How vaccine equity will get us back to "normal" sooner

A consistent approach to vaccinating those most at risk should not be defined by our borders but a shared global priority for human recovery.

This briefing is by Rudayna Bahubeshi and Leonardo Lozano. Write us at newsletterthebell@gmail.com

AS COUNTRIES STRUGGLE TO VACCINATE their populations as quickly as possible, global pressure is rising on high-income countries to ensure the purchasing, allocation, and delivery rollout is equitable. Accordingly, a number of high-income countries — including the U.K., Canada, and Germany — have pledged approximately $960 million USD to COVAX, a global vaccine-sharing initiative. Yet Canada didn’t do itself, or the basic principles of the program, any favours when (somewhat counterintuitively) it announced it will be tapping into COVAX for domestic use, in response to sluggish vaccine delivery. 

Countries are facing moral decisions domestically and abroad. They must strike the balance of an effective and ethical global strategy while meeting the needs of domestic populations, which also requires a calculated and equitable approach. In this piece we want to focus on three areas in which this conundrum of vaccine equity plays out: the vaccination of those who are incarcerated; strategies for reaching out to communities who have good reason to distrust the health care system; and finally, the challenge of “vaccinationalism”. 

Equitable access to vaccines should be prioritized in dose allocation as well as delivery, which in part means reckoning with systemic discrimination in health care. With more immediate vaccine allocation, one of several populations to closely consider is those who are incarcerated. Phase one of the Canadian vaccine rollout includes a plan to vaccinate 600 federal inmates, who are elderly or at higher health risk. Despite this only amounting to five percent of the federal prison population, politicians including Erin O’Toole and Ontario Premier Doug Ford lambasted the federal government

Correctional facilities are high risk for outbreaks. Not only are they often densely congregated settings, but some inmates continue to report lack of access to masks, gloves, and sanitizer. At one correctional facility, Stony Mountain Institution in Manitoba, it was recently reported nearly half of inmates have had COVID-19 (more data on federal institutions here). Although some provinces have recognized the need to expedite access to vaccines to those incarcerated, in many cases plans have yet to be seen. Provinces should also look at greater efforts to decarcerate to limit harm and prevent further risk of COVID-19.

The Canadian Civil Liberties Association has pressed for further action from provinces and territories. In talking to Max Bell students last month, Special Advisor to the WHO Director-General, Dr. Peter A. Singer highlighted it is critical the same level of care is delivered to all in Canada, including those inside of prisons, and that we must consistently follow empirical evidence and use the same measures of risk analysis. He also emphasized that vaccine distribution should be an opportunity to address inequities in how COVID-19 is being experienced, and not further perpetuate them. This is especially relevant to incarcerated populations when we consider the way some communities are over policed and over criminalized. The outcome of this is that Indigenous and Black populations are starkly overrepresented.   

In addition to the provision of doses, culturally competent care and targeted strategies for distribution are also going to need to be considered. A December Angus Reid poll indicated that there continues to be notable reluctance among Canadians to receive a vaccine. There is understandably significant frustration with false news and anti-vaccination campaigns. But it is also important to bring nuance to this data because for some, reluctance may be steeped in a history of poor health care experiences. In fact, several medical experts, politicians, and researchers have highlighted how experiences of racism, including incidents resulting in irrevocable harm and fatalities, in health care have degraded trust and accessibility, which can be leading to vaccine hesitancy. 

There have been many calls for eradicating systemic discrimination and delivering culturally competent care over the years, including from health experts and researchers. These calls for changes in health care can also be found in the Truth and Reconciliation Commission’s Calls to Action, which highlights a need for anti-racism training in medical and nursing schools. So, while urgency for anti-racist, culturally competent care is not new, the stakes and need are particularly high, as Black, Indigenous and racialized populations have disproportionately experienced COVID-19. Some are seeking to bridge gaps through community focused town halls to address vaccine concerns, community-led city-wide strategies, and community partnerships with hospitals. More initiatives such as these are required.

Domestic vaccine equity challenges demonstrate social and economic gaps that are also visible on the global stage. The dynamics are different, but there are common challenges of inequity and who-goes-first, as well as the need for strategic approaches.

By the third week of 2021 the WHO’s Director General, Dr. Tedros, expressed concern that out of the 52 countries who started vaccine programs, very few were low-income countries. More concerning is that only 25 individual vaccine doses out of 60 million administered internationally were in low-income nations. This tangible asymmetry was called by the Secretary-General of the UN “an absence of a global coordinated effort.”

As some countries try to handle the global challenge, distribution inequity is contradicting the WHO’s target to vaccinate all health workers and high-risk groups of its 192 country members before April 7th. The UN has emphasized the need to avoid “vaccinationalism,” which could delay global recovery. However, some leaders are defending their actions to vaccinate their populations before providing support to other nations. At this rate, more than 85 low-income countries will not have sufficient access to COVID vaccines before 2023 and many African countries, among others, are expected to be some of the last states to have full access to vaccines. The main obstacles to the low-income countries are the distribution barriers for rollouts, health, and communication infrastructure limitations, but most importantly a power dynamic forcing them to rely on international support. 

Some state leaders may be betting that by inoculating their entire population first, they could restart their economies more quickly. However, Dr. Peter Singer highlighted that “there is only one way to restart the global economy, and that is to deal with the public health problem.” A recent study from the National Bureau of Economic Research confirms this, stating that the “global GDP loss of not vaccinating all the countries, is higher than the cost of manufacturing and distributing the vaccines globally.” So, even if all high-income countries vaccinate their entire populations, they will still carry the costs of the global pandemic on their economies. 

We all wish to go back outside, visit our loved ones, see businesses reopen, and attend social events. But at this pace, with this social disarray and anxiety to get vaccinated, readjustment could take longer. Everyday we are tested to stay at home, wear a mask, and keep our distance. We should also challenge our leaders to vaccinate those experiencing the most risk first and work with global accountability. If we agree to wait for our turn, and prioritize access to vaccines to those who need it most, we may have the chance to go back outside sooner. (RB, LL)

Rudayna Bahubeshi works in the nonprofit sector, with a focus on racial, gender, and economic justice. She is currently completing her MPP at McGill University’s Max Bell School of Public Policy. She has written for several publications, including the CBC and TVO. She resides in Tkaronto.

Leonardo Lozano holds a MSc. in Science, Technology and International Development from the University of Edinburgh and is currently completing his MPP at the Max Bell School of Public Policy at McGill University. He worked as a social and energy policy advisor at the Mexican Secretary of Energy. Presently, he is the Vice-President of Academics at the Public Policy Association of Graduate Students (PPAGS), and resides in Montreal.

Related: Last month, Max Bell Policy School students had the opportunity to discuss COVID-19 policies with the Special Advisor to the WHO Director-General, Dr. Peter A. Singer

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The Bell is edited by Emily Nickerson, Mariel Aramburu, and Andrew Potter of the Max Bell School of Public Policy at McGill University. If you have any feedback or would like to contribute to this newsletter, please send an email to the editors at newsletterthebell@gmail.com