Ottavia Ciani 
Refugee Issues Researcher at ImpACT

The majority of the richest countries in the world have bought or reserved more than enough COVID-19 vaccine to protect their populations, threatening availability for lower-income countries. Some experts have projected that while most U.S. and E.U. citizens will be vaccinated by the end of the year, it will likely be 2024 before many other countries can do the same. A report from the Centre for Global Development estimated there would not be enough doses to vaccinate everyone until 2023.

According to data compiled by Duke University in North Carolina, 6.4 billion doses of vaccines have already been purchased, and another 3.2 billion have been reserved or are under negotiation—all primarily by governments of high-income countries. In fact, The New York Times has calculated that with these purchases, the European Union could inoculate all of its residents twice. The governments of Great Britain and the United States could vaccinate their populations four times and Canada six times.

This domination of the market took place with dizzying speed: The Pfizer-BioNTech vaccine was granted emergency approval on 12 December and distribution began two days later. However, months before—in the summer—the U.S. government had already reserved 100 million doses for its own use. It also purchased 200 million doses of the Moderna vaccine (approved for use in the United States on 18 December) and reserved 810 million doses of still-to-be-approved vaccines from AstraZeneca, Johnson & Johnson, Novavax and Sanofi.

The United States is not alone: The EU has bought or reserved 1.3 billion doses of vaccines and the UK government has claimed 357 million.

“As wealthy countries continue to hoard doses, the lifesaving potential of vaccines risks being undermined by inequality and corporate interests,” warns Amnesty International.  

Sharing of knowledge and technology

According to Oxfam, more than half of the projected doses of COVID-19 vaccine have been claimed by wealthy nations that account for just 13% of world’s population. Chema Vera, interim executive director of Oxfam International, warns, “Governments will prolong this crisis in all of its human tragedy and economic damage if they allow pharmaceutical companies to protect their monopolies and profits. No single corporation will ever be able to meet the world’s need for a COVID-19 vaccine. That’s why we are calling on them to share their knowledge free of patents and to get behind a quantum leap in production to keep everyone safe. We need a people’s vaccine, not a profit vaccine.” 

There are large differences in the willingness of the drug companies engaged in vaccine development to produce sufficient supply for poorer nations.

Oxfam is a member of a coalition pushing for a “people’s vaccine.” Other members are Amnesty International, Frontline AIDS and Global Justice Now. The coalition estimates that only 1 in 10 people will be vaccinated in nearly 70 lower-income countries due to the massive hoarding by wealthy countries. Although steps are being taken to ensure equitable access to the vaccines, the People’s Vaccine Alliance warns that there won’t be enough doses for everyone everywhere until the drug companies share their technology to allow more vaccines to be produced and distributed.

Currently, there are large differences in the willingness of the drug companies engaged in vaccine development to produce sufficient supply for poorer nations. Moderna and Pfizer have so far set aside doses only for wealthy countries. (On top of that, additional aid would be required for less-resourced countries to use their vaccines, since they require extreme cold storage.) In contrast, AstraZeneca has pledged two-thirds of its doses to lower-income countries at a cost of just $4 a dose. However, AstraZeneca’s production capacity is not sufficient to meet this demand. It could it supply up to 38% of the global population if only one dose was needed; however, that is not the case.

"The moment that we have all talked about, of global solidarity and global cooperation, is now,” John Nkengasong, head of the Africa Centres for Disease Control and Prevention, told CNN. “The litmus test is actually now. It makes absolutely no moral sense to have excess doses of vaccines in certain countries and absolutely no doses of vaccines in other areas of the world."

Equal access

The U.N. special rapporteur on the right to health has issued guidelines for making lifesaving medicine affordable to as many people as possible, in particular children, the elderly and those living in poverty. The guidelines call on companies to be as transparent as possible in determining access to their products and to respect both the letter and spirit of the Doha Declaration on the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). The declaration recognizes states’ responsibility to protect public health and promote universal access to medicines, including allowing compulsory licensing and parallel imports. The declaration also states that access to health care should be granted to all, irrespective of economic status. At least half of the world’s population cannot afford health care; thus, vaccines are likely to be unavailable to half of the world unless they are free and aid is provided to assist in creating the necessary infrastructure.

Winnie Byanyima, executive director of UNAIDS and under-secretary general, has expressed concern about corporations’ use of their monopolies to artificially restrict supplies of life-saving medicines and thus inflate their prices, as they did with AIDS drugs. UNAIDS and the People’s Vaccine Alliance are calling for a new approach that puts public health first by sharing knowledge and maximising supplies.

“Unless something changes dramatically, billions of people around the world will not receive a safe and effective vaccine for COVID-19 for years to come,” warns Anna Marriott, Oxfam health policy manager.

Wealthier countries have been allowed to reserve doses for 50% of their populations, while lower-income governments were able to claim to only enough for 20% of their residents.

Enter COVAX

The Access to COVID-19 Tools (ACT) accelerator was launched in April by the World Health Organization (WHO), the European Commission and the French government. One of its initiatives is COVAX, focused on bringing all relevant parties together to assure innovative and equitable access to COVID-19 vaccines. To date, it has reserved 700 million of the 2 billion doses it aimed to obtain and distribute by the end of 2021. The E.U. has contributed €500 million to COVAX to help reserve vaccines for 92 low- and middle-income economies. 

However, COVAX’s distribution scheme has faced criticism. Wealthier countries have been allowed to reserve doses for 50% of their populations, while lower-income governments were able to claim to only enough for 20% of their residents. Richer countries also are allowed to pay a higher price in return for choosing their preferred vaccines. States that join COVAX should demand transparency and accountability.

Insufficient supply

Production is another challenge. It is almost certain that drug companies won’t be able to produce all of the reserved doses in the near future. Pfizer had announced it would produce 100 million doses by the end of 2020, but later cut that prediction in half. Some experts cited by The New York Times have predicted there won’t be enough vaccines for everyone until 2022 at the soonest; others have put the timeline at 2024.

For all these reasons, COVAX and the World Health Organization have asked countries that have already reserved large quantities of the vaccines to donate a portion to low-income countries or to those that are most at risk. Canada is already discussing this option. However, experts believe that even if rich countries donate a portion of their doses, there won’t be enough vaccine for every country. In addition, those that do receive the Pfizer and Moderna vaccines won’t have the facilities or training needed to store them properly. Inevitably, the poorest will be left behind.

Refugees and migrants

Especially vulnerable groups, such as refugees and displaced persons, must be paid particular attention. Only if everyone is given access to the vaccines can we all be safe. Migrants, refugees, asylum seekers and displaced persons should be included in vaccination drives. The fact that they often live or work in overcrowded or otherwise unsafe conditions and/or have no access to clean water make them high risk. No one should be left behind.

Recommendations

• Governments must make every effort to provide vaccines to everyone within their borders, irrespective of income and citizenship status.
• Pharmaceutical companies should set aside doses for lower-income countries and provide additional support for transport, storage, etc.
• COVAX should adopt a more transparent and accountable distribution scheme.
• Companies should prioritise people over patents, taking an open-source approach to sharing their technology and know-how.
• Governments should include migrants, asylum seekers and refugees in their vaccine distribution programs.