The distribution of vaccines has constantly been an area of importance for governments and international organisations, especially during times of health crises. However, targets to ensure that all nations and all citizens have access to vaccinations has historically (and quite recently) been an issue. The COVID-19 pandemic highlighted the need for discussion around this topic since we saw the inefficiency and delays in distributing vaccines that resulted in tragic losses, community disturbances and economic devastation.
The polio epidemic appeared in Europe and the US, quite unexpectedly in the 1900s. Possible medications and vaccinations were tirelessly researched in order to end these outbreaks, until a successful vaccine was finally created in 1955, by US physicians: Thomas Francis Jr. and his colleagues. A couple years of experimentation and development led to mass immunisation programmes across the US by 1957, and later in Europe with Hungary in 1969 and Czechoslovakia in 1960. In 1997, polio was reported to be eliminated from the US and in 1998 for Europe. These successes were celebrated as it reduced polio illnesses and hence the mortality rate substantially, allowing for us and future generations to avoid the life-threatening disease.
However, we often forget the great delays of these mass immunisation programmes in other countries, particularly countries with developing economies. This inequality was illustrated when India and China’s programmes were implemented much later in 1995. India only received the “polio-free certification” from the World Health Organization in 2014 – a whole 17 years after the US. One would have hoped that the urgent nature of health crises would mean that the world would collaborate to ensure that all nations would have access to eradication methods. Yet, this was not the case in the 20th century, and is still not the case in the 21st century. Whilst India prioritised their commitment in allocating their vaccines regionally in a way that the most remote areas would obtain it, at a global level this has not been the case. These delays cause detrimental effects which equate to greater number of losses, slower economic recovery, and long-term effects – a vicious circle indeed.
Not learning from mistakes, the recent pandemic suggested a stark inequality in vaccine distribution. Global Justice Now, a pressure group that campaigns for issues in the Global South and its development, found that rich countries (Canada, UK and Australia) pre-ordered vaccines in order to vaccinate their populations three times over, whilst poorest countries suffered with none. This was overlooked during the excruciating circumstances, as nations prioritised helping their own country first before others. One in seven people in low-income countries were fully vaccinated by 2022, compared with 3 in 4 in high-income countries; this certainly is a considerable problem as we missed the WHO’s target to vaccine 70% of people in all infected countries by mid-2022.
So what is actually causing these delays? Firstly, financial accessibility is a key factor that is a barrier to many countries attempting to keep their populations alive. Many low-income nations lack the money to buy enough vaccines for distribution, in particularly sub-Saharan Africa which unfortunately had the lowest number of vaccinated people, despite their desperation. This is exactly why COVAX (COVID-19 Vaccines Global Access) was set up during the 2020 pandemic. Its primary objective was to supply vaccines to all countries worldwide and its initiative explored ways in ensuring equitable access, no matter the financial situation. Hence, optimism struck at this time as, finally, this issue was being recognised as serious. Their policy involved high-income countries purchasing for enough vaccines that they would be able to vaccinate 20% of their population (which later increased to 50%). COVAX hoped that this money would facilitate investment into research and supplying the 92 lower and middle-income countries with vaccines. However, whilst this idea had good intentions, it was unfortunately a failure in practice. Countries such as the UK made deals with vaccine companies directly rather than COVAX itself, resulting in their goal to be left unfulfilled. Furthermore, if we zoom in to domestic inequality, financial factors are also prevalent. Studies indicated that those citizens who had insurance had a higher vaccination rate. Therefore, lower and middle classes within a population were also affected by domestic inequalities.
Political factors also influenced the large delays in global allocations – this includes the level of public trust in the government and general political stability within a nation. For example, Ethiopia’s low levels of public trust in its government directly fed into a low willingness to actually receive and use vaccinations. Therefore, even if Ethiopia’s government had access to it, public perceptions did not allow vaccination programmes to be carried out due to allegations of corruption and governmental incompetence. As well as this, rural to urban divides contribute to “vaccine willingness” as well. Western medicine is not trusted by all due to the traditions, culture and tribal communities. Many rural tribes across the globe (including in China, Africa and South America) disregard the prospects of western medicine and don’t necessarily trust it over their own healing methods and beliefs. This is simply to do with culture and therefore must be respected. However, the COVID-19 Pandemic signified many mixed messages about vaccine immunity, extent of harm, vaccine effectiveness and side effects. These ideas may be blamed to cause a lower vaccine willingness in many parts of the world, even in the US where there was a distinct divide between those who got vaccinated and those who heavily criticised it. Quite simply, there was no consistency in what news was being spread about vaccines.
We have seen how the inequal approach of vaccine distribution, both in the past and present, has led to many health injustices. The example of mass global pandemics like COVIDf-19 has brought this issue to the forefront. With acknowledgement and international cooperation, a common agenda for global health leadership is needed to prevent future medical crises.
