The Covid-19 pandemic has highlighted the importance of managing outbreaks of infection as a global community. Many important advances have been made by countries together, including a range of highly effective vaccines to prevent serious illness and death.
But the extent of inequality in countries’ access to the vaccine stands in stark contrast to these achievements and will likely be seen as the biggest failure in the response to the Covid-19 pandemic. This is the clear message from United Nations Secretary-General António Guterres, who told the United Nations General Assembly this week: “We have passed the scientific test, but we get an F in ethics.
Ireland is one of the lucky ones. It has achieved an impressive level of immunization coverage (90 percent of the eligible population). However, only 30 percent of the 7.9 billion people in the world are fully immunized. This figure drops to just 3% when you consider the 648 million people living in low-income countries.
Leaving a large portion of the world’s population unvaccinated […] creates ideal circumstances for the generation of viral mutations
The World Health Organization (WHO) has set global immunization targets, starting with 10% coverage by the end of September 2021. This is the level required to protect the most vulnerable in populations – those groups that worried us in Ireland at the start of the pandemic like the elderly. In low-income countries alone, achieving even this critical first goal requires the administration of approximately 52 million immunization courses.
In Ireland, we’ve learned that delays can dramatically change the trajectory of the number of virus cases and deaths. Those of us who work in infectious specialties have seen this before. The reluctance to roll out HIV treatment to Africa in the early 2000s led to millions of additional infections and associated deaths, the legacy of which we still grapple with today. History is repeating itself with Covid-19, where we now have an extremely effective intervention to prevent death but which is not accessible in low-income countries.
Healthcare workers – already a scarce resource in the Global South – risk their own health every day by going to work, knowing that their colleagues in richer countries have long enjoyed the protection of a vaccine.
Leaving a large portion of the world’s population unvaccinated, with subsequent viral replication and transmission, creates ideal circumstances for the generation of viral mutations. In a world increasingly interconnected economically, politically and socially, allowing transmissions and deaths to continue is exacerbating the impact of the global pandemic on everyone.
The ability to access vaccines has been uneven for countries in the South from the start. Those who wanted to buy vaccines were overtaken by the great powers of the Global North. Covax was created with the aim of supporting equitable distribution of vaccines, but donations from participating countries (which may have received Covax vaccines themselves) have been significantly lower than their pledges.
The hoarding of vaccines by rich countries is part of the problem; the British Medical Journal reported in August that only 10 countries could have an accumulated surplus of 3.8 billion doses of Covid-19 vaccine by the end of the year. Many countries have already started to extend booster doses to the general population, often from a perspective that overlooks international priorities.
Doctors know that choosing not to act is a conscious decision. We call on the government to choose to act in this global health crisis.
Current levels of donations will not provide the number of vaccines needed and will only serve to worsen a power imbalance between rich and poor countries built on paternalism and dependence; the foundations of colonialism.
It is essential that booster programs consider the risk of vaccine diversion from global populations that have not yet been vaccinated
Strict international intellectual property rules currently block vaccine production. The Trips (Commercial Aspects of Intellectual Property Rights) waiver is a temporary suspension of intellectual property designed for use in situations like this, where global security is threatened and is already supported by many countries, including states. -United. As pointed out in Nature in March: “Perhaps the strongest argument in favor of a temporary waiver is that patents were never designed for use in global emergencies such as wars or pandemics. “
Ireland has a reputation for defending human rights globally and for showing solidarity with the world’s most vulnerable people. We call on the government to listen to the experts and to follow the unequivocal advice of the WHO.
We ask him to support the Trips waiver at the World Trade Organization summit in November, and to approve the Covid-19 technology access pool, in order to facilitate the sharing of know-how by pharmaceutical companies .
We urge him to ensure that future vaccine purchases for the Irish are rational and as needed, so that they do not go to waste. Finally, it is essential that booster programs take into account the risk of vaccine diversion from global populations that have not yet been vaccinated.
One of the most important jobs of a physician is to advocate for patients, fulfilling our responsibility to prevent harm without harm. We call on the government to use its high international reputation to show leadership in facilitating access to vaccines for all.
Dr Christine Kelly is an infectious disease physician, clinical researcher in public health virology and a founding member of Doctors for Vaccine Equity