countries have long been afforded the protection of a vaccine.
Leaving a large proportion of the world’s population unvaccinated, with ensuing viral replication and transmission, creates ideal circumstances for the generation of viral mutations. In a world which is increasingly interconnected economically, politically and socially, allowing transmissions and deaths to continue exacerbates the impact of the global pandemic for everyone.
The opportunity to access vaccines has been unequal for countries in the Global South from the outset. Those wanting to buy vaccines were outcompeted by large Global North powers. Covax was set up with the aim of supporting equitable vaccine distribution, but donations from participating nations (who may have received vaccines from Covax themselves) have fallen markedly short of their pledges.
Vaccine hoarding by wealthy nations is part of the problem; the British Medical Journal reported in August that just 10 countries could have an accumulated surplus of 3.8 billion doses of Covid-19 vaccines by the end of the year. Many countries have already begun to roll out booster doses to the general population, often with a perspective that neglects international priorities.
Medical practitioners know that choosing not to act is a conscious decision. We call upon the Government to choose to act in this global health crisis.
Current levels of donations will not provide the number of vaccines needed and will serve only to deepen a power imbalance between rich and poor countries built on paternalism and dependence; the foundations of colonialism.
It is essential that booster programmes take into consideration the risk of diverting vaccines from global populations who have not already been vaccinated
Strict international intellectual property rules are currently blocking vaccine production. The Trips waiver (trade-related aspects of intellectual property rights) is a temporary suspension of intellectual property designed for use in situations such as this, where global security is threatened and is already being backed by many countries including the United States. As highlighted in Nature in March: “Arguably the strongest argument for a temporary waiver is that patents were never designed for use during global emergencies such as wars or pandemics.”
Ireland has a reputation for upholding human rights globally and showing solidarity with the world’s most vulnerable people. We ask the Government to listen to the experts and follow unequivocal advice from WHO.
We ask it to support the Trips waiver at the World Trade Organisation summit in November, and to endorse the Covid-19 Technology Access Pool, to facilitate the sharing of know-how by pharmaceutical companies.
We urge it to ensure that future vaccine purchases for Irish people are rational and in line with what is needed, so that they do not go to waste. Finally, it is essential that booster programmes take into consideration the risk of diverting vaccines from global populations who have not already been vaccinated.
One of a doctor’s most important jobs is advocating for patients, applying our responsibility to prevent harm without prejudice. We appeal to the Government to use its international high standing to show leadership on facilitating access to vaccines for all.
Dr Christine Kelly is an infectious diseases doctor, clinical fellow in public health virology and founding member of Doctors for Vaccine Equity