MEXICO CITY – For the past few weeks the UK and US have watched with relief as their citizens were vaccinated against COVID-19. In much of Latin America, Africa and much of Asia, however, the news was answered with a message of a mixture of resignation and anger.
For many people in developing countries, there is still no light at the end of the tunnel.
These countries are struggling for access to the long-awaited vaccines after rich countries reserve enough doses to vaccinate their populations multiple times.
“International solidarity needs to grow,” Martha Delgado, the Mexican official in charge of negotiating the country’s vaccination contracts, told BuzzFeed News. She reiterated concerns in developing countries, warning that the global pandemic will never end until everyone has access to the vaccine. She wants the US and other western countries to think beyond their own borders and immediate needs. “Nobody will be safe until everyone is vaccinated,” she said.
Canada, for example, has pre-ordered at least four times the amount it needs to vaccinate its 38 million citizens. Britain has secured enough to cover nearly three times its population. The European Union and the US could immunize almost all of their residents twice the number of vaccine doses they reserved. According to the BMJ, a medical journal, almost a quarter of the world’s population will not have access to a vaccine until at least 2022.
So far, some of the poorer countries hardest hit by the virus only have pre-orders to cover a small fraction of their population. Peru, where a dramatic lack of oxygen left the country on the edge of the country earlier this year, and El Salvador, where more than one in four people fall below the poverty line, have pre-ordered doses for less than half of its population, according to an analysis by the New York Times.
The countries that have pre-orders but have no political or economic clout will have to wait longer than the great powers. Mexico, which according to its government has signed contracts with the various pharmaceutical companies to vaccinate 116 million of its 126 million citizens against COVID-19, says it won’t complete the operation until March 2022.
After Delgado told the BBC that “at least Mexico has the money to buy vaccines,” Xavier Tello, a Mexico City-based health policy expert, tweeted a post linked to the interview in which he said: “ I can have the money to buy a Tesla myself; But if someone else has already paid, I’ll probably have to be on a waiting list. “
Many in Mexico say the country can’t wait much longer. The country has the fourth highest death toll on paper, behind only the US, Brazil and India, but the official number – 118,598 – is likely much lower than the real death toll. In addition, there were at least 60,000 other “excessive” deaths in 2020.
And Mexico’s health care workers say they are reaching their limits due to ongoing PPE shortages, exhaustion and grief. More than 2,250 doctors, nurses and medical staff have died, according to government figures. With nearly three times the population of Mexico, around 1,500 healthcare workers have died in the United States.
Who gets how many vaccines and when has opened an unprecedented ethical debate. Should governments give priority to their own citizens? Should the first vaccines be allocated to a specific section of the population in each country? Should people at risk be given starting doses around the world before they are distributed among people without comorbidities?
Arthur Caplan, director of medical ethics at NYU School of Medicine, said he was partially defending the first school of thought – vaccine nationalists. Countries that can afford it should take care of their own first, “plus a little extra for insurance,” in case current vaccines are only for a limited time immunity and a booster is needed in the near future.
However, when it comes to making a more ethical choice, Caplan said that once a state has vaccinated its health care workers, older adults, and people with pre-existing medical conditions, it should afterward vaccinate the same populations in other countries before turning young Adult and low-risk vaccinated population.
COVID-19 has so devastated the world that equity in the distribution of vaccines between countries is not part of decision-making.
“The rich countries are in such bad shape they don’t think about it,” Caplan told BuzzFeed News.
While the second option – allocating vaccines to an equal number of people in each country – seems fairer, it can ultimately become ineffective. Ignacio Mastroleo, an Argentine expert on medical ethics and part of the World Health Organization’s expert group on ethics and COVID-19, notes that, for example, the same amount of vaccines in Peru and Poland would not take into account that the virus killed 11,600 more people in the former than the latter (their populations are 32 million and 38 million respectively).
This option “does not address the needs of the population,” said Mastroleo, adding that the poverty rate in Peru is ten times higher than in Poland.
Mastroleo said if there is a silver lining, unlike the 2009 swine flu pandemic, there are efforts by international organizations this time to support equality in access to vaccines. One of these mechanisms, co-founded by WHO and known as COVAX, is a global pool of vaccines that poorer countries will have access to. However, the program will only serve less than 20% of the population of the 92 low and middle income countries.
Unequal access to vaccines is likely to happen not only between countries but also within countries, leaving millions of vulnerable people vulnerable to the virus. On Monday, during an interview with Blu Radio, Colombian President Iván Duque announced that there are no plans to vaccinate undocumented people. If the country did this, it could lead to a “rush” of immigrants into Colombia. There are currently 1.7 million Venezuelans living in Colombia, around 55% of whom are not citizens. Most of them fled an economic collapse and humanitarian crisis in Venezuela.
Aid to millions of people may not come to millions of people until late 2021 or even later, according to Delgado, when countries that have hoarded surplus vaccines either sell them or donate them to poorer states.
“This is the wrong strategy,” said Delgado. Relief will come sooner when people stop “seeking their own salvation”.