The COVID-19 vaccine has been in our lives for a full year, and while it’s helped us move forward in our fight to defeat the pandemic — with just over 46% of the world being fully vaccinated — there remains a great number of people, mainly in low-income countries, who are struggling to access life-saving doses. 

We made several strides in this battle against the pandemic in 2021. Our understanding of the virus and ability to detect mutations has improved, and the very fact that we have vaccines as an effective weapon against COVID-19 means that we have a fighting chance against the pandemic. Plus, it’s a huge milestone that over 8 billion vaccine doses have been administered worldwide over the course of the year. 

While these positive movements towards defeating the pandemic should be applauded, vaccine nationalism and global inequality remain the largest challenges the world faces in this public health war. What’s unfortunate is that this was predicted almost a year ago, with health experts explaining that vaccine hoarding can only prolong the pandemic, and public health and world leaders calling for an equitable distribution of COVID-19 vaccines. 

“Allowing the majority of the world's population to go unvaccinated will not only perpetuate needless illness and deaths and the pain of ongoing lockdowns, but also spawn new virus mutations as COVID-19 continues to spread among unprotected populations,” World Health Organisation (WHO) Director-General, Dr. Tedros Adhanom Ghebreyesus, said in February.

However, despite these early warnings, not enough has been done by world leaders over the year to close the vaccine inequality divide. 

Vaccine nationalism, where rich countries hoarded more than enough vaccines to inoculate their populations while middle- and low-income countries scrambled to secure doses, is still ongoing, 12 months after the first COVID-19 vaccine was approved for use. 

Meanwhile, the predictions of Dr. Tedros and others have become a reality, as the world has experienced the Beta, Delta, and now Omicron variant mutations. So long as there remains inequality in access to vaccines, there is a high possibility that we will continue to see more variants emerge. 

Vaccine nationalism has robbed citizens in lower-income countries of essential access to life-savng health care, and needs to be dealt with in order for us to have a real shot at ending the pandemic once and for all. 

Here’s a run-down of the most significant vaccine equity issues that need to be addressed for us to effectively tackle the pandemic next year. 

1. Dose Sharing

This remains the most convenient way to provide those in need with access to vaccines. While wealthy nations such as the UK and Canada have fully vaccinated around 81% and 60% of their populations respectively, the entire continent of Africa, home to 1.3 billion people, is far behind, having fully vaccinated just 6% of its population. 

Wealthy nations, namely the G7 countries and EU member states, made commitments to share their excess COVID-19 vaccine doses with low- and middle-income countries in need. Some have made good on their promises, such as France taking the lead in April by being the first wealthy nation to donate its surplus doses to the COVAX Facility, and the United States having donated just over 260 million doses to those in need, the most of any donor country. However none have entirely achieved their intended commitments for this year, and several are way behind on reaching their donation goals. 

While booster shots are currently being encouraged as a way to tackle the Omicron variant, there remains a great deal of the world that has yet to receive their first dose. Wealthy countries have secured enough doses of the vaccines to both administer booster shots to their own populations, while continuing to ensure more vaccines reach low- and middle-income countries too, and they must prioritise this. 

2. Planning Dose Donations

The first step towards equity is that countries agree to share their excess doses in the first place. The second step however, is to make sure that vaccines are well-received. This year Africa has experienced last-minute vaccine donations and donations of doses that are soon-to-expire, resulting in complications for vaccine rollouts across the continent and the destruction of millions of much-needed doses.

Over the course of the year we’ve seen countries and private entities make huge pledges to distribute surplus vaccines or purchase vaccines for nations in need, however very few of them had secure plans to accompany their announcements. For example, while the UK pledged 100 million vaccine doses to countries in need in June this year, the country vaguely mentioned the end of September as a donation date, and failed to supply which countries would benefit.

The African Union, WHO, African Vaccine Acquisition Trust, and Africa CDC released a joint statement at the end of November, highlighting that this lack of planning has caused problems on the continent. 

