The world needs vaccine equity, not charity
Article content
Second in a two-part series on vaccinating the world..
Global vaccine equity should be viewed by the world’s wealthy nations as an investment in the health of their own citizens, not as an act of charity.
What is the link between vaccine inequity and the emergence of the Omicron variant of concern?
“I don’t know that anybody fully has the answer to that,” Jason Nickerson, the Médecins Sans Frontierès (MSF) humanitarian representative to Canada, replied. “We don’t know enough about this variant to say definitively one thing or another about how or where it originated.”
However, throughout the COVID-19 pandemic, the World Health Organization, MSF and public health experts have been warning that leaving large segments of the global population unvaccinated could lead to “variants emerging that are more dangerous, more harmful and potentially evade the vaccines that we have in use,” Nickerson told the Whig-Standard in a telephone interview.
“Whether that what’s happened here or not, I don’t think we can say definitely, but vaccine equity has always been about doing the morally correct thing. But also vaccine equity has always been a sound public health strategy.”
Switzerland recently became the first country to trade places with COVAX in manufacturers’ supply queues. Is this a significant development or a drop in the bucket?
“I think it is significant,” Nickerson answered. “The reality is that the shipment of millions of doses protects millions of people. That’s not an insignificant thing.”
Nevertheless, vaccine inequity “is not a problem that charity is going to fix,” Nickerson asserted. “The sustainable solution that the world needs is to be utilizing all the available manufacturing capacity in all parts of the world to produce the true number of doses that are actually required.”
Canada and vaccine inequity
On Twitter, you stated that Canada adopted a “first-dose-fast” approach domestically but not globally. What did you mean by that?
Nickerson explained that Canadian public health officials adopted a strategy of “getting first doses into as many eligible arms as possible before moving on to second doses for some.” The strategy was to protect as many people as possible from severe illness and reduce transmission of the virus, said the MSF representative, who is also an adjunct professor in the department of health, law, policy and ethics at the University of Ottawa.
“That same strategy and that same logic should be applied globally, but that’s not what the world decided to do. The world decided to prioritize first and second doses for people in high-income countries before even at-risk people in most low-income countries had their first dose.”
As a result, much of the world has been left unprotected, Nickerson added.
Major problems with donations
Donations of vaccine doses to Africa are often executed in ways that cause major problems for recipient countries.
Last month, those problems were addressed in a joint statement issued by the African Vaccine Acquisition Trust (AVAT), the Africa Centres for Disease Control and Prevention (Africa CDC) and COVAX (the international vaccine acquisition facility). According to the statement, “the majority of the donations to date have been ad hoc, provided with little notice and short shelf lives.” And unpredictable deliveries make it difficult for recipient countries to plan vaccination campaigns and administer the doses in a timely fashion.
Short shelf life of vaccine donations creates logistical burdens for recipient countries and can lead to the expiration of doses. And an unpredictable supply creates bottlenecks and forces African countries to redirect scarce resources from other initiatives.
The joint statement calls upon donors and manufacturers to adhere to a new standard for donations as of Jan. 1, 2022. For example, donors should ship doses in large and predictable volumes. The shelf life of the doses should have a minimum of 10 weeks after they arrive in the recipient country. Recipient countries should be given at least four weeks advance notice of shipments.
What does MSF say about the joint statement?
“We know from experience that vaccination campaigns can be difficult,” Nickerson replied. “They’re logistically complex, and they take time to plan.”
“I think that these are extremely reasonable expectations,” he said of the joint statement. “If the world is serious about making good use of all available doses, then we need to recognize that you can’t just simply dump tens of millions or hundreds of millions of doses close to expiry in other countries and hope for the best.”
Booster shots
According to the Government of Canada website, as of Dec. 2 Canada’s central vaccine inventory held 10,927,470 COVID-19 vaccine doses. Expiration dates were not available.
Does it make sense to use the doses in Canada’s central inventory for second and third shots for Canadians? Or should Canada donate them to Africa?
“I really don’t know,” Nickerson replied candidly. “That really depends on many, many moving pieces, like how quickly doses can be moved from one place to another, how close to the expiry date they are, and so on. I really don’t have a very good answer to that question, unfortunately.”
When Canada takes new deliveries from vaccine manufacturers, should Canada automatically set aside 10 per cent or 20 per cent of the doses and send them right to COVAX instead of putting them in freezers?
“I think that is generally easier for doses to go from the factory to the country where they are going to be delivered,” Nickerson answered. “UNICEF is one of the organizations that has been calling for a percentage of all shipments of vaccines going to high-income countries to be automatically going to COVAX.”
Nickerson wants to know what Canada is going to do with the millions of doses in its freezers. “It goes without saying that vaccines in freezers do not produce antibodies,” he said. “What is the plan here? The absolute worst thing that could happen is for these vaccine doses to be allowed to expire in a freezer.”
In addition, Nickerson pointed out that “there are more doses sitting in freezers in the central vaccine inventory than Canada has donated to COVAX or bilaterally.” And he is “not entirely sure why Canada continues to accept shipments of millions of vaccine doses that are going to be sitting in freezers.”
As of Nov. 22, “over 8.3 million surplus vaccine doses have been delivered so far through the COVAX Facility,” the Government of Canada website reads. “Canada has also shared 762,080 AstraZeneca doses through direct, bilateral arrangements with countries in Latin America and the Caribbean.”
For Nickerson, this is the bottom line: “Vaccines should be used to vaccinate people who are at risk and are currently unprotected, whether they are people in Canada or somewhere else. They need to be put to use.”
Given all the anti-vaccine disinformation that circulates on social media, it is important not to discourage Canadians who need third doses from getting them.
What is MSF’s policy on third doses for Canadians who are vulnerable?
“The choices that need to be made are choices about the ways in which vaccines are manufactured, distributed and ultimately used in countries. I think, of course, Canadians need to listen to public health advice and to the advice of their physicians. And so we need to do the things that we know work to protect them. I, similarly, don’t want to discourage people from getting vaccinated. … It’s really fundamentally a problem about manufacturing and distribution as opposed to purely a focus on third doses,” Nickerson said.
Follow Geoffrey P. Johnston on Twitter @GeoffyPJohnston.