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Vaccine inequality persists as world enters third year of the Covid-19 pandemic

Prof. Syed Munir Khasru

South China Morning Post (Hong Kong)
December 24, 2021



In 2022, the world enters the third year since Covid-19 appeared in late 2019, with different variants emerging. Pfizer estimates that the pandemic could extend to 2024, even when large swathes of the global population have been vaccinated.

To understand why the pandemic is stretching out, three things need to be examined: the importance of herd immunity; vaccine efficacy; and, the emerging Covid-19 variants.

Social distancing, wearing a mask, personal hygiene routines and government-imposed national lockdowns have all been put forward as ways to reduce the spread of Covid-19. After the World Health Organization announced that the coronavirus outbreak had become a pandemic in early 2020, it was clear there was no quick cure for the highly infectious virus.

The one long-term solution is to prevent its spread by achieving herd immunity through a global mass vaccination programme. After a year of research, the world produced vaccines with comparatively high rates of efficacy.

However, herd immunity continues to be crucial to prevent the pandemic from continuing. This needs to be achieved before vaccine efficacy falls as new variants emerge across the globe.

The pandemic took a drastic turn in South Asia, particularly India, where lockdowns were lifted too early, leading to a rapid spread of Covid-19 and the subsequent mutation to the Delta variant. This variant brought down vaccine efficacy, but they were still effective.

India responded by banning vaccine exports and initiating a rapid inoculation programme across the country. One year after the emergence of the Delta variant, yet another variant – Omicron – has emerged from South Africa, and we have no one but ourselves to blame for this.

Vaccines distribution has been uneven from the very beginning. While developed and rich nations overstocked vaccines, there was rarely enough available for poorer countries.

Group of 7 countries have bought about a third of the global Covid-19 vaccine stock despite representing barely 13 per cent of world’s population. This has caused poorer countries, particularly in Africa, to fall behind in achieving herd immunity.

Only about 6 per cent of Africa’s population – 77 million people across 54 countries – are fully vaccinated. It is not surprising, then, that the Omicron variant emerged from a largely unvaccinated and exposed continent.

To tackle the new variants, vaccine producers have started production of a third booster dose. British researchers say these boosters could be more than 80 per cent effective against the Omicron variant. Boosters have gained popularity in rich countries, with much of the population seeking a third vaccine dose.

However, the WHO has strongly opposed the roll-out of booster doses, asking rich nations to instead donate two doses of the vaccine to countries that do not have enough to meet the minimum vaccination rates. So far, the world has only managed to delay the Covid-19 pandemic and has yet to achieve a long-term solution, that is, herd immunity.

While booster shots are necessary for vulnerable populations and front-line workers, it should not be the primary means of achieving herd immunity. As nations continue to put their resources into these boosters, the world risks a situation where more Covid-19 variants emerge, with many people still unvaccinated and exposed to the virus.

Lower-income countries have struggled to get vaccines since they first came to market at the end of 2020. Some producers have seemingly not been thinking of the greater good when pricing their vaccines, either.

If we compare the first few vaccines that received WHO clearance, Pfizer BioNTech and Moderna cost US$20 and US$33 per dose respectively. Considering that two doses are required, the per capita cost of a vaccine is therefore at least US$40, more than the typical monthly salary in many developing countries.

The fact that some vaccines also need to be stored at minus 70 degrees Celsius also creates logistical problems for poorer countries.

By contrast, the Oxford AstraZeneca vaccine is priced at a more friendly US$4, and can be stored at regular fridge temperatures. The company even pledged 64 per cent of its supply to developing countries.

However, the British population received priority even with this vaccine. And, although supplies were pledged to developing countries, higher-income developing nations were at the front of the queue for supplies.

As we enter 2022, the world needs to come together to beat the virus, and this can only be done by achieving herd immunity as quickly as possible. Developed countries are moving towards donating vaccine doses to poorer countries – once they have achieved good vaccination rates for their own populations.

The largest effort to ensure poorer countries receive fair and equitable access to Covid-19 vaccines is the Covax Facility, an initiative led by the WHO. It aims to collect donations, whether vaccines or money, from developed countries. Covax has already shipped more than 792 million doses to 144 countries.

Rich countries with spare vaccines are donating them to their allies, including China’s pledge of 1 billion vaccine doses for Africa. Other large-scale donations could greatly boost global herd immunity and we could hopefully see an end to the pandemic.

With just 48 per cent of the global population fully vaccinated, this is a job half done. Achieving herd immunity will get more difficult unless there is significant, rapid progress on global vaccination soon.