Vaccine Equity, Prioritization, And More: An Overview

Introduction “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, made this statement in a Vaccine Equity campaign held by the World Health Organization (WHO) in January 2021. […]


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, made this statement in a Vaccine Equity campaign held by the World Health Organization (WHO) in January 2021. The invention of the vaccine against the deadly COVID-19 is unmistakably a savior to the people of the world. Such vaccines are being produced on a massive scale every day to meet the unimaginable demand of the world population. 

However, it is not the production, but the effective distribution of vaccines that plays a vital role in curbing the pandemic. Hence, countries across the world were brought together by WHO through a campaign to announce the equitable distribution of vaccines. Globally, noble frontline workers – namely doctors and medical professionals – bravely involved themselves and sacrificed their own lives in the battle against such a major health crisis. Those warriors deserve to be honored and be protected, which is the primary criteria of the Vaccine Equity campaign. Vaccine equity can be successfully achieved by the distribution of vaccines as per the degree of necessity of the diverse population around the world. 

The inter-country distribution of vaccines is a debatable subject matter. High-income countries work meticulously to acquire vaccines for their domestic development, which leads to the scarcity of vaccines in low-income and middle-income countries. This is a hindrance to efficiently curtailing the pandemic. The general overview is that the effectiveness of equitable distribution of vaccines will have a better outcome than equal distribution of vaccines.

Vaccine Prioritization

The COVID-19 pandemic is one of the most impactful pandemics in the history of the world. More than ten million people have been infected, and more than a million people died. This situation still prevails, causing 34 million people around the world to fall below the extreme poverty line in 2020 alone, the numbers sure to increase by the end of 2021. The Gross Domestic Product (GDP) of many developing countries is plummeting, which leads to national crises. The health care system in these countries have also been destabilized by the pandemic.

The major concern of many countries is to protect their people from the risk of infection, and in turn to protect their GDP from falling further; this exposes the dangers of vaccine nationalism. These measures have led to a major impact on the production of vaccines and their equal distribution. The scarcity of vaccines created by most of the developed countries has forced the other developing countries to prioritize the equitable distribution of vaccines within the country. Hence, the Strategic Advisory Group of Experts on Immunization (SAGE) of WHO has taken initiative to propose a roadmap to prioritize the uses of COVID-19 vaccines in the areas of limited supply. 

The Roadmap (SAGE WHO, 2020) is based on the epidemiological setting and vaccine supply scenarios. The term “epidemiology” is defined as the study and analysis of the distribution, namely who, when, and where are the determinants of health and disease conditions in particular populations (Epidemiology 2021). According to the SAGE WHO Roadmap, the public health strategy for use of vaccines depends on the burden of the disease and the local epidemiology. The other strategy taken into account for the Roadmap is vaccine supply scenarios where the distribution will be decided according to the availability of the vaccines. 

The combination of both the strategies helped SAGE WHO to arrive at a better Roadmap with an initial focus on Stage I. Specifically, these efforts concentrated on the direct reduction of the morbidity and mortality in a country with a limited supply of vaccines. SAGE WHO proposes to supply vaccines to the front-line health workers who are at higher risk of transmitting infection, followed by the supply of vaccines to older adults depending on age-based risk defined by the specific country or region. This proposal ensures the equitable distribution of the vaccines, which effectively reduces the speed of the transmission of COVID-19 in many countries. 

The obstacle to equity

“The main obstacle to equity is scarcity,” said Richard Hatchett, the CEO of CEPI (Coalition for Epidemic Preparedness Innovations). IFC Insights – The case for equitable vaccine distribution 2021). The preliminary challenge of equitable distribution of vaccines include development and production. Most high-income countries hoard vaccines in advance with the motive to protect themselves, leaving behind the low and middle-income countries in despair. Scholars call this behaviour ‘Vaccine Nationalism’; it poses imminent danger to the model of equity in distributing vaccines. 

To answer to the call of help of the entire world with resourceful and exhaustive action is not easy, to say the least. Therefore, the Access to COVID-19 Tools (ACT) Accelerator was initiated by WHO to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. When vaccine production was in control, COVAX was introduced as the vaccine pillar of the ACT Accelerator. COVAX is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), and WHO. The object of COVAX is to expedite the development and manufacture of COVID-19 vaccines, and to guarantee equitable access for every country in the world. (WHO, Covax 2020). 

Additionally, in coordination with the ACT Accelerator, the Vaccine Equity Project was initiated with the help of technical experts, public health professionals, and implementers. It supports professionals in low and middle-income countries coordinating with key national decision-makers and mobilizers from Ministries of Health (MoH), and local implementing partners to prepare for and operate equitable COVID-19 vaccine programs. (Sandoval, COVID-19 vaccine Equity Project 2021).

