Help yourself by helping others: The case for global vaccine generosity

As the world rolls out its largest ever vaccination campaign in a bid to control the spread of COVID-19, the fissures of global inequality that the pandemic has exposed are threatening to take on a dangerous new dimension.

In the 49 wealthiest countries, 39 million people had been vaccinated by last week, according to the World Health Organization (WHO). In Africa’s poorest nations, just 25 individuals had been inoculated, all in Guinea.

WHO Director-General Tedros Adhanom Ghebreyesus has warned of a “catastrophic moral failure” if rich countries do not share more widely the vaccines that they have produced or bought. But governments also have a moral duty to protect their own citizens, which they must balance against any international obligations they might feel.

“It is about what is the right balance to strike,” says Maxwell Smith, a bioethicist and member of the vaccine distribution task force in the Canadian province of Ontario. “And it’s a very difficult question.”

Canada has drawn special attention because its government has negotiated deals to buy 400 million doses of COVID-19 vaccine, the largest per capita stock in the world and enough to vaccinate its population five times over.

Globally, richer countries that are home to 16% of the world’s population have bought or reserved 60% of vaccine supplies, according to Duke University’s Global Health Institute in Durham, North Carolina.

Canadian Prime Minister Justin Trudeau, whose country prides itself on its generous foreign aid tradition, has said that his government will donate any surplus vaccines to COVAX, an international initiative to meet lower-income nations’ needs, and to which Ottawa has already given money. But he won’t say when.

A rising tide lifts all boats

COVAX, the largest vaccine procurement and supply operation in history, was set up by the WHO and other international organizations in a show of global solidarity to level the vaccine playing field. Its fundraising wing aims to provide vaccines to 20% of people in the world’s 92 poorest nations by the end of the year.

COVAX last week announced its first purchase agreement for up to 40 million doses of the Pfizer-BioNTech vaccine. It is preparing to deliver its first vaccines next month, and hopes to supply two billion doses this year.

The fund received a major boost last week when President Biden announced that the U.S., which had stopped funding the WHO under Donald Trump, would become a contributing member of COVAX. But it still faces a $2.8 billion shortfall.

Dr. Kate O'Brien, WHO’s immunization director, says more than 50 COVAX members also have their own bilateral deals with vaccine manufacturers. “When countries do bilateral deals and secure their doses for early deployment, and those early doses are not distributed across all countries of the world, it inherently creates an inequity,” she says. “We do have solidarity and we do have countries with bilateral deals. There are actions that can be taken now that will continue to improve on equity.”

Failure to take such actions would be shortsighted from a practical standpoint, whatever its moral shortcomings, say many humanitarian and health experts. However many people in the richer parts of the world are vaccinated, they point out, as long as the virus is still active, and likely mutating, somewhere in the world, we are all vulnerable, and travel and trade will remain difficult.

“The government needs to explain ... that vaccinating all our citizens is not going to make the problem go away,” says Anne-Catherine Bajard, policy manager for Oxfam Canada. She believes that Canada should contribute vaccines to COVAX even before it has finished inoculating all its citizens, so as to be part of the global strategy that is needed to put an end to the pandemic.

If the government says it will pledge supplies but gives them only when it wishes, “it’s not actually submitting itself to a global strategy managed by health experts,” Ms. Bajard argues.

And economic self-interest should also act as another spur to generosity, suggests a recent study by the Rand Corp., which found that the United States, Europe, and other high-income regions would lose $119 billion a year in gross domestic product for as long as the poorest countries are denied vaccines. That is far more than the $25 billion it would cost to supply those vaccines.

Your nurse or my teenager? 

The WHO director-general appealed rather to ethical considerations last week, as he pleaded with wealthy countries to be more forthcoming. “It is not right,” he argued, “that younger healthier adults in rich countries are vaccinated before health workers and older people in poorer countries.”

In Israel, which leads the world in inoculation rates, everyone over the age of 40 is entitled to a shot, as are teenagers facing matriculation exams.

In Canada, at any rate, where the vaccination rollout has been unexpectedly slow, donating doses to other countries would be politically untenable at the moment. But nor have larger questions surrounding a future donation been addressed.

“In terms of the ethical dilemma, whether we allocate to front-line [health] workers first, before we allocate to our population, I don’t feel like any politicians or government leaders are really grappling with that,” says Liam Swiss, an aid and development researcher at Memorial University in St. John’s, Newfoundland.

In Canada, says Dr. Smith, people are generally in agreement that the most vulnerable people should be vaccinated first. But they do not apply the same thinking on a global scale.

Vaccination “is something that every person on earth has an equal claim to,” he adds. “Vaccines are going to be a scarce resource and we want to make sure they are distributed fairly among all the people in the world. And clearly, that’s not happening.”