Global Community Takes a Shot at COVID-19 Vaccine Equity

By Joanne Lu

On February 24, Ghana became the first country outside India to receive COVID-19 vaccine doses as part of a global initiative, called COVAX, to provide equitable access to the vaccines, particularly in low-income countries.

“This is a historic step towards our goal to ensure equitable distribution of COVID-19 vaccines globally, in what will be the largest vaccine procurement and supply operation in history,” the World Health Organization (WHO) said in a press release.

Since then, more than 16 million COVID-19 vaccine doses have been shipped to 27 countries through the COVAX initiative, according to a March 18 update from the WHO. In Africa, 25 million vaccines have been sent to 38 countries through COVAX, bilateral deals and donations, and 30 of those countries have started vaccination campaigns.

While these developments are certainly cause for celebration, they come as some of the world’s richest countries have purchased a surplus of more than 1.2 billion excess doses, according to The ONE Campaign. Canada, for example, has secured enough vaccines to immunize its population five times over. For comparison, nearly 7 million doses have now been administered in Africa, while the U.S. surpassed that number in just four days.

Meanwhile, the majority of low- and middle-income countries have had to “watch and wait,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus wrote in the Guardian. In mid-February, the UN reported that 2.5 billion people in 130 countries still had not received a single vaccine dose.

Even Ghana – which opted to administer its 600,000 AstraZeneca/Oxford vaccines to 600,000 people as their first dose, instead of to 300,000 people as their two recommended doses – still has to trust that its government or COVAX will come through in time with enough vaccines to give people their second doses. With Ghana’s government planning to vaccinate 20 million people by the end of October (meaning 40 million doses), the shipment on February 24, though “historic,” was still a just small step that should have happened much, much sooner.

The rush by wealthy countries to secure first access to vaccines has been dubbed “vaccine nationalism,” which the WHO and others have condemned.

“Even as they speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue,” Dr. Tedros said in January. “This is wrong.”

Additionally, experts warn that vaccine nationalism will slow recovery – both from the virus and its economic effects.

“[Vaccine nationalism] is a problem morally. It’s a problem in terms of public health, because we need to vaccinate more widely in order to tackle issues like the barriers. And it’s bad news in terms of the economic impact as well,” Mark Suzman, CEO of the Bill and Melinda Gates Foundation, said in February.

The Gates Foundation helped set up the COVAX Facility and has also funded vaccine, therapeutics and diagnostics research and development. Suzman says that some of the modeling supported by the Gates Foundation shows that there’s going to be “much longer, lingering economic damage” if vaccinations are concentrated in wealthy countries and not distributed evenly.

According to the World Economic Forum, high-income countries and regions, including the U.S., the U.K., and the European Union, could lose around $119 billion per year, until a global recovery is secured.

“A me-first approach might serve short-term political interests, but it is self-defeating and will lead to a protracted recovery, with trade and travel continuing to suffer,” wrote Dr. Tedros in the Guardian. “The threat is clear: As long as the virus is spreading anywhere, it has more opportunities to mutate and potentially undermine the efficacy of vaccines everywhere. We could end up back at square one.”

According to the WHO, there’s a lot that countries and companies can do to promote equitable vaccine access, including dose sharing, technology transfer, voluntary licensing, and waiving intellectual property rights. Oxfam has called for a “People’s Vaccine,” one that is “mass-produced, fairly distributed, and made available to every individual, rich and poor alike.” A People’s Vaccine, the organization says, would “unlock the production of billions more doses in the shortest amount of time and ensure access for everyone, everywhere across the globe.”

Meanwhile, the Fred Hutchinson Cancer Research Center has stepped up to serve as the coordinating center for vaccine clinical trials of the COVID-19 Prevention Network (CoVPN) to continue developing vaccines, even though there are a few options on the market already.

“We need multiple successful vaccines to protect the entire global population from COVID-19,” said Dr. Larry Corey, former president and director of Fred Hutch, who will co-lead the CoVPN’s vaccine testing pipeline.

