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Centring Justice and Equity in Conversations on Global Vaccine Distribution

Photo: Agência Brasília, CC BY 2.0 <>, via Wikimedia Commons

More than a year-and-a-half into the Covid-19 pandemic, global vaccine production, procurement and distribution has been concentrated in countries located predominantly in the Global North. Our World in Data figures (as of October 2021) tell us that “45.5% of the world population has received at least one dose of a COVID-19 vaccine. 6.3 billion doses have been administered globally. Only 2.3% of people in low-income countries have received at least one dose.”

A recurrent feature in speeches made by multiple world leaders at various forums is to highlight that Covid-19 is a “global” crisis and requires a “global” response. However, the figures quoted above do not generate much confidence in such statements and illustrate the highly uneven effects of Covid-19 across the world. As debates in many Global North countries take place on when to administer booster shots and strategies to re-open nightclubs, one cannot help but juxtapose the catastrophic events in several Global South countries that could have been potentially averted if justice and equity - instead of self-interest - informed access to Covid-19 vaccines.

NOTE: Data updated as of October 1, 2021. SOURCE: Vaccine Purchases | Launch and Scale Speedometer (

Tracing the Roots of Global Vaccine Inequity

While inequities in Covid-19 vaccine distribution require urgent redressal, it is important to view the current predicament as reflecting a larger structural imbalance and power hierarchy in global health governance. To understand this better, one can go back to the 1995 Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), signed by members of the World Trade Organisation (WTO). While provisions under TRIPS applied to all WTO members and countries were given specific deadlines to enact these, the agreement came under heavy criticism for its “one-size-fits-all policy that aims at extending the stricter patenting laws previously used in industrialised countries to developing countries, regardless of their radically different social and economic conditions” (Médecins Sans Frontières). Moreover, through protections guaranteed under TRIPS, a few pharmaceutical companies were now in a position to monopolise global vaccine production.

A major flash-point occurred in the late 1990s, at the height of the HIV/AIDS epidemic in South Africa when a small number of pharmaceutical companies decided to sue the South African government for its 1997 Medicines Act. The Act intended to make affordable medicines more accessible in view of the scale of the epidemic but was opposed by several global pharmaceutical companies on grounds of its alleged violation of patent rules under TRIPS. The companies pursued the case and were supported by governments in the USA and EU at a time when 400,000 people in South Africa had died from AIDS related diseases, partly because of the high cost of treatment (Oxfam, 2001).

Problematizing Charity-based Approaches to Covid-19 Vaccine Distribution

Fast forward to 2021 and yet again, countries located primarily in the Global South bear the disproportionate costs incurred by governments predominantly in the Global North, where leadership has prioritized profits of a small number of pharmaceutical companies over equity and justice. The proximity of these governments to pharmaceutical lobbies led to a scenario earlier this year where over a hundred countries’ demands to temporarily suspend the Covid-19 vaccine intellectual property waiver was opposed ahead of talks at the WTO.

While the Biden-led US government has subsequently shown intent to stand behind this demand, the overarching public narrative has centred around charity and donations of vaccines to countries in need. At the Global Vaccination Summit in late September 2021, “Biden announced that the US will donate an additional 500 million Covid-19 vaccines to low- and middle-income countries around the world, bringing America’s total global donation to more than 1.1 billion doses” (The Guardian, 2021). Further, under the U.S.-EU Agenda for Beating the Global Pandemic, the EU pledged over 500 million doses, in addition to commitments made through GAVI’s COVAX Alliance.

While the premise of COVAX is based on channelling vaccine donations to countries that lack capacity and access, delays in delivery and the recent rolling back of its 2021 vaccine target have cast a shadow on the Alliance’s ability to ensure supply in the first place. The demand-supply mismatch we see today is the result of several factors – vaccine hoarding by wealthy countries, prioritization of booster programmes over distributing excess vaccines, and ultimately, inadequate donations to COVAX.

While the role of COVAX in facilitating equitable vaccine distribution can hardly be understated, the fundamental issue in prioritizing a charity and donation-based approach over equity is that it glosses over the innate hesitancy of wealthy countries to democratise vaccine production. Opposing the demand for a Covid-19 intellectual property waiver and refusing to exert pressure on pharmaceutical companies to share their vaccine technology is a deliberate attempt to institutionalise a system of dependency and maintain the power imbalance in global health governance. Further, relying on charity instead of showing willingness to implement long-term policies denies the opportunity for countries in the Global South to build manufacturing capacity and be better prepared to tackle future health crises.

In Whose Interest is it to Democratise Vaccine Production and Distribution?

Vaccine nationalism and self-interest is rooted in the fundamentally misinformed assumption that protecting one’s citizens is enough to resume normal life, to the extent possible. Scientifically, the Covid-19 virus is bound to mutate and infect people across geographies until vaccines are made equally accessible across the world.

While this realisation has perhaps dawned on wealthy countries and pushed their governments to announce intentions to donate excess vaccines, the pace of catastrophe and the cost of inaction has already devastated the Global South. It is time for citizens in wealthy countries to hold their governments morally responsible and accountable for prolonging the Covid-19 pandemic.

At the same time, global South solidarity offers a way to counter the power imbalance at the heart of global health governance. Shifting the focus away from charity and pushing forward joint demands of intellectual property waivers, and sharing of technology can enable governments to invest in building their capacity and medical infrastructure. Ultimately, prioritizing equity and justice will give countries a shot not only at fighting Covid-19, but future pandemics as well.



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