Last week, the World Health Organisation and UNICEF reported that just 10 countries accounted for three-quarters of the 128 million vaccine doses administered worldwide to date.  

Almost 130 countries with a population of over 2.5 billion had yet to vaccinate anyone.  

Recently the director general of the World Health Organisation, Tedros Adhanom Ghebreyesus, warned of a ‘catastrophic moral failure’ due to the consequences of vaccine nationalism as the world’s richest countries monopolise available vaccine supplies, often buying very much more than required and hoarding it.  

According to Duke University Global Health Institute, as of mid-January, more than 7 billion vaccine doses had been purchased globally with the vast majority for high-income countries containing just 16 per cent of the world population. Most high-income countries now have more than 100 per cent coverage with some capable of vaccinating their populations many times over.

Public health experts and analysts have highlighted the major conflict between those demanding access to vaccines as a ‘global public good’, pharmaceutical companies vigorously defending their exclusive patent rights, the vaccine nationalism of individual countries and international institutions and structures.

In the summer of 2020, David Fidler of the Council on Foreign Relations in Washington summed up the consequences arguing that ‘ineffective nationalistic policies appear to create a gap between science and politics that makes the pandemic worse and undermines what science and health diplomacy could achieve’.

There are other fundamental issues related to global availability: for example, if the EU’s call is that its member states vaccinate 70 per cent of adult populations by summer 2021, what does this signify for high-risk people in poorer countries in need of the vaccine more urgently than less vulnerable adults in the EU?

It clearly suggests this is not a ‘global’ pandemic in terms of response; it leaves many vulnerable people effectively abandoned denying the trite phrase that we are all in this together and it highlights once again deepening and morally indefensible global inequalities.  It clearly also suggests that it will be business as usual in global health.

It is estimated that nine out of every 10 people living in the poorest countries will miss out on vaccination this year.

The UN described the initial response to AIDS when it emerged in the 1980s as a ‘story of wasted time and opportunities, of failure of leadership, of denial and discrimination’ and many health experts and activists are now suggesting the same is true of COVID-19.

They note that in global health terms the current approach is self-defeating and will cost lives globally (and not just in poorer countries), will give the virus opportunities to mutate and evade vaccines and will damage economic recovery worldwide.

Vials of the Pfizer COVID-19 vaccine. It will take years to vaccine vast majority of people in the developing world. Photo: AFP

More than 180 countries have signed up to the Covax initiative supported by the WHO and many international vaccine advocacy groups. This initiative seeks to organise countries into regional blocs to confer greater power in drug company negotiations.

Under the scheme, 92 could have their vaccines funded by donors if enough governments subscribe sufficiently (on this there is good news as the US under Biden is now subscribing).  However, the power and wealth of richer countries in monopolising vaccines is undermining the scheme and creating a vaccine apartheid. 

The situation is further compounded by weak public health capacity in poorer countries, by a lack of adequate and costly testing and by a dearth of data and research.  

A related difficulty is that voters in richer countries judge their governments against the detail emerging from the fastest-vaccinating countries (such as Israel) and seldom think about (or even hear about) countries like Nigeria, where a population of 200 million awaits the first phase of vaccination.   

Today, it is estimated that nine out of every 10 people living in the poorest countries will miss out on vaccination this year.  Production delays and hoarding could undermine even this figure.  Unjustifiable discriminatory (and largely secret prices) hinder access further and push more countries into yet another debt crisis (South Africa is reputed to have paid double the European price for the Astra Zeneca vaccine). 

In effect, just a handful of poorest countries expect to be able to immunise their frontline health workers in the coming months while the vaccination of their general populations is unlikely for several years.  

In so many fundamental ways, COVID-19 has highlighted existing fault lines and inequalities before any consideration of the long-term impact of the pandemic.

The situation has been graphically and accurately described as an immoral race towards the abyss.