Addressing vaccine equity and hesitancy

With recent announcements from Pfizer/BioNTech, Moderna, and Oxford/AstraZeneca reporting the high efficacy of their coronavirus vaccines, the likelihood of having a vaccine by next year has increased significantly, offering hope for all of humanity that the pandemic will come to an end.

However, leaving aside the challenges of vaccine distribution and logistics—of which there are many—there are two major issues that must be addressed if low- and middle-income countries (LMICs) are to benefit from the vaccines.

First of all, addressing equity—that is, making sure that people get it regardless of status or ability to pay. Already, there are reports that high-income countries have pretty much gobbled up the vaccines supply, leaving the rest of the world competing for what’s left, or having to wait longer. According to the Duke Global Health Innovation Center, approximately 6.4 billion doses of potential vaccines have already been purchased, with the vast majority of these doses going to high-income nations. Experts are thus echoing concerns that COVID-19 vaccines may not reach LMICs in time, or in doses sufficient for mass vaccination. Lest we forget, wealthy nations dominated vaccine supplies during the 2009 influenza A (H1N1) pandemic.

Despite initiatives that recognize the need to ensure global supply, “vaccine nationalism” has prevailed in many parts of the world. For instance, the US and Russia have rejected the WHO COVID-19 Vaccines Global Access (Covax) Facility, a global effort that assists in developing and distributing COVID-19 vaccines equitably. China, on the other hand, has taken a somewhat vague stand by praising the aims of Covax while refusing to commit to the project. While it is completely understandable that leaders feel obliged to “protect their people first,” the response to this pandemic must be collective, and no country is truly safe until all are safe.

To overcome this, nations should work together in demanding greater equity in accessing vaccines. The Covax initiative by WHO is one good example. At the regional level, Asean can play an important role to ensure that its members are not left out, including in terms of the capacity to distribute vaccines. Likewise, Asean should capitalize on its existing capacities; the region hosts two of the world’s top 20 largest vaccine exporters—Indonesia and Singapore. Meanwhile, vaccine development and trials have commenced in Indonesia, Thailand, Singapore, and Vietnam.

Even if countries manage to acquire vaccines, there is the question of who gets them first. In this, of course, health care workers should be prioritized, as well as those with high risks of exposure and vulnerability. Given today’s vast inequities within countries, it will not be surprising if vaccines are more easily accessed by the higher socioeconomic groups at the expense of those with greater needs. This can result from a lack of local distribution policies and regulations, or weak enforcement of those regulations, plus weak health systems and systemic corruption.

But even if people have the opportunity to receive the vaccine, they may refuse it, and this brings us to the second challenge: vaccine hesitancy. A recent global survey across 19 countries found approximately 30 percent of their respondents disagreeing with, or having no opinion of, COVID-19 vaccination. A more recent survey in the Philippines showed that just 66 percent of the population is willing to get a COVID-19 vaccine.

This is disturbing, and calls attention to the mistrust people have for political and medical institutions. Without a concerted communications plan to address people’s fears and misconceptions, hesitancy can easily worsen. It is worth noting that anti-vaxxers have long been using the massive attention on COVID-19 to propagate disinformation.

The risk of vaccine hesitancy also underscores the importance of not rushing the vaccine, despite our collective desperation to have them. As what happened to the Philippines with the dengue vaccine, any scandal can undermine the global vaccine effort.

Of course, vaccines are not the only solution to the pandemic. Lives still need to be saved each day without it. But if we are to make the most of vaccination, we must ensure two things: First, that the vaccines are equitably distributed among and within countries. Second, that we continue to build trust by reaching out to people, in order to address their doubts and fears.

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Raudah Yunus is a researcher, writer, and social activist based in Kuala Lumpur. Gideon Lasco is a physician, anthropologist, and Philippine Daily Inquirer columnist.