United Nations Independent Expert on human rights and international solidarity, Mr Obiora C. Okafor, released a statement urging global coordination and equitable sharing of the COVID-19 vaccines on the road to recovering from the pandemic.
Unequal distribution
Mr. Okafor’s statement points out that so far, the acquisition of the vaccine has been predominantly in richer countries of the Global North. In what he terms the “vaccine-divide”, the Global North has left little access for the 90% of the population residing in the Global South. Richer countries have, “acted in their perceived national self interest” in order to overcome the pandemic at home, irrespective of the situation in the Global South.
“This pandemic will not end for anyone, until it ends for everyone. The virus can still travel from the vastly unvaccinated massive population of the Global South to the Global North, including in its increasingly mutating forms. This would likely bolster or reignite the pandemic, even in states that have vaccinated large swathes of their populations, or otherwise complicate or delay the effort to end it,” said Mr. Okafor.
His suggestion is for countries to join into a globally coordinated vaccine distribution programme, which is “preferable over the individualised approaches adopted by all-too-many of the richer states.” The COVID-19 Vaccine Global Access Facility (COVAX) led by the World Health Organization (WHO), is aiming to provide equitable access to vaccines across the globe, fairly distributing two billion doses by the end of 2021. Mr. Okafor does note that many richer countries have contributed large sums of money to the COVAX programme, but “undermine its effectiveness” and the overall effort to bring an end to the pandemic for all people by engaging in vaccine hoarding.
Similarly, UN independent experts González Morales and Tlaleng Mofokeng have urged States to ensure that migrants are also included in national COVID-19 vaccination programmes, as global immunisation access for everyone who needs them “is the only solution” to ending the pandemic.
“The prioritisation of vaccines within countries should include all those who qualify under a priority group, regardless of who they are. Migrants should be granted access to vaccines on an equal basis with provisions for nationals,” they said.
They encourage international solidarity, equality and inclusiveness, calling for world leaders to avoid discriminatory discourse that may exclude certain vulnerable groups, such as migrants in difficult or irregular situations. The inclusion of migrants regardless of their status in another country is vital for both the migrant population and the host community, thus should be included in all stages of public health responses.
COVID-19 has a disproportionately negative effect on those who are in the most vulnerable of populations, with migrants falling into this category. Many migrants and refugees have little access to healthcare and sanitation, especially in overcrowded camps or temporary facilities. The International Organisation for Migration (IOM) estimates there are 272 million migrants worldwide, who are more vulnerable than others because of “personal, social, situational and structural factors.” Many who are already in crisis situations see their vulnerabilities exacerbated by the pandemic, particularly displaced persons. The majority of the world’s 41.3 million internally displaced persons and 25.9 million refugee populations are concentrated in developing countries. Turkey, Pakistan, Uganda and Sudan host the largest number of refugees, whilst Syria, Columbia, the DRC and Somalia have the highest number of internally displaced persons. This highlights the need for a fairer global distribution programme of the vaccine as stressed by UN experts.
Vaccine rollouts so far
In a historical effort to bring an end to the pandemic, four different types of vaccines have been approved. The most commonly distributed is the RNA vaccine, led by Pfizer-BioNTech and Moderna, with wealthy countries signing deals to buy roughly 600 million doses, accounting for nearly half of Pfizer-BioNTech’s total production capacity up to the end of 2021. The Oxford-AstraZeneca vaccine was authorised in December 2021, with the UK granting emergency use authorisation in Argentina, India, Dominican Republic, El Salvador, Mexico and Morocco.
The EU’s rollout of the vaccine has been slow and poor, with European leaders facing an emergency after AstraZeneca announced it will not be able to provide the number of doses to Europe that it had expected. The EU signed a £300 million deal and expected 80 million doses by the end of March 2021, but AstraZeneca has said that they can offer only 31 million, a 60% drop. The firm blamed the EU’s supply chain for this failure, but European leaders criticised this, having contributed funds to AstraZeneca to grow its production capacity.
European Commission President Ursula von der Leyen accused the company of “rowing back on a promise to use EU funds to ramp up its production capabilities.”
Faced with this problem, European countries plan to implement rules to force manufacturers in Europe to notify authorities when exporting the vaccines to a “third country”, a category which now includes the UK as it has left the EU.