Though many multilateral organisations are working hard to achieve equity, countries like the USA, who are the primary source of critical raw materials required for the production of vaccines, have held on to their exports to other countries (including India). This was because the USA, under a local act, needed to prioritize their federal contracts for the sake of their national security. (Raghavan, Explained: Why does India need COVID-19 vaccine ingredients from the US? 2021) This posed a major threat to vaccine makers around the world. Among the countries affected were India, as India was facing the second wave of COVID-19. Later, the US agreed to export raw materials, oxygen concentrators, and other medical (and allied) appliances to India, seeing India’s continuous struggle in the battle of COVID-19. (Bhandari, US agrees to deliver raw materials to India required for Covid-19 vaccines 2021).

Even though the Serum Institute of India is the world’s largest vaccine maker by the number of vaccines produced, they largely depend on the imported raw materials from other countries, and production halted for a while due to delay in imports of raw materials. This reduced India into a menace of vaccine insufficiency during the onset of the second wave of COVID-19.   

Such another obstacle to equity is sharing of technology required for the production of vaccines, as the World Trade Organisation (WTO) protects the intellectual rights of its member states under the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement. Therefore, the invention of this particular technology is considered to be the property of the inventor state, and only upon paying huge amounts of money to the inventor state the other states could use the said technology; this becomes a huge expenditure at the present crisis to low income and middle-income countries for such massive production. Considering the said fact, India, along with South Africa, has initiated a proposal to the WTO to temporarily suspend certain provisions of the TRIPS Agreement with regards to the vaccines. This is to enable cost-effective, equitable, and universal access of vaccines for developing countries. (Rajagopal, Coronavirus: Experts point to ‘contradiction’ in India’s push for IPR waiver on vaccines 2021).

Nevertheless, few countries recognize and protect the right to health, (considered as their Human Rights responsibility) thus leading them to share their technology and inventions to facilitate other countries to help improve their vaccine manufacture. The WHO also initiated COVID-19 Technology Access Pool (C-TAP), encouraging its member states to share their intellectual property and data regarding COVID-19 diagnostics, therapeutics, and vaccines from its developers. This uplifts the significance of Human rights viz. right to health, and increases the production of vaccines for global needs (WHO, COVID-19 technology access pool).  Additionally, there exists a Human Rights guideline (proposed in 2016) named the UN High-Level Panel on Access to Medicines, which aims to monitor and check the trade of medicines, and their IP protection to prioritize public health. (Perehudoff & Jager, Drug Company Practices: Is COVID-19 a New Dawn for Human Rights Norms or Business as Usual? Katrina Perehudoff and Tessa Jolan Jager 2021).

It is pertinent to note that these benevolent organizations are significantly complying with human rights by safeguarding the right to life and health, and equal access to life-saving immunization for everyone under Articles 3, 7and 25 of the Universal Declaration of Human Rights. 


The new mutated strains of the COVID-19 virus complicates immunization across the world. As per medical recommendations, current vaccines would lose their viability in less than a year due to mutations of the new strain – thus demonstrating that the nightmare is not over yet, unless the scientists and other medical professionals discover a proper exit solution for the rapid spread of COVID-19. (Dhaliwal & Replication-Receiver, An urgent call to action for vaccine equity 2021). 

Unfortunately, the production and distribution of vaccines is not on par with the rate of spread of COVID-19. Many developing countries, like India, are suffering because of the second wave, due to a lack of medical facilities to facilitate the size of the current population. Due to the mutated new strains of COVID-19, the significance of immediate vaccine inoculations has increased. This has urged countries around the world to procure vaccines for themselves, leaving behind marginalized countries in jeopardy – this can easily be corrected with humanity being on top of the list of priority of action.

The outbreak of the second wave of COVID-19 has halted many lives, which can only be resumed by speeding up the inoculation program. The present situation continues to deteriorate as vaccine nationalism becomes a vaccine war. As developed countries arbitrarily procure vaccines for themselves without consideration, the shortage makes other countries provoke disregard for each other. Considering the said risk, the European Unions, one of the biggest vaccine producers, has recently chosen to preserve the export supply of vaccines, rather than explicitly banning manufacture; done to prevent a vaccine war. (Jamie Dettmer, EU backs Off sparking VACCINE WAR 2021). This gives hope to many countries for a successful inoculation program. Moving forward, the other countries will also be more considerate in eliminating vaccine nationalism to provide equitable access to the countries around the world. 

Keeping in mind the current situation, we have the responsibility as informed citizens to end the chain of spread by being more vigilant in wearing masks, maintaining social distance, cleaning our hands whenever we come back home, and getting vaccinated whenever our turn arrives. 

Remember, we are all part of a race where no one can win until everyone wins.

Prepared by Nisha and Sanya

Research And Analysis 

Hibiscus Foundation


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