Vaccine Equity – the other half of the equation

As the first COVID-19 vaccinations were rollout out at the end of 2020, there was great hope that 2021 would be the year in which the world managed to contain COVID-19, and life could resume as normal. However, even before the emergence of the Omicron variant it was clear that for many that would not be the case. Global distribution of COVID-19 vaccines has been highly inequitable. In Sub-Saharan Africa, only 1 in 4 health workers have been fully vaccinated, and the continent has the lowest proportion of people fully vaccinated – just 7 per cent. 

Prior to the emergence of Omicron, calls by the World Health Organisation and Gavi, the Vaccine Alliance for better global distribution of first round vaccinations, and a moratorium on booster doses had largely been ignored by higher income countries. Our research, published earlier this year, uncovered some of the challenges that countries faced in getting access to vaccines in a seller’s market with countries paying varied prices for vaccines, and in many cases having to sign up to extensive indemnification clauses, shielding manufacturers from liability. 

Earlier this week, Dr Ngozi Okonjo-Iweala, Director of the World Trade Organisation, reminded us at Transparency International UK’s Annual Lecture that the costs of failing to achieve equitable distribution of vaccines goes beyond health: “The IMF estimates that failing to vaccinate 70% of the population in all countries would mean forgoing as much as $9 trillion in global economic output between now and 2025.” With the World Bank estimating that 150 million people will be pushed into poverty by the end of 2021 due to COVID-19, it is crucial that we get vaccines distributed globally. 

“What we say about vaccine inequity is very similar to what one can say about corruption. It is bad for moral, political and economic reasons”
Dr Ngozi Okonjo-Iweala, Director of the World Trade Organisation,  15 December 2022

However, global supply is only half the equation. There is much work to be done in-country to ensure that vaccines reach the arms of those who need them the most. Decades of under-investment in national health systems mean that many countries lack the infrastructure, and resources to deliver vaccines. 

When vaccines do arrive, a lack of trust in governments, fuelled in part by historic corruption, means that some may be hesitant to take up vaccines. This is compounded by recent reports of vaccines arriving erratically, or with short shelf lives. 

We’ve had multiple reports of corruption in the vaccine rollout, with vaccines going to those with political or economic connections, or bribes being solicited for either vaccines, or vaccine certificates. Over the past year Transparency International Global Health has been working with colleagues in Bangladesh, Uganda, and Zambia to ensure greater equity and transparency in national vaccine rollouts. We’ve developed a machine learning tool to track reports of inequity and corruption around the world. We  have also been working with our partners in these countries to advocate for adherence to equitable distribution, ensuring that health workers and vulnerable populations get priority. To mitigate corruption, we’ve been working on the introduction of corruption reporting mechanisms, to allow potential cases to be identified, and countered as soon as possible. 

As we look forward to 2022, we need to focus not just on ensuring that there is a more equitable global supply of vaccines, but to ensure that we have the systems and mechanisms in place to deliver those vaccines. That means strong health systems and governance that allow public services to be delivered as effectively as possible.