While vaccine development and manufacturing continues to ramp up, organizations like Americares are also working hard to support “vaccine readiness.” Gavi, the Vaccine Alliance, says that a country’s vaccine readiness can be assessed on four fronts: awareness of evidence-based information; acceptance of the new vaccine; accessibility to the vaccine, especially in the hardest to reach places; and availability of infrastructure to store and deliver vaccines. In particular, Americares is tackling misinformation head-on, with weekly Q&A videos about COVID-19 vaccines and other resources.

Mercy Corps’ CEO Tjada D’Oyen McKenna says that important lessons about building public trust can be drawn from past Ebola outbreaks. In Liberia, for example, Mercy Corps helped train more than 15,000 community messengers to help combat misinformation in their own communities, reaching more than 2.4 million people. (That’s over 56 percent of the population.)

Mercy Corps is especially concerned about the vaccine reaching people in conflict zones, where the pandemic tends to take a back seat to other basic needs that feel more pressing, suspicion and misinformation thrive, and violence has destroyed infrastructure for vaccine delivery and threatens the safety of health workers. In late February, the U.N. Security Council passed a resolution demanding “vaccine ceasefires” in conflict zones.

Similarly, organizations like Medical Teams International are advocating for migrants and refugees to be included in vaccination campaigns in countries like Colombia. Closer to home, Medical Teams International is getting together equipment, like freezers, to distribute vaccines in Washington state.

Of course, effectively executing the largest global vaccine rollout in history requires working closely with local leaders. CARE’s comprehensive two-year vaccine initiative will support national, regional, and local governments with logistics, public education and strategies to ensure fast and fair vaccine distribution.

VillageReach also participates daily in Ministry of Health-led response efforts, including vaccine planning. Recently, Mozambique received its first shipment of vaccines. VillageReach will support the Mozambique Ministry of Health with the supply chain planning and logistics, as well as training vaccinators. With its organizational mission of reaching the last mile, VillageReach knows all too well the importance of working with community health workers, like vaccinators, to reach even the most remote places.

PATH – which supports the Serum Institute of India, manufacturers of the Oxford/AstraZeneca vaccines that are being shipped through the COVAX Facility – also recognizes the critical role of vaccinators. That’s why even before the COVID-19 pandemic, PATH’s Living Labs Initiative was working with frontline health workers to understand the day-to-day challenges that prevented them from achieving their immunization targets and professional goals. Now, insights from these health workers are helping to optimize labeling for COVID-19 vaccines, informing local adaptations to WHO’s training guidance for health workers, and supporting the ministries of health in Kenya and Zambia as they develop vaccine plans.

“We know from experience that when we listen to health workers, they identify challenges—and solutions—that no one else sees,” says Dr. Joseph Kayaya, lead product manager with PATH’s Living Labs Initiative.

In Africa, the experience and expertise of health workers is on full display right now as vaccination campaigns there have covered a lot of ground quickly – despite receiving late shipments of limited doses.

“This is due to the continent’s vast experience in mass vaccination campaigns and the determination of its leaders and people to effectively curb COVID-19.” said WHO Regional Director for Africa Dr. Matshidiso Moeti in a press release. “Compared with countries in other regions that accessed vaccines much earlier, the initial rollout phase in some African countries has reached a far higher number of people.”

Although the vaccine rollout so far has been slow and uneven, the fact that it’s happening is an encouraging sign that recovery is on the horizon. Tracking the pandemic from its beginning was the data-visualization company Tableau. Now, it’s turned its attention to tracking global progress toward recovery, helping to inform individual behavior, business decisions, and government policy. The company’s new Global Tracker pulls information daily from multiple sources to allow people to see and interact with data on things like localized disease spread, testing and vaccination, and social policy indicators, both in the U.S and globally.

Through private and public sector cooperation, a massive global vaccination campaign that reaches every person is possible. But it will require setting aside the business-as-usual notion of vaccine nationalism in order to put all of us first. As Dr. Tedros said: “While the virus has taken advantage of our interconnectedness, we can also turn the tables by using it to spread life-saving vaccines further and faster than ever before.”

The following GlobalWA members are working toward global equity on COVID-19 treatment and prevention.