“The majority of the donations to-date have been ad hoc, provided with little notice and short shelf lives,” the statement reads. “This has made it extremely challenging for countries to plan vaccination campaigns and increase absorptive capacity.”

“Countries need predictable and reliable supply,” they added. “Having to plan at short notice and ensure uptake of doses with short shelf lives exponentially magnifies the logistical burden on health systems that are already stretched.”

The statement also goes on to include a way forward for those seeking to donate to the continent; this includes recipient countries being made aware of dose donations not less than four weeks before they arrive in the country, and vaccines having a shelf life of at least 10 weeks from when they enter the recipient nation. 

3. SDR Allocation and Adequate Use of SDRs

History was made when the International Monetary Fund (IMF) announced the largest allocation of Special Drawing Rights (SDRs) — a financing source that can be traded between countries — in its history this year. The allocation of SDRs worth $650 billion was announced in August, and was described by IMF Managing Director Kristalina Georgieva as a “shot in the arm” for countries’ economies. 

“Countries can use the space provided by the SDR allocation to support their economies and step up their fight against the crisis,” Georgieva said. 

The allocation of SDRs is a huge win for getting the world back on track, however, the way the reserve asset is distributed currently does not benefit the most vulnerable countries. The structure for SDR allocations is unfair, as wealthier member countries that have a bigger share of quotas in the IMF and likely do not need most of their SDR allocation, will receive larger shares of SDRs.

Poorer countries need SDRs most, not only to keep their economies afloat, but also, and most crucially, to purchase much-needed COVID-19 vaccines, tests, and treatments for their populations. However, these countries have the least amount of SDRs to work with. 

In order to even this out, wealthier nations — namely members of the G20 — will need to share their SDR allocation with vulnerable ones that do not have the national funds to fight the pandemic on their own. Some member countries have committed portions of their SDR shares to nations in need, however these shares will not yet be enough to assist and sustain poor countries. You can read more about how SDRs can be used for a global recovery here. 

Once SDRs have been allocated, there needs to be accountability on the part of recipient countries in need. According to an International Budget survey, COVID-19 funds in some countries in Asia and Africa have not been managed appropriately, with funds going into pre-COVID debts and some unaccounted for entirely.

Transparency will be key to ensure SDRs are being used to protect the vulnerable from the pandemic, and that is why Global Citizen is not only calling for the G20 nations to share their SDR allocations, but also for African nations to commit their SDRs to purchasing vaccines.

4. Prioritising People Over Profit and Waiving Patents

Much can be said (and has been said) about the role that wealthy nations have to play in ensuring vaccine equity, however, a huge sector that also needs to be held accountable is the pharmaceutical industry responsible for producing vaccines. 

Pharmaceutical companies have a lot of power in making sure that everyone, everywhere has access to doses. Two things that they can do in ensuring vaccine equity is continuing to work directly with the COVAX Facility to provide doses for vulnerable nations, and most importantly, sharing their patents and supporting technology transfers so that manufacturing sites can be established in developing countries. 

Vaccine donations, while important, are not enough to end the vaccine drought in middle- and low-income countries, and also come with their fair share of complications as highlighted above. These nations need direct access to vaccines and the independence to provide their populations with the life-saving medication, rather than waiting on charity from those who can afford it.

While there has been a global call — led by South Africa and India — for Big Pharma to waive their patents on vaccines, pharmaceutical companies have been headstrong in not giving up intellectual property that they are notably making billions of dollars in profit off of. This is despite the fact that vaccine supply would increase exponentially for countries that need them most, not just for this health crisis, but many others. 

In order for vaccine equity to be achieved, developing nations need to be supported in their pursuit of manufacturing vaccines on home soil. This starts with wealthy nations supporting the TRIPS Waiver, and pharmaceutical companies sharing the knowledge and technology needed for these countries to produce doses. You can read more about the TRIPS waiver and what pharmaceutical companies need to do to support vaccine equity here.