Disparities in COVID-19 vaccine equity persist, though the situation has improved
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Although COVID-19 vaccine equity has improved globally as the pandemic has progressed, some disparities in access have remained, according to experts.
In mid-October, WHO’s emergency committee met to discuss the evolving situation surrounding COVID-19. Before the meeting, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, addressed the committee and said that much progress has been made but reminded them that there is still more to do.
“We have never been in a better position to end COVID-19 as a global health emergency,” Tedros said, adding that the number of weekly reported deaths is near the lowest since the pandemic began and that two-thirds of the world’s population is vaccinated, including 75% of health care workers and older people.
“But our work is not yet finished,” he said. “There are still wide disparities in vaccination rates.”
According to the latest information from Our World in Data, 67.9% of the world population has received at least one dose of COVID-19 vaccine with nearly 13 billion doses given, though that only accounts for 23% of people in low-income countries.
“There are still unacceptable gaps in access, putting far too many at risk of severe disease and death,” Tedros added.
Jean Nachega, MD, PhD, MPH, associate professor of epidemiology, infectious diseases and microbiology at University of Pittsburgh Graduate School of Public Health and professor extraordinary of medicine at Stellenbosch University in Cape Town, told Healio that these data show that vaccine access inequity is still a reality, especially in low- and middle-income countries, though the situation at least in terms of COVID-19 vaccines has somewhat improved.
“The global COVID-19 vaccine scale-up is a moving target in the right direction,” Nachega said.
One example, he said, is that the WHO-led COVAX initiative now estimates that more than 40% of the adult population in low- and middle-income countries can be vaccinated with current available funding and donations.
“So, in some ways the supply side issue has improved but there is a persistent global problem of vaccine hesitancy including in low- and middle-income countries,” he said.
According to Nachega, another source citing this progress is a 2021 Nature Medicine article that reported a median COVID-19 vaccine acceptance rate of 78% for COVID-19 in the general population in 10 low- and middle-income countries of which in Africa. The lowest acceptance rate reported was still relatively high 66.5% in Burkina Faso.
Nachega explained that the most common reasons for low of COVID-19 vaccines and vaccine hesitancy leading to low vaccine uptake in sub-Saharan Africa, for example, include misinformation and disinformation disseminated on social media and other platforms, which he said mislead the public about COVID-19 vaccine side effects (eg, infertility), presumed lack of safety data and inaccuracies about the potential for harm.
He and colleagues wrote a paper published in 2021 that further addressed challenges to vaccine rollout in African countries.
In addition to misinformation, Nachega and colleagues cited access to laboratory facilities for COVID-19 testing and scaling up testing and sequencing for detection of local SARS-CoV-2 variants, scaling up research on vaccine effectiveness, prioritizing funding for and access to efficacious vaccines, strengthening high-quality and large-capacity storage infrastructure, ensuring effective pharmacovigilance and addressing vaccine hesitancy while identifying priority populations for vaccination.
“Effective health communication and intensive community engagement are needed to convey accurate information and facilitate optimal vaccine uptake, issues which much be addressed quickly by national governments with support from partners such as WHO and the Africa Centers for Disease Control and Prevention,” they wrote.
Nachega added that the keys to improving vaccine equity are to continue to increase vaccine acquisition, increase vaccine uptake through implementation science, support vaccine manufacturing, increase skills and availability of raw materials and implementing multicomponent intervention to address COVID-19 vaccine hesitancy.
Nachega said that the world is unlikely to get to a place where ending the Public Health Emergency of International Concern for COVID-19 is possible without improved rates in lower-income countries.
“No country is safe until every country is safe,” he said.
References:
- Nachega JB, et al. Lancet Global Health. 2021;doi:10.1016/S2214-109X(21)00097-8.
- Our World in Data. Coronavirus (COVID-19) Vaccinations. https://ourworldindata.org/covid-vaccinations. Accessed on Oct. 31, 2022.
- Solis Arce JS, et al. Nature Med. 2021;doi:10.1038/s41591-021-01454-y.
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