Americares

As COVID-19 infected millions around the world and forced families into isolation, Americares launched into action, responding in more than 30 countries with critically needed protective gear and training for frontline health workers. Since launching its response last February, the health-focused relief and development organization has dedicated every resource to ensure health workers stay safe and can continue their lifesaving work. Americares response also included telehealth consultations to ensure patients continued to receive care during community lockdowns and medical facility closures, launched public education campaigns to combat misinformation and made water system improvements to help slow the spread of the virus. The “Americares COVID-19 2020 Special Report” details its global response to the crisis.

Bill & Melinda Gates Foundation

In their 2020 Goalkeepers report, Bill and Melinda Gates reflected on how COVID-19 has impeded progress toward the Sustainable Development Goals, and what the world needs to do to come together to end the pandemic. For one thing, the foundation believes a shared global response is critical: “Together, we can ensure a safe and effective vaccine is distributed equitably and affordably for every last person on earth—not just those with ability to pay. The virus does not adhere to borders, and neither can the vaccine. A global response must also aim to build more resilient health systems that protect the world’s most vulnerable and prevent future disease outbreaks.” To date, the foundation has committed about $1.75 billion to support the global response to COVID-19, including funding the development and procurement of new tests, treatments, and vaccines, and supporting interventions to alleviate the social and economic effects of the pandemic globally. The focus for 2021 is to ensure equitable, timely, and scaled delivery of proven interventions.

Fred Hutchinson Cancer Research Center

Fred Hutch is part of the global scientific community racing to stop the COVID-19 pandemic. Scientists from across the organization have been tackling all aspects of the disease and the virus that causes it – including researching how it spreads, how it affects people’s bodies, and developing potential therapies and vaccines. In July 2020, Fred Hutch became the coordinating center for vaccine clinical trials of the COVID-19 Prevention Network, leading operations across at least five large-scale efficacy trials with over 100 clinical trial sites in the U.S. and abroad. Three months later Fred Hutch opened the COVID-19 Clinical Research Center, one of the first stand-alone facilities in the nation designed to test novel interventions to treat and prevent COVID-19, from Phase 1 through 3 clinical trials for COVID-19-positive participants and, in the future, participants with other infectious diseases.

Human Rights Watch

Human Rights Watch (HRW) builds on decades of research and advocacy to shed light on the immediate and long-term impacts of Covid-19 on human rights. The pandemic has exposed the frailties in our social system. While billionaires grew richer by $1.9 trillion in 2020, hundreds of millions of job losses were concentrated in low-wage industries. These losses disproportionately affected women and people of color, pushing many into poverty. HRW reported on the devastating impacts of Covid-19 on historically marginalized communities and the most vulnerable members of our population in the U.S. HRW also called on the U.S. Congress to safeguard frontline meatpacking workers and spoke out on the inaccessibility of online vaccine registration systems for the elderly. The organization has also continued to sound the alarm on rising domestic violence rates, and advocated for protecting tenants’ rights to adequate housing and financial relief. In 2021, HRW remains steadfast in its commitment to build a rights-respecting future and defend human rights for all.

International Rescue Committee

Over the past year, the IRC scaled up its response to the coronavirus pandemic in over 40 countries, providing essential health care services to refugees, sharing vital information about hygiene, handwashing, and self-isolation, training health workers on how to keep themselves safe, and providing protective equipment to aid workers. Through partnerships with organizations like COVAX, the IRC is helping countries prepare for the rollout of COVID-19 vaccines. The IRC is also working with Gavi, the Vaccine Alliance to advocate for equitable access to vaccines—including for populations affected by crisis. As vaccines become available, the IRC will help administer them through the network of health facilities it supports around the world. The IRC also helps refugee and immigrant communities impacted by COVID-19 in the United States, including in Washington state, through health services, remote learning support for K-12 students, distribution of food and masks, emergency financial assistance, and more.

Lynden

Lynden International is a global freight logistics provider, headquartered in Washington state, with developed services to multiply the capacity of organizations doing global health and humanitarian work. Before the coronavirus pandemic, Lynden participated in epidemic response measures for Ebola and Zika outbreaks and continued to work to build health system resilience with government, foundation, and NGO stakeholder clients worldwide. To combat the spread of COVID-19 Lynden has worked with these same organizations to deploy personal protective equipment (PPE), sanitizing supplies, and test kits globally to lower- and middle-income countries, as well as native communities and remote locations in the United States since March 2020. While COVID-19 vaccines were in development, Lynden worked with logistics partners to enhance cold chain capabilities in Africa, and it began vaccine distribution to underserved communities in Alaska and offshore locations in the U.S.   Lynden is also expediting deployment of cold chain containers in which vaccines are transported and collaborating with organizations supporting the UN COVAX facility and African Union efforts to distribute vaccines equitably.

