As frustration in Canada grows over a slow vaccine rollout, there are countries around the world that have yet to administer a single dose.
Canadians may look with envy at the U.S., U.K. and Israel, where large portions of the populations have been able to get their first dose of the vaccine, but there are at least 49 countries where less than one per cent of the population have received their first dose, and more who are reporting no vaccine data at all, according to data collected by OurWorldinData.org.
Experts worry that with so few countries approaching herd immunity by mass vaccination, COVID-19 might be here to stay and could give way to variants that could evade our current vaccines.
On a global scale, Canada ranks in the top 40 for the percentage of the population that has received their first dose, and that’s not so bad, says one expert.
“We’re actually doing very well if you put it in the global perspective,” Alison Thompson, a public health ethicist at the University of Toronto, told CTVNews.ca in a phone interview on Wednesday.
And globally, countries shouldn’t want to battle it out for the top spot.
“I wouldn’t want to be doing the best at it right now, because that would mean that you are behaving in a way that is so nationalistic that it’s just sidelining everybody else,” she added.
On the one hand, she said, it would be difficult for politicians to convince Canadians to give up their doses to lower-income countries, but that’s not the only issue.
“The other problem is that we have just primarily treated this as a problem for markets to solve,” she said. And, you know, just said ‘let's just do business as usual’, and allocate vaccines based on the ability to pay.”
THE PROBLEM WITH COVAX
COVAX was put in place to ensure equitable rollout of vaccines. Higher-income countries funded COVAX to help get vaccines to 92 lower-income countries around the world. Canada put $440 million towards the program, half to secure doses for countries in need and half to secure doses for Canadian citizens.
Canada drew backlash for drawing upon COVAX for 1.9 million AstraZeneca doses in the program's first allotment of vaccines. Some political leaders and experts called the decision unethical
At the time of the COVAX controversy, Canada had provided first doses to more than 2 per cent of its population. As of April 13, the entire continent of Africa has provided first doses to 0.69 per cent of the 1.2 billion people living in African countries.
“This is a good example of vaccine nationalism,” said Thompson.
She said that despite helping fund COVAX, withdrawing from it erodes the government’s message of vaccine equity.
“I feel like that's undermined by the fact that we're now drawing from the correct supply to vaccinate our own citizens, so it's a bit of a mixed messaging in terms of where our priorities are,” she added.
The premise of a program such as COVAX is that every life is of equal value, but rich countries buying up millions of doses are not behaving in that way, Thompson said.
In many of the countries waiting on COVID-19 vaccines, they’re also facing other public health crises like Ebola, tuberculosis and HIV.
“That also speaks to the legacy of colonialism and racism and these structural inequities that are really, really impacting global health,” she added.
This could have been an opportunity for global governance in the vaccine rollout, said Thompson.
“With the exception of COVAX and just leaving it up to individual countries to determine how philanthropic they want to be, we really failed in terms of having any kind of global governance over the distribution, and even the manufacturing of vaccines,” she said.
The World Health Organization may seem like the natural home for this type of program, but Thompson said they no longer have the pull that they once held.
“They’ve had some black eyes recently,” said Thomspon. “With Trump saying that he’s pulling out of the WHO, they really kind of lack the clout anymore to be able to pull that off.
“This points to a real gap in terms of global governance and the authority of the WHO to sort of control this kind of situation, and obviously that has a lot to do with the power of international pharmaceutical companies as well.”
Even with a program like COVAX in place, rich countries, like Canada are buying up doses.
“The truth is, 10 of the richest countries in the world have really hoarded about 80 per cent of the vaccines,” Dr. Ivar Mendez, Provincial Head of Surgery at theUniversity of Saskatchewan and Saskatchewan Health Authority, told CTVNews.ca in a phone interview on Wednesday.
He said that the rate of vaccination in high-income countries is one in four or five, whereas in lower-income countries, like Bolivia where he is doing COVID-19 work, the rate is one in 500.
“We haven’t resolved this issue at a global level,” he said. “Part of the resolution is a more equitable distribution of vaccines around the world, because what is hindering us in the variants and those will be coming from the low-resource countries.”
Mendez said that when vaccine rollouts hit a snag in high-income countries, doses meant for low-income countries are often redirected to make up for the shortages.
Lower-income countries are also relying on vaccines that haven’t faced the same rigorous trials as those approved for emergency use by Health Canada. In Bolivia, they’re using the Chinese Sinopharm vaccine and Russia's Sputnik V.
