No One is Protected Until We’re All Protected

Posted 3 March 2021

The production and early roll-out of COVID-19 vaccines have been at a record pace and are a major public health achievement, but the lack of equitable distribution threatens to undermine this accomplishment. While vaccines are rolled out in high-income countries, the lack of vaccines being distributed to low- and middle-income countries is a moral failure that must not be tolerated. The COVAX Facility, a global risk-sharing mechanism for pooled vaccine procurement co-led by Gavi, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization, is the principle framework to ensure fair and equitable allocation of COVID-19 vaccines globally, with a goal of vaccinating 2 billion of the most vulnerable segments of society in 2021.

'We have it within our collective power to ensure that all countries have access to safe
and effective vaccines to help protect all people.'

However, while 190 countries have signed on to participate in COVAX, the vast majority of vaccination to date has occurred in high-income countries, mostly through direct purchase circumventing COVAX, and often in volumes sufficient to vaccinate their population many times over. Despite representing only 16 percent of the world’s population, high-income countries have secured a majority of vaccine doses projected from major suppliers for 2021. That translates to billions of people shut out of the vaccine supply chain around the globe. Additionally, the prices nations are paying for vaccines vary widely, threatening the price regulation promised through COVAX. Putting the moral imperative aside, massive numbers of unvaccinated people is a potential driver of mutations and dangerous variants, prolonging the pandemic, increasing global mortality and morbidity, and impeding economic recovery and a return to “normal life.”
While we may be off to a rocky start living up to global promises of equitable distribution, a course correction is still possible. We commend U.S. President Joe Biden’s recent commitment of $4 billion to COVAX as a step in the right direction. Moving ahead and working together, we — researchers, global leaders, policymakers, manufacturers, regulators, health workers and advocates — need to remove every possible barrier to researching, manufacturing and distributing safe and effective vaccines at a reasonable cost for all, and do so faster. 
This includes:
  • Advocating for countries that have signed on to COVAX to abide by the strategic guidelines set forth, which are in the global interest.
  • Advocating for full funding of COVAX, which presently falls billions of dollars short of the funds needed to fully implement the program.
  • Advocating for open and transparent pricing schemes, with the goal of providing free or reduced-cost vaccines to nations in need, in both the short- and long-terms.
  • Innovating on and investing in delivery strategies for equitable access, as we have in vaccine development and production.
  • Continuing to invest in research on second-generation vaccines that are easier to administer, particularly in low-resource settings (e.g., single dose, less stringent cold chain requirements), and protect against emerging virus variants.
  • Engaging in strong collaboration and information sharing on clinical trials and close coordination between regulators and the WHO to ensure immediate uptake and equitable access to products once they are found safe and effective.
  • Trading and cooperating on a global level to minimize supply chain challenges and removing any bottlenecks to manufacturing processes.

We have it within our collective power to ensure that all countries have access to safe and effective vaccines to help protect all people. The pandemic has shown us that our fates are linked. No one is protected, until we’re all protected.