Medical Teams International

Since the COVID-19 pandemic began, Medical Teams International President & CEO Martha Newsome has placed a high priority on global equity in treatment and prevention. For example, when the first cases were identified in the world’s largest refugee camp in Kutupalong, Bangladesh, in May 2020, Medical Teams responded by opening the camp’s first isolation and treatment center in partnership with Food for the Hungry and UNHCR. Medical Teams’ strategy of educating and equipping community health workers has empowered them to share best practices in prevention throughout impacted communities in Uganda, Guatemala, Colombia, Lebanon, and Bangladesh. In the Pacific Northwest over the past year, Medical Teams’ staff and skilled volunteers have tested nearly 30,000 people. Globally, Medical Teams has conducted more than 1.91 million screenings. These numbers represent vulnerable populations without access to traditional healthcare, such as refugees, migrant farm workers, and individuals and families lacking housing.

Mercy Corps

As higher-income countries continue to secure agreements for COVID-19 vaccines above and beyond what’s needed for their populations, millions of people are standing at the back of the line. Mercy Corps is advocating for equitable vaccine access for lower-income and conflict-affected countries unlikely to have widespread access to vaccines before 2023, as well as often overlooked and hard-to-reach populations, like refugees and internally displaced people, who are at risk of being left out of vaccination efforts. In Colombia, Mercy Corps is partnering with El Espectador, a national Colombian newspaper, on a nationwide campaign to build empathy, understanding and support for Venezuelans in Colombia, and to advocate for vaccine equity for migrants. Mercy Corps is also working to combat misinformation and build vaccine acceptance through information campaigns launched during COVID.

OutRight Action International

In the wake of COVID-19, OutRight Action International launched a research project to document the immediate and severe impact of the pandemic on LGBTIQ people globally. Its findings were based on interviews with advocates in 38 countries, and featured on BBC Newshour among other news outlets. OutRight also launched a Global LGBTIQ Emergency Fund to support grassroots LGBTIQ organizations on the frontlines of providing emergency assistance to LGBTIQ people experiencing loss of income and food, lack of access to HIV medication and healthcare, increased domestic violence, and even scapegoating by religious and government leaders. Moreover, LGBTIQ people often are not reached or left behind by government or traditional relief efforts, and many grassroots LGBTIQ organizations are on the brink of survival – threatening to set the movement for equality and human rights back by years. To date, OutRight’s Emergency Fund has raised more than $1.65 million from 300+ companies, foundations and individuals and has issued 125 grants in 65 countries, reaching more than 50,000 people. OutRight will be issuing a second call for applications and additional grants this spring and throughout 2021, as funding is available.

Oxfam America

Oxfam America is advocating for a People’s Vaccine, a COVID-19 vaccine that is patent-free, mass-produced, fairly distributed, and made available free of charge to every individual across the globe. Within this work, Oxfam America is leading a coalition of partners to pressure the Biden Administration to ensure the technology and know-how to make COVID-19 vaccines is shared with the world. This coalition wrote a public letter calling on President Biden to champion a People’s Vaccine, which was signed by more than 200 leaders from the fields of public health, medicine, global development, and racial justice, as well as faith leaders, economists, Nobel laureates, former members of Congress, and artists. Oxfam America is leading other efforts, taking both public and insider approaches, to pressure the Biden Administration to push for a People’s Vaccine, which have included meetings with Administration officials and a grassroots petition to President Biden. Watch Oxfam America’s video about the People’s Vaccine here.