Thirty-five million vaccines have so far been distributed to states across the US, but less than half of these have actually been injected. The US has had a slow vaccine rollout in conjunction with its overall poor pandemic response, as the country with the highest total cases and deaths in the world. An aid package of $8.75 billion was approved by Congress in December, with hopes that vaccine distribution will improve under the new President Joe Biden, who rejoined the WHO after taking office last week. Biden has voiced his intention to increase state funding, calling for a $25 billion package for vaccination manufacturing and distribution, as well as opening 100 federally funded vaccination sites and mobile units to reach people in remote areas. The Biden administration proposed releasing all available vaccine doses as soon as they become available despite delays in receiving second doses. This is similar to the UK’s response, where many key workers and priority groups have had their second vaccine shot delayed by up to 12 weeks.
China has offered priority access to Chinese-developed vaccines to African, Middle Eastern and South Asian countries. In December 2020, the Sinopharm vaccine, developed by a state-run firm in China and with a 79% efficacy rate, was approved for use by the government, but the government has been criticised for lack of transparency around the trials.
Regional giant India has begun the world’s biggest mass-vaccination programme with the Serum Institute of India, with plans to immunise 300 million people by July and distribute vaccines to its South Asian neighbours. It uses the AstraZeneca vaccine and one developed by local firm Bharat Biotech (Covexin). The Serum Institute and Bharat Biotech have a combined stockpile of 70 million vaccines, but turnout has been underwhelming and low due to fears over the vaccine and misinformation. Overall national turnout has been 64%, whilst in some states such as Tamil Nadu and Punjab turnout in the first two days of vaccination was 22% and 23% respectively. Covaxin has not completed phase three trials; making India one of the few countries rolling out a vaccine that is still in its trial stages and with no final data on its efficacy. This has attributed to the low turnout, with concerns from healthcare workers who were first to receive the vaccine.
Finally, Israel has seen the most success in distributing its vaccine to 20% of its population, however this has only been possible with the exclusion of occupied Palestinians from access to vaccinations. Over 4.5 million Palestinians, who already face restricted access to healthcare, live in the West Bank and Gaza Strip that is occupied by Israeli military forces. The 20% of the total population, who have so far been vaccinated, amounting to over 2 million citizens, includes Israeli settlers in the West Bank, but there are no commitments to providing vaccines to the Palestinian population as well. The vaccine rollout prioritised healthcare workers, at-risk groups and those over age 60, but also includes Palestinian citizens of Israel and residents of occupied East Jerusalem. Israeli authorities claim that responsibility for vaccinating the Palesitnain population in occupied West Bank and the Gaza Strip falls on the Palestinian Authority (PA), with Israel’s Health Minister telling Sky News that “they have to learn how to take care of themselves.”
“Israel’s duties under the Fourth Geneva Convention to ensure medical supplies, including to combat the spread of pandemics, are heightened after more than 50 years of occupation with no end in sight. These responsibilities, alongside its obligations under international human rights law, include providing vaccines in a nondiscriminatory manner to Palestinians living under its control, using as a benchmark what it provides for its own citizens,” said Human Rights Watch.
The obligations of the Palestinian Authority (PA) to protect the right to health of Palestianians in occupied areas does not absolve Israel of its responsibilities, they added. PA Health Minister, Mai Alkaila, announced on 9 January that the PA, the WHO and several companies have reached an agreement to procure a sufficient supply of the vaccines for Palestinians in occupied territory, but that there is “no specific date” for the arrival of any doses. The PA’s Foreign Minister has called on the international community to pressure Israel to provide vaccines to Palestinians in occupied territory, as the PA’s attempts to secure vaccines themselves does not remove Israel’s responsibilities under the law of occupation.
“The fact that Israeli citizens, including settlers in the West Bank, are receiving vaccines at one of the most rapid rates in the world indicates that Israel has the ability to provide the vaccines to at least some Palestinians in the occupied territory, but has chosen to leave them unprotected.” – Human Rights Watch
The international community should urge Israel to fulfil its obligations as the occupying power of the West Bank and the Gaza Strip and follow international law to provide vaccinations to Palestinian citizens. So far, efforts to rapidly vaccinate as many people as possible has accentuated the divide between the Global North and the Global South, but this must be lessened in order to protect vulnerable people in all countries and see an overall end to the spread of the virus. Countries in the Global North which have procured large supplies of the most commonly distributed vaccines should work with the COVAX scheme and the WHO, committing to a fair and equitable global health response to the pandemic.