Epidemics are complex events: complex in their origins, their spread, their effects and their consequences – which can be at one and the same time medical, social, political and economic.
The global impact of a single pathogen may vary significantly between settings and there is no one-size-fits-all intervention strategy.
Equity and solidarity issues are often part of the picture: access to medical countermeasures remains difficult, especially for low-income countries and countries facing humanitarian emergencies, and this difficulty is worsened when vaccine or treatment production is limited.
Recently, our Prime Minister Dr Keith Rowley, who is also Chairman of CARICOM, called for the equitable distribution of COVID-19 vaccine resources for the benefit of all nations.
Dr Rowley made the call while addressing the World Health Organization’s Media briefing on COVID-19 Thursday 18th February 2021.
Rowley said that while there is an understandable rush to receive vaccines, small island states “are more than a little bit concerned that there is, or is to be, hoarding and price gouging as well as undue preference in some quarters.”
A 2018 WHO report stated that market mechanisms do not ensure a fair distribution of resources based on public health demands.
Global mechanisms are needed to ensure fair access to life-saving interventions during crises. A number of organizations are dedicated to this goal (among them are CEPI,
the Coalition for Epidemic Preparedness Innovations; the International Coordinating
Group; GAVI, the Vaccine Alliance; the Pandemic Influenza Preparedness Framework) but more
efforts are required.
In September 2020, WHO pushed countries to sign up for a plan that will buy a vaccine in huge quantities and distribute it in an equitable way. But it grappled with two big issues: how to get the high-income countries to join, instead of hoarding early vaccine supplies for their own populations; and how to share the vaccine in a fair way.
WHO’s “fair allocation mechanism” proposed distributing vaccine in two phases. In the first phase, all countries would receive vaccine proportional to their population; initially enough vaccine to immunize 3% of their population, with the first doses going to frontline workers in health care and social care. Then, additional vaccine would be delivered until 20% of a nation’s population is covered. WHO envisaged that these doses would be used to immunize those at the highest risk from COVID-19: elderly people and those with comorbidities.
In the second phase, vaccine to cover additional people would be delivered to countries based on how urgently immunizations are needed.
Ezekiel Emanuel, a bioethicist at the University of Pennsylvania, criticized WHO’s approach in the first phase. Countries with the biggest need should be at the top of the list from the start, he says. He compares the situation to a doctor facing an overflowing emergency room. “The doctor doesn’t go out into the waiting room and say: ‘I’m giving 3 minutes to everybody sitting in the waiting room.’ The doctor says: ‘All right, who’s got the most serious illness? … I’m going to attend to you first.’” At the moment, he notes, sending vaccine to South Korea, New Zealand, or many African countries would not do much to reduce deaths from COVID-19 because these nations have low case rates; he says the vaccine could be put to better use elsewhere.
Last month the head of the WHO Dr Tedros Adhanom Ghebreyesus pointed out that fewer than five dozen total doses of the vaccine had reached one poorer country, while richer nations obtained millions. In the U.S., a Kaiser Health News analysis of state health department data shows that Black Americans — who have been dying of COVID-19 at higher rates than others — are getting vaccinated at lower rates so far, among a host of early issues that include an inadequate supply.