In his opening speech at the 148th session of the Executive Board on 18 January, the WHO Director General Dr Tedros Adhanom Ghebreyesus reminded the audience that inequitable access has been the norm over the last four decades. To illustrate his point, he pointed to examples of the delays in providing HIV treatments and, more recently, the H1N1 vaccines. It took ten years for HIV medicines to reach poor countries, and by the time swine flu vaccines were deployed to the poorest global citizens in 2009, the pandemic was over. According to Dr Tedros Ghebreyesus the present situation does not seem very promising—over 39 million COVID-19 vaccine doses have been administered in “at least 49 higher-income countries” compared with just 25 doses in a single low-income country.
There are logistical challenges for the vaccines’ distribution in many parts of the world, but these are not the only obstacles. With more than 50 signed bilateral agreements between countries and manufacturers it seems that the 2 billion doses for low- and middle-income countries that were secured as part of the Gavi COVAX Advance Market Commitment (AMC) mechanism are not a priority for delivery.
The WHO has called for a global priority list of vulnerable patients, the elderly and health workers, before vaccination is rolled out for other groups in individual countries. But is such altruism possible? Is it reasonable, or politically feasible, for countries to give priority to COVAX doses, before vaccinating their whole populations? It’s a question that high-income governments, and their treasuries, need to consider, as a recent RAND report estimated that unequal allocation of vaccines could cost the global economy up to US$1.2 trillion a year in GDP.
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