As the UK approves the Pfizer BioNTech vaccine, these authors call for an inclusive approach to vaccine allocation

For the majority of health threats that humanity has faced these past three decades—be it Ebola, swine flu, HIV/AIDS or others—reflections on an equitable response have been an afterthought, and this has only happened solely thanks to the fight and advocacy for social justice by global health activists. Provision of life saving medical and public health interventions have often disregarded the most vulnerable in society, despite the fact that they are more likely to be disproportionately affected. A prime example is the HIV/AIDS epidemic, during which the delayed establishment of a life-saving antiretroviral (ARV) programme in South Africa—one of the first African countries to get access to ARVs—is estimated to have caused the preventable loss of 330,000 lives between 2000 and 2005.

Global health activists have stood up during each new health threat to say that it is time to ensure that history doesn’t repeat itself. However, we have never succeeded in making this inclusive approach a universal principle. The covid-19 pandemic is an opportune time to issue that statement again. Today the UK government announced that the UK’s independent Medicines and Healthcare Products Regulatory Agency (MHRA) has just approved Pfizer and BioNTech’s covid-19 vaccine. Recent developments with the Pfizer and Moderna trials illustrate a 95% and 94.5% effectiveness of their vaccines respectively as well as a potential 90% effectiveness of the Oxford University vaccine. We know that despite the many vaccine development trials taking place, it will take years before the whole world is vaccinated. However, it is time to ensure that, for once, vaccine allocation is made with an equitable agenda at the forefront.  

It is important to be proactive in this discussion because historically various players within the health industry have disregarded equity. Pharmaceutical firms have continuously abused their power by leveraging subsidies and exploiting the sick for profit. For example, while the cost of production of a 12-week Hepatitis C treatment was $68-136, it was sold at the market price of $84,000 in the US. Given the structure of the patent system and intellectual property rights, we are at risk of having a few companies monopolize the production of the covid-19 vaccines and consequently charge high prices. This is despite the development of this lifesaving product being paid for partially by taxes from citizens, including the vulnerable. Unless we come together in solidarity to advocate and fight for equitable distribution, the usual scenario that occurred with the distribution of medicines for HIV/AIDS, hepatitis, and other deadly diseases will be repeated.

The COVAX facility, an initiative co-led by GAVI – the Vaccine Alliance, the World Health Organization, and the Coalition for Epidemic Preparedness Innovations (CEPI), aims to create a safety net for all countries, providing two billion doses of covid-19 vaccine by the end of 2021, to cover 20% of each of the 186 member countries’ populations. So far, COVAX has raised $2billion but will need an additional $5billion by the end of 2021. This is the first time in history that organisations across the world have come together, at the same time, to support the production and anticipate a fair allocation of a life-saving medical product, regardless of ability to pay. COVAX is a promising initiative that presents the opportunity for lower vaccine prices, but with major players, such as the US, currently refusing to join COVAX, it’s difficult to ascertain if the $5billion goal will be reached. 

Moreover, if we are to distribute the vaccine equitably for all, we need to ensure that the vaccine is tested in more diverse locations. For instance, Oxford University has partnered with the University of Witwatersrand in South Africa to carry out ethical clinical trials of this vaccine. 

The search for a vaccine should not cause divisions. Throughout the past few months, we have seen various nationalistic and protectionist moves in countries around the globe. In June, the US monopolized the market for Remdesivir, buying up stocks of this potentially life-saving drug for the following three months. Although Remdesivir is no longer recommended as a treatment for covid-19, at the time this monopolisation of the drug was widely criticised. Moreover, a competition ensued between the US and Germany over a biotech company, CureVac, to ensure that the production of vaccines occurs on their own soil. These examples of greed and the inevitable competition to reach the finish line will not help us end this pandemic any sooner. 

Instead, we should come together as a human family, reinforcing values of international solidarity to prevent any more suffering and deaths from covid-19. Now more than ever, we have seen how interconnected we are, with the health, economic, and social impacts of this pandemic traversing nation states. Therefore, as we expectantly wait for the rollout of a safe and effective vaccine, we need to design equitable, global distribution mechanisms that include the vulnerable, keeping in mind that no country is safe until we all are. This is the only way that we can prevent the legacy of the HIV/AIDS epidemic from repeating itself in the 21st century. 

Agnes Binagwaho, vice chancellor of the University of Global Health Equity in Rwanda. She previously worked as the Executive Secretary of Rwanda’s National AIDS Control Commission, as Permanent Secretary of the Ministry of Health, and as the Minister of Health.

Kedest Mathewos, research associate at University of Global Health Equity

Paul Kadetz, associate professor and the chair of the Center for Executive Education at the University of Global Health Equity.

Competing interests: None declared.