COVID boosters are coming, yet many countries still can't access vaccines, causing preventable death

Vaccination is a global strategy, yet many low-income countries can't access then, perpetuating the pandemic

Published September 10, 2023 3:59PM (EDT)

Vials of the Pfizer/BioNTech Covid-19 vaccine (Leon Neal/Getty Images)
Vials of the Pfizer/BioNTech Covid-19 vaccine (Leon Neal/Getty Images)

In an August 2021 press conference, Mike Ryan, the director of the World Health Organization's (WHO) Health Emergencies Program, likened COVID-19 vaccinations to life vests one straps on in a sinking ship. He criticized high-income countries for stockpiling their third doses before parts of the rest of the world got their first.

"We're planning to hand out extra life jackets to people who already have life jackets while we're leaving other people to drown without a single life jacket," Politico reported him saying in a press conference. "That is the reality."

Two years later, yet another booster could be rolled out in the U.S. as early as this week. Meanwhile, two out of three people across low-income countries still have not gotten their first shot. Although more than 5.5 billion people have been vaccinated against COVID, representing a massive public health triumph, vaccines haven't been distributed equally, and many low-income countries left behind in the initial rollout still haven't caught up. 

Two out of three people across low-income countries still have not gotten their first shot.

Yet the very nature of a pandemic occurs "on a scale that crosses international boundaries," said Dr. Joanne Liu, a professor at McGill University's School of Population and Global Health and former international president of Doctors Without Borders. Ignoring parts of the world in our response will only perpetuate the pandemic for everyone.

"We all know that in a pandemic, we are all in it together," Liu told Salon in a phone interview. "It's not good enough that one country gets to the finish line. We all need to get to the finish line at the same time if we want to end a pandemic."

In 2021, the WHO set a target of vaccinating 70% of the global population by mid-2022. Today, close to 73% of the population has had at least one shot, but more than a dozen low-income countries, including Yemen, Syria and the Democratic Republic of the Congo all have less than 20% of the population vaccinated. We likely missed our window into ever being able to achieve 70% vaccination across individual countries, said Dr. Krishna Udayakumar, the Director of the Duke Global Health Innovation Center.

"Without a doubt, we lost almost a year of potential progress when vaccines were available in many high-income countries and there was significant demand around the world, but vaccines were not made available," Udayakumar told Salon in a phone interview. "By the time that supply caught up and more equitable distribution started to happen well into 2022, we saw that the demand was nowhere near what it was because of that lack of timely availability, but also because we were past the Omicron wave at that point and the entire nature of the pandemic had shifted."

"We lost almost a year of potential progress when vaccines were available in many high-income countries and there was significant demand around the world, but vaccines were not made available,"

Distributing vaccines is a complex process. They must be tested and approved to ensure their safety; they are expensive and hard to transport; and availability is at the mercy of supply chains. At the beginning of the pandemic, one of the main issues in distributing vaccines was supply, and many wealthy countries hoarded extra doses instead of donating them elsewhere.

Meanwhile, manufacturers like Moderna were accused of selling most of their supply to rich countries for high profit, although a spokesperson said Moderna has been working to improve vaccine access globally and pointed to a deal reached with Gavi and COVAX in which they distributed 100 million doses to low-income countries.

Data show that delays in COVID vaccination caused more cases and deaths in low-income countries, with one study published in June of this year estimating up to 50% of deaths could have been prevented if low-income countries were given the same access to vaccines in the initial rollout as high-income countries. Another study published last year attributed 1 million excess deaths globally to greed.

"Inequity really characterized the COVID pandemic, and that contributed to quite a bit more death and suffering than it should have," said Peter Maybarduk, the Access to Medicines Director at Public Citizen.

More recently, pharmaceutical companies were accused of slapping higher price tags on vaccines for low and middle-income countries. Johnson & Johnson, for example, charged South Africa 15% more per dose than it charged the European Union, while Pfizer-BioNTech charged South Africa nearly 33% more per dose than it charged the African Union, according to an analysis of vaccine contracts recently released by the Health Justice Initiative. In the earlier stages of the pandemic, Bangladesh and Uganda were also reportedly overcharged.

A J&J spokesperson denied the claim and said South Africa paid the same price as other global customers. Pfizer-BioNTech did not respond to Salon's request for comment.

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"If you're South Africa, or Colombia or another developing country, you're kind of negotiating alone in the dark with this pharmaceutical company and you don't know what a fair deal is because the prices that everyone else is paying aren't public," Maybarduk told Salon in a phone interview. "You may have people that are in a desperate health situation that you need to protect, so it makes it hard to say no or drive a fair bargain."

"You may have people that are in a desperate health situation that you need to protect, so it makes it hard to say no or drive a fair bargain."

The Gavi COVAX initiative aims to restore equitable access to COVID-19 vaccines and has successfully distributed two billion doses to underserved countries. But it struggled to get off the ground, and this year, the global rollout is facing a new problem: demand. Pandemic fatigue is slowing vaccine uptake in many countries that still have high numbers of unvaccinated residents, according to The Washington Post

When the public health emergency was declared over earlier this year, funding for pandemic surveillance and data collection dried up and public attitudes about the pandemic and vaccination shifted. In many low-income countries, other global health threats like cholera or Ebola outbreaks and natural disasters have taken priority over the pandemic, Udayakumar said.

"There are enormous competing priorities," Udayakumar said. "The funding has also almost entirely gone away whether it was for vaccine purchases early on or for distribution and delivery support, so much of the infrastructure that was set up in the midst of the pandemic has also not continued anywhere near the same level."

Currently, the focus has shifted to vaccinating high-risk individuals in countries left behind in the initial rollout. However, according to data from the WHO, disparities remain, with 23% of older adults in low-income countries in the COVAX program having received their first booster. In comparison, 43% of older adults in the U.S. have gotten boosters.

To shift manufacturing power to the Global South, 15 low and middle-income countries are working to create their own vaccines in the mRNA vaccine technology transfer hub. The recipe for Pfizer and Moderna's mRNA vaccines, which are more effective than monovalent vaccines, is patented, and that information is not shared with these new manufacturers, Maybarduk said. 

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"That contributes both to vaccine shortages but also to a two-tier global vaccine access reality, where the people who are getting vaccines in the Global South are generally getting vaccines that have inferior efficacy," Maybarduk said. "So you have both vaccine apartheid in the absolute sense of shortages, and in the sense that it was as if the world was offering poor vaccines to poor people."

Although another pandemic is the last thing people want to think about, it's a matter of "when" not "if" the next one will strike, Liu said. COVID illuminated global inequities that have always been present. Time will tell if we learn from our mistakes in distributing vaccines equitably in the next one.

"COVID-19 should be our Chernobyl moment," Liu said. "Who wants to have their life put on hold for 20-plus months? … Who wants to have their loved one dying alone with suited men and women around them? Nobody. So, therefore, let's try to make these changes and make sure that collectively we all prepare much better."

By Elizabeth Hlavinka

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