“Poor countries are being pushed to vaccines that have not met the standards that are demanded by rich countries,” he said. “When in poor countries, there is absolutely no vaccine and you will take anything, rather than nothing, you know, high-resource countries have the luxury of choosing.”
Countries including Denmark and even Canada are able to pause use of the AstraZeneca vaccine without causing too many issues for their vaccine rollout because they can choose to purchase more doses of a different vaccine.
“Again, this is inequity. High resource countries choose the vaccine that they want, poor countries may be left with the vaccines that may not be as effective, and where the scientific data is yet to be seen, and they get hit harder and harder every time.”
With variants spreading globally, and vaccine rollouts chugging along, there’s the risk that more variants and mutations will take hold and be able to evade the current vaccines.
“Without equity on vaccination, we won’t be able to get out of this pandemic,” he said.
“If COVID-19 continues to rampage through the global south unchecked by mass vaccination, this radically increases the likelihood of yet more variants of concern emerging. There's always the possibility that the existing vaccines will not provide sufficient protection against future variants,” Bianca Dahl, a medical anthropologist with the University of Toronto, told CTVNews.ca in an email on Wednesday.
It doesn’t help that some countries are hoarding doses.
“Despite how slow Canada's vaccine rollout has been compared to the US, UK, Israel, and other countries, we are the single worst culprit of vaccine hoarding worldwide -- having ordered enough vaccines to inoculate our population five times over,” said Dahl.
Mendez said that this behaviour is self-defeating, since new variants will spread quickly in countries with fewer people inoculated, and borders won’t stop them from spreading.
For Dahl, inequitable vaccine rollouts around the world are largely leaving people of colour unvaccinated.
“When experts talk about vaccine apartheid, this isn't just a metaphor. It's a description of what amounts to racial segregation in access to and uptake of the vaccines, on both a global and local scale. If vaccine apartheid is not aggressively combatted, the COVID-19 pandemic will continue morphing into a disease primarily targeting people of colour across the globe,” said Dahl.
Canada has said it will donate its extra doses to countries in need, but there is currently no clear timeline on when that will happen. But, it’s not as simple as giving doses to other countries.
“This isn't just a question of simply getting doses to those countries, either. South Africa reportedly paid over twice as much as the European Union for the AstraZeneca vaccine. This adds to the inequities and the burden of this disease worldwide,” Dahl added.
In Canada, the vaccine rollout is targeting those who are most vulnerable to COVID-19 first, and for Dahl, this is how a global vaccination effort should work as well.
“We should be ensuring that all people worldwide who are most vulnerable are protected first,” she said. “The rapid spread of this pandemic has clearly demonstrated how interconnected the world is. Leaving the most vulnerable populations and countries to languish is in nobody's best interest.”
PHARMACEUTICAL FIRMS' ROLE
Part of the problem is that these vaccines are patented, preventing other companies from manufacturing them to boost supply around the world.
“A crucial first step is that we need to eliminate the intellectual property rights limitations on the manufacture of vaccines and on other scientific knowledge about COVID-19,” she said.
Until we can boost manufacturing of the vaccine, supply will struggle to keep up with global demand.
“We know from the HIV/AIDS epidemic that protecting pharmaceutical companies' intellectual property rights results in a body count: we need to mobilize all possible resources to manufacture and distribute these vaccines,” said Dahl.
Lower-income countries are calling for the ability to make the vaccines themselves, but patents are preventing that from happening.
“There's a call by the poorer countries to make the manufacturing process available to everybody, rather than being just secrets hidden from different companies,” said Mendez.
This stems from a deeper issue of how governments allow pharmaceutical companies to work.
“This is symptomatic of a much bigger problem with how we treat pharmaceutical products as private commodities instead of global public goods,” said Thompson. “That is the legacy of colonialism, and market failures and neoliberal policies around how we let these huge corporations behave.”
EQUITABLE VACCINE ROLLOUTS
Experts agree that the only way to end this pandemic is by achieving herd immunity through vaccination, but vaccine rollouts need a global lens.
“By definition a pandemic is a global event, and global events need global solutions,” Mendez said.
By prioritizing one population over another, countries are putting higher value on those lives.
“At the end of the day we are saying that Canadian lives are more important than the lives of other people in other countries where they can't access vaccines,” said Thompson.
With enough doses to vaccinate 154 million people having been ordered, Canada is directly contributing to the issue.
“The lower-income countries that are most harmed by vaccine nationalism and vaccine apartheid are also disproportionately the places that have been harmed by the legacies of colonialism and predatory structural adjustment policies,” said Dahl. “We in Canada are morally complicit in this problem.”