The people’s vaccine: How a covid-19 vaccine will be a test of global accountability and equity 

With over 66 million confirmed cases and more than 1.5 million deaths globally, the burden of covid-19 on global health systems continues to weigh heavily. As the pandemic devastates communities around the world, lack of access to vaccines in low- and middle-income countries (LMICs) could result in further consequences. LMICs, which account for 75% of the global population, already require an estimated US$274 – $371 billion annually to reach the Sustainable Development Goal health targets by 2030. The urgency of ensuring that everyone, everywhere, has the right to the highest standard of health has never been more apparent. 

The development of several covid-19 vaccine candidates has demonstrated the breakneck speed at which the scientific and medical community can respond to global health issues. While these developments have been largely met with optimism and hopes that we may soon turn the tide on the pandemic, they also present another challenge: ensuring equitable access to a covid-19 vaccine worldwide.

The race for a covid-19 vaccine has become one of the most decisive races of our time. Yet the defining moment of the race will not be who finishes first, but if and how we can deliver a vaccine equitably, to all people across geographies and income levels. With global procurement and distribution plans already in development, vaccine equity must remain a top priority. 

Even before the pandemic hit, at least half of the world’s population were not receiving the essential health services they needed. When it comes to vaccine coverage levelsa proxy measure to assess how well a health system is functioningthe Gates Foundation and Institute for Health Metrics and Evaluation (IHME) has estimated that the pandemic has set the world back by about 25 years in only 25 weeks, with childhood vaccination rates dropping to levels last seen in the 1990s. While this paints a grim picture of the impact of the pandemic, it also emphasizes just how crucial it will be for countries to invest in their public health systems, especially primary health care and universal health coverage (UHC), to ensure that any lost progress can be regained and that everyone has access to essential healthcare. 

In September 2019, just several months before covid-19 swept across the world, leaders committed to achieve UHC in a historic declaration that recognized the right to health for all. More than a year later, with millions of people affected by covid-19and millions more lacking access to basic health services due to lockdowns and overburdened health systemsthat goal is more urgent than ever. We must hold leaders accountable to their commitments to achieve UHC, starting at the primary health care level. Accountability remains vital to drive tangible progress towards health targets and will be critical to the equitable distribution of a covid-19 vaccine. 

We must also be able to count on continued global cooperation for lasting impact that goes beyond political declarations and vaccine research. COVAXan initiative led by Gavi, the Vaccine Alliance, the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI)aims to pool countries’ purchasing power and donor funding to coordinate affordable and equitable distribution of covid-19 vaccines. Despite this novel undertaking, the initial fair allocation (equal to 20% of a country’s population, to cover prioritized target groups) poses a significant challenge for LMICs, which will need to mobilize additional resources to vaccinate the rest of their populations. 

While initiatives like COVAX are essential to ending the pandemic, increased cooperation and transparency are needed across all sectors. Such cooperation has been key to overcoming other global health challenges. For example, the recent eradication of wild poliovirus in Africa was the result of multinational and multisectoral collaboration, serving as a testament to what can be achieved through accountable and transparent partnerships. 

Lastly, we must ensure that health remains a fundamental human right, rather than a political issue, to accelerate post-pandemic social and economic recovery. It is the responsibility of all stakeholders to protect this right by advocating for equitable access to health solutions to fight the pandemic and instill lasting change. The right to health for all people must remain at the core of vaccine innovation and rollout, for this pandemic and beyond. 

Accountability in public health remains a necessity to ensure that life-saving vaccines reach all who need them, especially the most vulnerable. We have made a commitment to leave no one behindit is time to turn that commitment into action. With millions of people’s lives at stake, cooperation involving global health actors and governments in the months ahead will ultimately determine whether we collectively or selectively defeat this pandemic. No one is safe until everyone is safe.

Brenda Killen, The UN Secretary-General’s Independent Accountability Panel for Every Woman, Every Child, Every Adolescent (IAP) Member; Director Governance, GAVI, the Global Vaccine Alliance

Elizabeth Mason, Co-Chair, IAP; Honorary Professor, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine (LSHTM) 

Giorgi Pkhakadze, IAP Member; Professor in Public Health, David Tvildiani Medical University

Joy Phumaphi, Co-Chair, IAP, Executive Secretary, African Leaders Malaria Alliance (ALMA2030) 

Competing interests: none declared