Vaccine inequality is a major problem – we need to fix it

By definition a pandemic is global. For our classics loving prime minister, the clue is in the name. “Pan” from the Greek for “all” and “demos” from the Greek for “people”. The word is used to describe something that effects all people and Covid-19 certainly lives up to the label.

Therefore, it stands to reason that we require a global solution. A solution that recognises that coronavirus does not slam on the breaks when it encounters a country’s borders. Possessed with a global passport, the virus enters countries at will. But that is where the generalities stop, because how the virus spreads and how a population is protected has been a decidedly individualistic – and even exclusive – affair. Instead of developing a global solution, nations have focused on themselves. Such selfish actions have led to a response riddled with inequity – as some countries have access to their choice of vaccination and some have none at all. This focus on national interests is fuelling the global crisis, not fixing it.

While the UK prepares to roll out a THIRD booster shot to its population, other countries are struggling to get the first jab administered. In fact, many countries are relying on vaccine donations from countries like the UK, via an initiative known as Covid-19 Vaccines Global Access (Covax), otherwise they may be unable to vaccinate their population at all.

While most high-income countries have donated vaccine doses, none have exactly covered themselves in glory. This week, the World Health Organisation (WHO) – alongside a number of other organisations including Unicef and the African Union – released a “Joint Statement on Dose Donations of Covid-19 Vaccines to African Countries”, reminding donating countries not to send about to expire vaccines with little notice, as many countries reliant on these donations were not able to mobilise quickly enough to actually use them. It certainly smacks of performance over genuine charity. More the vaccine equivalent of spring cleaning your kitchen cupboards and then smugly giving the food bank a motley crew of maraschino cherries, lentils you’ve never used and 16 cans of chickpeas the day before the sell-by date.

Hardly humanitarian, charitable, or ethical. Which brings me back to the booster shots and why it isn’t ethical to be levelling-up the UK immunity before the rest of the world manages to even have their first jab. Omicron is not just the newest version of this persistent and resilient virus, but it is a shining example of the consequences of global health inequality and inequity, and how these inequities will only prolong the pandemic.

Let me explain how we got here.

The majority of vaccines have been bought, used and future doses earmarked by high income countries. Using our wealth, power and infrastructure, countries like the UK have been able to secure enough vaccine to immunise the population twice, and we’re gearing up for a third. We are panic buyers on a global scale. Reminiscent of the toilet paper shortages of 2020, this has left lower income countries with less money, less buying power, and in some cases, poorer vaccine rollout infrastructures looking at empty shelves, unable to access the vaccines needed to protect their own populations.

What does vaccination have to do with prolonging the pandemic? Variation. Viruses, especially RNA viruses like Covid-19, work by entering your body and using the body’s own cells to make copies of itself. As this copying process occurs, errors happen and these errors become mutations that develop into variations. The more opportunities to infect, the more opportunities the virus has to copy itself and the more errors – and thus variations – can occur. Cutting transmission, the process of one person infecting another, is key to breaking this cycle of copy-error-variation. Vaccination (coupled with mask wearing and hand-washing) helps break this cycle by thwarting transmission and lessening the impact of the infection. Both of which mean the virus has less opportunity to develop variations.

In buying up stock and not sharing with those countries struggling to afford vaccines and the associated costly rollout programmes, high income countries are actively engaged in creating an inequity of vaccinations. This is unethically prolonging the pandemic and contributing to the development of dangerous variants of concern – a deadly combo. Which is why the government decisions to open up boosters to all age ranges in the UK, and buy stocks for 2022 and beyond, is not everything it appears to be. Yes, it may protect the UK population, but it will do so at the cost of global vaccine coverage and the fight towards global immunity.

As we go once again around the horn with a variant of concern, perhaps it is time to take a step back from national solutions and consider how global solutions which rectify vaccine inequities, are both more efficient and certainly more ethical in providing the global immunity equity needed to break the cycle.

To borrow from the WHO, no one is safe unless everyone is safe. I don’t know about you, but almost two years into this life-changing pandemic I think it is time to make everyone safe.

Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health and co-director of the Centre for Health and Society at Aston University. Dr Paton is also chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians and a trustee of the Institute of Medical Ethics