From Afghanistan to Ukraine, COVID-19 cases continue to surge worldwide. The World Health Organization (WHO) estimates that more than half of Europe will be infected with the omicron variant by mid-March. This unprecedented level of infection has battered health systems and demoralized a weary global public, yet the conversation continues to focus on the severity of infection rather than the hard truth: Transmission must be limited everywhere to reduce the rise of new variants and save lives. We need vaccine equity to end the pandemic.
The omicron variant, detected in 149 countries, spreads rapidly and is two to four times more transmissible than the delta variant, even with past infection or vaccination. Its speed presents two key problems which emphasize the urgency of vaccine equity.
First, though a complete vaccine series with boosters prevents individual cases of hospitalization and death, high vaccination coverage, comparable to the United Kingdom’s 80 percent rate, is needed to decouple hospitalization and mortality from case rates. Without the wall of immunity granted by vaccines, health systems, particularly those affected by humanitarian crisis or conflict, will continue to be pushed past their capacity. In Africa, where the continent’s vaccination rate is just 11 percent, this poses an imminent threat. Since the new year, deaths in Burkina Faso have risen 15 percent while Mali, Mozambique, and Niger have all experienced an 8 percent increase in deaths.
Second, every infection represents a risk not just for the infected individual but for mutation. The more the virus spreads, the more likely it is that new, dangerous and perhaps vaccine-elusive variants will arise, prolonging the pandemic. For example, it is hypothesized that omicron developed in a single immunocompromised person with a prolonged infection that continued to replicate and mutate, and that other variants have emerged in locations with low vaccination rates. An effective response is not to blame suspected origin countries and close borders but to ensure vaccine access for every individual worldwide, including refugees and others affected by crisis.
The international community committed to vaccinating 40 percent of every country’s population by the end of 2021 and 70 percent by mid-2022. While much of the world achieved this target, it was met in just seven of 54 African nations. The outlook is even worse for the 2022 targets.
Fortunately, more vaccines are coming. COVAX, the global initiative to ensure equitable access to COVID-19 vaccines, has delivered its billionth dose across 144 counties, and new vaccines will be hitting the market. These developments are critical but only part of the puzzle and, as the CEO of Gavi, the co-lead of COVAX, warns more funding is needed. To build a durable wall of immunity, increases in vaccine supply must be matched with substantial investment in health systems and supply chains including transportation, storage and human resources. Also, the unique needs of humanitarian contexts must be better reflected.
The Inter-Agency Standing Committee (IASC), which coordinates humanitarian action across the U.N. system, estimates 167 million people are at risk of exclusion from the vaccine. Even if refugees and other populations of concern were included in national distribution plans, 60-80 million people live in non-government-controlled (link) areas beyond the reach of government vaccination campaigns. Nearly one-third of the world’s refugees live in Africa and 12 of the 20 countries at greatest risk of humanitarian deterioration in 2022 are located on the continent. In this context, achieving the targets in Africa will require more than delivering doses to national governments, it will require a coordinated approach that acknowledges the unique risks that crisis-affected populations face and prioritizes those left out of government services. These efforts should also address vaccine hesitancy, though studies show that claims of widespread distrust in the vaccine are overblown and Africans are prepared to be vaccinated at higher rates than Americans if access allows.
A solution is possible. We need to empower humanitarian and local organizations and other frontline responders with the resources needed to deliver vaccines. This must include legal protection, by waiving the COVAX Humanitarian Buffer’s liability requirements, to enable these groups to manage vaccines for populations not covered by national governments.
In Cox’s Bazar, Bangladesh and the Bidi Bidi Refugee Settlement in Uganda, we see the impact of civil society. Here and elsewhere, the International Rescue Committee is providing lifesaving vaccines, transportation for high-risk and immobile refugees and educational outreach on vaccine safety and efficacy. These initiatives are significant but are not of the scale needed to protect those at high risk or defend against future variants or surges. They do, however, provide a template for how to provide vulnerable populations with the services they are entitled to and the resources that are required to make the effort a success.
As long as vaccine inequity persists so too will the pandemic. We must act urgently to raise the needed resources for delivery costs and achieve the 2022 global targets everywhere. This effort must start with those furthest behind — refugees and others experiencing humanitarian crisis — because only once we account for everyone can we truly defeat COVID-19 and commit to the long process of recovery.
Dr. Mesfin Teklu Tessema is the senior director of Health at the International Rescue Committee.