PATH

PATH has been closely involved with the Access to COVID-19 Tools (ACT) Accelerator, a global public-private-philanthropic collaboration to accelerate the development, production, and equitable rollout of COVID-19 tests, treatments, and vaccines. COVAX is the vaccines pillar of the ACT Accelerator and PATH has been mobilizing its staff, networks, and partnerships to anticipate and address specific country needs. Through PATH’s expertise in vaccine financing, procurement, and partnerships, it is assisting the COVAX Facility with program design and operationalization. PATH is also leveraging its manufacturing expertise to evaluate production capacity and offering strategies for scale-up. In addition, PATH has been providing technical assistance to support COVID-19 vaccine trial-site readiness in Africa and Asia.

Save the Children

Save the Children responded to COVID-19 across 87 countries, including the United States, reaching 29.5 million coronavirus-affected people. Its teams launched and sustained an emergency response to contain the spread, protect communities, and support children and families. As vaccines are developed and rolled out, Save the Children is pressing leaders around the world and working with its partners to ensure the most vulnerable people will have access and are prioritized, as well as health workers, community leaders and teachers, who are critical to keeping children safe and learning. Find out more in a recently published report: A Chance to Get it Right: Achieving equity in COVID-19 vaccine access. Save the Children has been adapting and expanding how it delivers world-class programs and advocates for children, as well as launching new and innovative initiatives to prevent, mitigate and respond to the pandemic’s devastating impacts. More information on Save the Children’s overall response and impact can be found in its COVID-19: One Year On Global Impact Report.

Splash

Splash is a non-profit organization that delivers child-focused water, sanitation, hygiene (WASH), and menstrual health solutions in some of the world’s largest, low-resource cities. Its vision is for children in urban poverty to thrive and reach their full potential. Through Project WISE (WASH in Schools for Everyone), Splash plans to reach 100% of government schools in two major growth cities: Addis Ababa, Ethiopia, and Kolkata, India by 2023, serving one million kids. As schools re-open globally, Splash is especially focused on increasing handwashing with soap, the first line of defense against COVID-19. It does this through behavior change programs for teachers and students, as well as through patented handwashing stations designed just for kids. Through Splash Social Enterprises, the organization has launched a new project to design handwashing stations for a broader array of institutions (such as health care facilities and rural schools), helping provide access to handwashing for people of all ages in low- and middle-income markets.

Tableau Foundation

Software company Tableau’s free, publicly-accessible COVID-19 Data Resource Hub includes real-time data on case reports from Johns Hopkins University, the WHO and the CDC, as well as a curated gallery of visualizations from national news and health organizations. The foundation has also ramped up its Community Grants Program, expanding the number of grantees and streamlining the application guidelines. Tableau has created two other giving campaigns for employees: one to support frontline health workers, and another, the COVID-19 Response Fund, to meet the needs of community organizations and non-profits serving at-risk communities that are disproportionately impacted by the disease and its repercussions.

VillageReach

In the early months of the pandemic, VillageReach joined like-minded collaborators to form the COVID-19 Action Fund for Africa, a group of 30 organizations focused on getting personal protective equipment (PPE) to community health workers in Africa. Many African countries were shut out of the PPE market, making frontline health workers and their patients extremely vulnerable. More than 57 million pieces of PPE have been secured for 18 countries since August 2020. Fast forward to today and 80 days have passed since the first health worker in Washington state was vaccinated. COVID-19 vaccines arrived recently in Africa, but the number of available doses does not match the need. And as U.S. leaders announce vaccine availability for every adult by May, VillageReach continues to advocate for health workers in Africa – they need vaccines NOW.

World Vision

World Vision is responding to the devastating impact of COVID-19 in more than 70 countries. The organization is using its global reach and grassroots connections to encourage vaccine acceptance and uptake. This means ensuring that communities are accurately informed of the nature and purpose of each COVID-19 vaccine, that leaders and champions are equipped to support their constituencies, that public health decision makers understand vaccine acceptance barriers and the science of reducing vaccine hesitancy. World Vision is using mobile phones to enable health workers, in even the most remote areas, to access vital voice message trainings on COVID-19. Its networks to combat the spread and impact of COVID-19 include 300K faith leaders, 181K community health workers, government and private sector partners, as well as World Vision’s own humanitarian and development experts. Globally, World Vision participates in COVAX1 in an advisory role, providing guidance on community engagement and participating in a working group on demand-side preparedness.

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