Vaccine Equity: The Quest to Leave No One Behind
by Deborah Maufi, MD, MBA, Chief Medical Officer, Babymoon Care BV; a HIMSS Global Health Equity Network Task Force Member
"… the world is on the brink of a catastrophic moral failure—and the price of this failure will be paid with lives and livelihoods in the world's poorest countries… Not only does this me-first approach leave the world's poorest and most vulnerable people at risk, it's also self-defeating. Ultimately, these actions will only prolong the pandemic, the restrictions needed to contain it, and human and economic suffering." – Tedros Adhanom, MD, Director General, World Health Organization
It is evident that this pandemic has tested us more than ever, and we should continue to find ways to fight and leave no one behind. Now, even as we have several vaccines developed and being used, there's still much more to take into consideration to reach vaccine equity. An effective vaccine is our best hope for controlling the COVID-19 pandemic, but to defeat it, we need prompt and equitable distribution. We can only succeed if we face the challenge together.
We presently face the threat that even though the vaccines bring us hope, a significant part of the world could be left behind. Vaccine equity is not just a moral imperative. How we get the pandemic under control depends on it. Like never before, we see how social determinants play a big role in health inequities globally. This pandemic ought to be a motivation for making meaningful social change going ahead.
Vaccine rollouts in wealthier countries are moving faster than those in developing countries with comparative mortality. Today, seven vaccines are being used in at least one country with Israel at the top having more than a third of its population vaccinated with two doses and more than half have received at least one dose. Over 4.6 million doses have been given globally in 162 locations. Certainly, vaccine equity is a moral test due to unequal vaccine policies raising critical issues. Underserved communities are in danger of not receiving the vaccine supply on schedule, or not getting enough doses, because of lack of resources. Although there are already ongoing efforts to support developing countries such as the Covax scheme, there's still much to be done. For instance, only 23.6 million doses of vaccine had been distributed in Africa so far—an equivalent to around 1.7% of the continent's population.
Putting Priorities Into Action
CommuniVax, a coalition stemming from Johns Hopkins Bloomberg School of Public Health's Center for Health Security, formulated an action plan highlighting five principles to ensure vaccine equity among the Black, Indigenous and Latinx communities in the U.S. However, these principles can also be put in practice among other underserved populations including those in developing nations. These communities are among those most affected by the economic and social disruptions caused by the pandemic.
The five key principles focus on the following.
1. Iteration
The global race to get as many people vaccinated as possible must be balanced with trust in all communities. To achieve this, it is undeniable that repeated engagement with members of underserved communities is imperative. Although this will take time, committing to engaging them, listening and planning with them is required to put ideas into actions that leave no one behind.
2. Involvement
Not only should there be commitment, but also active collaboration with these communities. Two-way communication and engaging with representatives from underserved communities as partners, and even in positions of power, can bring us a long way—especially when we want to take into account the barriers to health equity affecting them. One way this should be possible is by empowering individuals and community organizers to effectively take part in the COVID-19 vaccination campaigns in manners that regard their self-determination and fortify their confidence.
3. Information
Employing best practices for communication is crucial during this pandemic to empower communities with accurate information and to expose misinformation. By recognizing that vaccine messages must also address specific concerns of underserved communities, we can build trust and increase vaccine acceptance. By identifying and supporting trusted influencers and organizations within these communities, accurate information related to COVID-19 vaccination can be relayed in the communities' own terms.
4. Investment
The vaccination process should serve as a platform to transform healthcare systems, make them inclusive and improve quality and access to all. It is also an opportunity to revive the economy—especially the underserved communities that are often economically challenged. All these efforts will only come to life with necessary investments of time and funding. Historically, these underserved communities such as in developing countries have experienced disease burdens that forced them to have treatment and vaccination programs. Making use of new and existing structures and then fight to keep these resources in place can be useful in rolling out COVID-19 vaccine programs in these communities.
The effects of the pandemic will not end in a single day. It is important to acknowledge that recovery will take time, therefore, the COVID-19 vaccination campaign must not be considered as the final step for returning to normality. Instead, it should be a platform to durable and meaningful social change—inclusive and equitable. A lasting change can be possible if the fore mentioned sanctions are integrated into existing initiatives and community benefits for instance—food security, housing and leadership—that determine the social and physical health of these communities.
These recommendations to achieving vaccine equity still face the challenge that global vaccine manufacturing capacity is inadequate. Even now that we have various vaccines, it will take time before enough doses can be manufactured to vaccinate the world's population. Who will pay for access to vaccines for underserved communities? Who has the highest priority? Who is responsible for making these decisions? Priority of access to initial doses is confounded, and possibly the hardest to determine especially without certain moral tradeoffs. A practical and ethical equilibrium in the quest for equity will require a distribution structure that prioritizes high risk groups in all countries. This framework would be established on the possibility that within countries, there are highest priority groups who should receive the first quota of vaccines, followed by the second highest priority groups and so on.
Although realizing these approaches will be challenging especially in the middle of a pandemic, COVID-19 vaccines present an opportunity to reorganize healthcare systems globally. In any case, it is essential to remember that challenges like this pandemic frequently come from social inequity and should be catalysts for change and improvement. Some activities might be more fitting in the short-term but those that are crucial for the long term will only be effective and impactful if we start today.
The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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