Vaccine Inequity: COVID-19 Vaccination Struggles by the Low and Mid Income Nations

No one is safe until everyone is safe. There is no better time to show solidarity other than NOW!

Vaccine Inequity: COVID-19 Vaccination Struggles by the Low and Mid Income Nations  Photo:

When the World Health Organization (WHO) made the ‘Call to Action’ regarding Vaccine Equity in January 2021, countries were urged to work together and in solidarity to ensure that the front line workers and the older people were protected from the COVID-19 scourge by getting them vaccinated within the first 100 days of the year. Under the campaign dubbed ‘VaccinEquity’, the clarion call was to address the inequalities that exist within the health system. According to WHO, over half a billion COVID-19 vaccine doses had been administrated worldwide as at January 2021.

Getting into half the year, vaccine equity is still a major concern globally with inequitable distribution of life-saving treatments being witnessed despite the call for world leaders, vaccine manufacturers, regulatory bodies, ministries of health and all governments to ensure that the COVID-19 vaccines are distributed for free at the point of care.

In his address to the press on July 3rd 2021, WHO Director General requested countries that had had most of their populations vaccinated NOT to order booster shots (third doses) while the rest of the world was facing a shortage of vaccine supply. EU, UK and USA have been reported to have purchased far more than they can possibly use. It is in the public domain that at least 11 countries in the world for instance Chad, Burkina Faso and Papua New Guinea have just vaccinated 1 percent of their population while high-income nations stocked lots of millions of doses which are not currently being utilized. Six months ago (January 2021), WHO had warned the world of a potential moral disaster if the inequity issue would not have been sorted early enough.

"The world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries." Dr Tedros Adhanom Ghebreyesus, WHO Director-General, January 18th 2021

The ‘Hot Bucket’

Supply Chain issues, Country roll-out delays and vaccine hesitancy are some the real-time concerns that have been reported and they should be addressed if at all we are to have a Global successful COVID-19 vaccination program.

In an article written by Devex, it was noted some African nations have had to destroy 450,000 expired COVID-19 vaccine doses and yet the continent is still experiencing massive shortage. This is ridiculous. WHO Africa regional office on July 15th 2021 informed the media that this was the case for 9 countries namely; Comoros, Democratic Republic of Congo, Gambia, Guinea, Liberia, Malawi, Mauritania, Sierra Leone and South Sudan. Major reasons cited were delays in shipment of vaccine doses (mainly AstraZeneca) and delayed roll-out by countries as a result of this shipment struggles. In addition, lack of proper planning and vaccine hesitancy in the continent has made it a tall order for some countries to administer the jabs. From a learning point of view, Ebola was contained and later eradicated in Sierra Leone as a result of timely roll-out of vaccines and planning for the long term nevertheless, countries haven’t learned nor replicated this for COVID-19.

Inequity is everywhere, there is a ‘huge disconnect’ between nations and this isn’t a novel phenomenon ; for instance vaccinations are happening everywhere in the United States, Canada has procured more than 10 doses for every resident while Haiti which is a mere 1888 miles from USA just received its first delivery on July 15th 2021.

We all know that vaccines are a key pillar for the global health security but despite this the nations in need of vaccines have been left with no choice because they can’t access them as donations nor purchase them for use as a result of the stockpiles held by some countries leading to global shortages for others. The global plan to provide poorer countries with vaccines has been underfunded and the rich countries have expanded their priority reach by vaccinating the younger populations as young as 12 years who are believed to be at extremely low risk of developing severe diseases, rather than donating these jabs to the susceptible populations in the low and mid-income regions where the healthcare workers even lack the essential jab. For sure it’s a world of ‘the haves and have nots‘ and this isn’t new in global health.

Globally, there were 15 vaccines that were reported to be in use with the Oxford-AstraZeneca and Pfizer-Biotech being the ones that are mostly used worldwide. The WHO Strategic Advisory Group of Experts on Immunization (SAGE) that handles COVID-19 vaccine conversations noted this on June 7th 2021.

In the Asia- Pacific region, countries like Fiji have had to introduce a ‘’No jab, No job‘’ policy for their public servants which ideally means that the public servants will lose their jobs if they are not vaccinated by November 1st while those in the private sector by August 1st 2021. In Fiji, non-compliance has been reported as a major issue hence the extra stringent measures since people are still conducting communal gatherings even though there are fines imposed for non-compliance. Japan is supporting the Asia-Pacific region with vaccines immensely.

Parting Shot

Despite the efforts by COVID-19 Vaccines Global Access (COVAX) Facility to purchase doses in bulk for the wider and larger distribution to the rest of the world especially to regions that are in dire need of the jabs, there have been unavoidable delays. Shipping and supply chain concerns are a major bottleneck in getting the vaccines to every country and into every arm. COVAX was instituted in April 2020 to prevent these kind of scenarios from happening but the sporadic rise in cases in the manufacturing epicenters such as India, led to a complete stop of global vaccine exports of the well renowned AstraZeneca vaccine. While the exports still remain in limbo maybe until towards the end of the year, the crisis is still biting hard. Countries in Africa have since resolved to purchase vaccines through the African Union since the rich are not willing donate the excess but the supply of the life-saving treatment is still limited in global market.

At this point, most low and mid-income countries especially the African countries have realized that they are fighting the COVID-19 battle on their own. It is due to some of these scenes and the reduction of the vaccine supplies to continent that have prompted Africa to explore the route of manufacturing its own vaccines and medicines through use of vital health technologies. It might appear as a first and fast thought ahead of time due to the current limited capacity and resources, but the journey has commenced. Dr. John Nkengasong, the Africa Centres for Disease Control and Prevention (Africa CDC) Director said in March 2021 and I quote ‘Africa is ready to produce vaccines because it has produced vaccines for other diseases’.

Countries like Japan are providing hope to the rest of the world while some of the other counterparts are widening the gap. In addition to being a powerhouse in Asia-Pacific as witnessed earlier, the Government of Japan has extended the olive branch to Latin America, Caribbean and Africa with COVID-19 vaccines and this kind of unity should be replicated by other wealthy nations if at all we are to achieve global vaccine equity.


The vaccine shortage and most importantly the vaccine inequity crisis has moved from days to weeks, weeks to months and let’s hope it doesn’t stretch to years. We can’t talk of global sustainable development when the poor continue to get poorer and the rich continue to eclipse themselves in another space. Unless the vaccines get to everyone, everywhere, then COVID-19 will still exist anywhere in this global village since no country can vaccinate its way out of the pandemic, not even the well-off ones.

East Africa Technical Family Planning and Reproductive Health Officer, Amref Health Africa and post-graduate student at the School of Government and Public Policy Indonesia

You need to login to write a comment!

  • user

    Thank you for the article. In as much as Africa needs stockpiles of the vaccine, what is being done about the vaccination apathy?

    Oct 13, 2021 6:02 pm