The WHO estimates that 71 vaccines candidates are in pre-clinical evaluations and at least five have already entered clinical trials. [1] At this point in time, it is difficult to predict who will get to the finishing line first.
On Monday 20 April, the UN General Assembly (UN GA) adopted unanimously resolution 74.L.56 calling for “equitable, efficient and timely” access to any vaccine developed to fight the pandemic. It calls for rapidly scaling up of manufacturing and establishment of supply chains that promote and ensure fair, transparent, equitable, efficient and timely access to drugs and future covid-19 vaccines. [2] Such an approach is much needed to prevent the rise of vaccine nationalism which is likely to intensify when a new vaccine is developed, or a new effective treatment is found.
To accelerate the development and distribution of a future vaccine, and to effectively operationalize the UN GA resolution, the WHO has set up the Access to covid-19 Tools Accelerator, a collaboration initiative to progress the development of coronavirus vaccine and therapeutics with speed and scale. It will coordinate the global effort to boost vaccine manufacturing capacity and ensure a vaccine is effectively and fairly distributed. These efforts are further boosted by the European community coming together and fundraising €7.4 billion to ramp up the work. [3]
The emphasis so far has been on highlighting equity in distribution among countries. This is important, but it is crucial to discuss how to organize vaccine campaigns in terms of population and professional groups. Frontline healthcare workers, older persons, pregnant women and people with certain chronic conditions will of course need to be given priority.
While covid-19 also has disproportionately greater impact on certain populations—and refugees and migrants can be in condition of vulnerability—it is often politically untenable to say that this group should be given priority when it comes to planning of vaccination campaigns. [4]
Seroprevalence studies show suboptimal immunity to various vaccine preventable diseases among refugees and migrants, and lower vaccination coverage of these groups compared with local host populations has also been observed. [5] In addition, there are specific barriers—informal (language, access to information and culture) and economic and administrative that prevent them from spontaneously accessing immunization campaigns. [6]
WHO EURO technical guidance on delivery of immunization services for refugees and migrants identifies some of these barriers, enablers, and behavioural factors determining vaccination uptake among refugees and migrants. [7] It puts forward tailored approaches and best practices including communication and advocacy strategies which could be used to guarantee covid-19 vaccine coverage in this population group.
A strong international agreement that goes beyond looking at supply between countries must be part of any future vaccine plan. It will be a tall order for the Accelerator to provide a clear direction and come up with a stringent matrix and conditionalities to ensure equitable access of vulnerable populations. For this to work for refugees and migrants, any such effort must be three-fold: delivery in difficult settings including humanitarian situations; targeted and culturally appropriate delivery for refugees and migrants in mainstream health services; and provision of vaccination for hard-to-reach refugees and migrants such as irregular migrants who would normally be reluctant to access services.
All future efforts need to build on existing structures and resources to bolster coordination and prepare a blueprint for future vaccine distribution in an equitable fashion. This includes good vaccination rates among refugees and migrants as an essential prerequisite for protecting their health and wellbeing and should occur as part of equitable provision of health services and extension of equal rights to healthcare.
Santino Severoni, Director Migration and Health, World Health Organization
Jozef Bartovic, Technical Officer, WHO Regional Office for Europe
Competing interests: None declared
References:
1] https://www.who.int/blueprint/priority-diseases/key-action/novel-coronavirus-landscape-ncov.pdf
2] https://www.un.org/pga/74/wp-content/uploads/sites/99/2020/04/A-74-L.56.pdf
3] https://ec.europa.eu/commission/presscorner/detail/en/ip_20_797
4] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30791-1/fulltext
5] Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA. Stockholm: European Centre for Disease Prevention and Control; 2018 (ECDC Scientific Advice; https:// www.ecdc.europa.eu/sites/portal/files/documents/Public%20health%20 guidance%20on%20screening%20and%20vaccination%20of%20migrants%20 in%20the%20EU%20EEA.pdf, accessed 18 March 2019).
Hargreaves S, Nellums LB, Ramsay M, Saliba V, Majeed A, Mounier-Jack S et al. Who is responsible for the vaccination of migrants in Europe? Lancet. 2018;391(10132):1752–1754
6] http://www.euro.who.int/__data/assets/pdf_file/0005/351644/HEN53.pdf?ua=1
7] https://apps.who.int/iris/bitstream/handle/10665/326924/9789289054270-eng.pdf?sequence=1&isAllowed=y