Walking the Talk: Equity in the COVID-19 Vaccine Rollout

As the world enters its second year living with COVID-19, much of the public attention and investment has shifted to large scale vaccination efforts. Scientists around the world have been called upon to dedicate unprecedented time, resources and energy to the development of a COVID-19 vaccine. The urgency is unquestionable, yet in the rush to vaccinate and be vaccinated personal and global ethics are on the line. We must avoid repeating the same mistakes that have been so starkly illuminated across the global response to the pandemic, namely increasing health disparities and health inequities in many marginalized populations.

In a recent article published in the Atlantic entitled “The Vaccine Line Is Illogical” author, Epidemiologist and Professor at the Yale School of Public Health, Dr Gregg Gonsalves reflects on his own experience with the COVID-19 vaccine rollout and the implications of exciting strategies for vaccine distribution both nationally (in the United States) and internationally.

While equity has been at the forefront of preliminary discussions regarding vaccine distribution, Dr Tedros Adhanom Ghebreyesus, Director General of the WHO has stated that while many countries “speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue.” Dr Tedros warns that “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 and the world’s poorest people.”

Unfortunately, the reality of these disparities are already present. More than 39 million vaccine doses had been distributed across 49 rich countries, while one poorer nation—Guinea—has received just 25 doses. These trends not only exist between high-income and low-income countries, but these disparities are also mirrored within countries. Despite efforts to ensure that those in greatest need of vaccination receive it first, fundamental issues regarding barriers to access have been all but ignored.

A recent article entitled “Older adults without family or friends lag in race to get coronavirus vaccines” illustrates that despite the “prioritization” of vaccinating older adults (a population that has been disproportionately affected by COVID-19) many of this population face significant barriers in accessing vaccination gateways and services. Those living alone or with limited mobility may be unable to travel to vaccination sites while others may not have access to the internet, or the digital literacy required to register online for appointments or receive notifications when vaccines become available.

Dr. XinQi Dong, Director, Institute for Health, Health Policy and Aging Research at Rutgers University has expressed increasing concern that “barriers to getting vaccines are having unequal impacts on our older population.” Those with limited resources and social supports, the very individuals most in need and at risk of COVID-19, the least likely to receive timely access to vaccination are being left behind. This situation is painfully ironic when leave no one behind (LNOB) is the central, transformative promise of the 2030 Agenda for Sustainable Development and its Sustainable Development Goals.

Initial reporting has indicated that Black and Hispanic individuals in the United States are two to three times less likely than Caucasians to have been vaccinated as of now. These trends extend beyond the United States and beyond even discussions specific to a COVID-19 vaccine. While COVID-19 has shone an unflattering light on public health shortcomings in addressing equity it also provides an opportunity to examine these issues more broadly. Issues of accessibility be it transportation, language or even time are all factors that impact access to other lifesaving vaccinations such as influenza, pneumococcal and shingles.

It is imperative that global leaders in public health continue to refine strategies for the equitable distribution of a COVID-19 vaccine, and these lessons learned, and policies developed extend beyond this time of crisis and become foundational to future discussions towards ending immunization inequity.

To learn more about the COVID-19 vaccine and immunisation amongst at-risk populations, contact Dr Holly Seale, Senior Lecturer at the School of Public Health and Community Medicine (SPHMC), University of New South Wales from the IFA Expert Centre. If you are an individual who works with older adults, IFA wants to hear from you to better understand how equity is conceptualized and operationalized within your organizations and countries of origin. To learn more about how to contribute to this important dialogue connect with Ms Anna Sangster (asangster@ifa.ngo), and sign the IFA pledge to End Immunization Inequity.