Why COVID vaccines are being distributed unevenly and unfairly

Credit: The People’s Vaccine Alliance
MOST NEEDY MISS OUT

Imagine this for a second. You’re at the beach and you notice two swimmers in difficulty. Each has encountered a beach hazard caused by the powerful surf. A rogue wave breaking along the shoreline has knocked a man off his feet and he is trying to regain his balance. At the same time, a rip current has dragged a woman out to sea and she is fighting a losing battle against the fast-moving tide.

You face a dilemma: The swimmers are 100 metres apart and you can’t rescue both at once. You quickly assess who has the greater need. While the man is disoriented, he has not suffered serious injury to his back or neck – he is unsteady, but standing. The woman, however, is clearly in grave danger of drowning – she is unable to stay afloat due to exhaustion and is slipping under the water.

The woman is far more vulnerable to the ravages of the sea, so you swim out through the breaking waves and rescue her. Bystanders commend you on saving her from certain death. As the male swimmer was able to stumble out of the water on his own, no lives were lost. Your judgment to use “likelihood of death” as a triage criterion was spot on. The swimmer most exposed to the elements was correctly identified and a fatality was averted.

Now imagine a different life-and-death scenario. This time, you are the boss of the World Health Organisation (WHO). You cast your eyes over the latest statistics on the number of COVID-19 deaths around the world. It’s clear that Brazil and Australia are navigating the virus differently. Brazil is in treacherous waters and has been unable to quell the pandemic waves. In contrast, Australia finds itself in calmer seas with little headwinds.

You face a dilemma: You don’t have sufficient doses of COVID vaccines to inoculate every citizen of both nations. You carefully assess which population is worse-off. Brazil has been unable to stem the tide of deaths and thousands more are expected to perish as a result of the pandemic. Australia, on the other hand, has done an outstanding job in containing the virus and has recorded an extremely low mortality rate from COVID-19.

As a leading epidemiologist, you know that vaccines should go first to the places where there is the greatest suffering. The primary measure of suffering is the number of premature deaths that a vaccine can prevent. As Brazil has far more reported COVID cases and deaths than Australia – in both absolute and per capita terms – it’s a no-brainer that Brazil’s needs are the greatest. Still, your decision to prioritise Brazil over Australia creates a storm of controversy.

As WHO Director-General, you know that each million doses of the vaccine will likely save the lives of hundreds of Brazilians. You also know that the same million doses given to Australians is probably not going to save more than one or two people. However, vaccines are not being distributed based on need but ability to pay. Countries with advanced economies have bigger cheque books, which has enabled them to push in front of countries with developing economies.

The unfairness of this is laid bare when we circle back to the lifesaving example. Australia can be likened to the male swimmer whose situation was non-life threatening whereas Brazil is akin to the female swimmer who was in serious peril. While none of the bystanders on the beach challenged your decision to rescue the swimmer needing the most help, you are being severely criticised for choosing the nation that needs the most help.

The hypocrisy of this double standard is even more pronounced when you learn further facts about the two swimmers. The male is from Australia and the female is from Brazil. You knew this before you plunged into the surf as you spoke briefly to the distressed families of both swimmers. However, knowing the nationality of each swimmer did not cause you to favour the Australian over the Brazilian – and quite rightly so!

Race and ethnicity should not be factored into the equation when rescuing swimmers or determining vaccine allocation. All lives matter and no life can be neglected. Yet, when it comes to COVID, we are witnessing the injustice of some humans being treated as less equal than others. The sad reality is that nearly 70 poor countries will only be able to vaccinate one in ten people against COVID-19 this year. The UN has labelled this distribution outcome as “wildly uneven and unfair”.

According to a press release issued by Oxfam International, rich countries are failing the vaccine equity test:

… wealthier nations have bought up enough doses to vaccinate their entire populations nearly three times over by the end of 2021 if those currently in clinical trials are all approved for use. Canada tops the chart with enough vaccines to vaccinate each Canadian five times. Updated data shows that rich nations representing just 14 per cent of the world’s population have bought up 53 per cent of all the most promising vaccines so far.

Anna Marriott, Oxfam’s health policy manager, adds: “No one should be blocked from getting a life-saving vaccine because of the country they live in or the amount of money in their pocket. But unless something changes dramatically, billions of people around the world will not receive a safe and effective vaccine for COVID-19 for years to come”.

The world has a moral obligation to help those in greatest need first. Given this, Australia, New Zealand and other nations which are not in immediate danger of “drowning” from COVID-19, should move towards the back of the vaccination queue. But this won’t happen as rich nations are focussed on national recovery, not global recovery as they are prioritising country over planet.

The WHO labels this behaviour as “vaccine nationalism” and blames it for the lack of solidarity against a common enemy. WHO Director General, Tedros Adhanom Ghebreyesus, has warned that the lopsided distribution of vaccines “harms everyone and protects no one”. Further, he believes that inoculating certain populations to the detriment of others is “medically self-defeating”.

The rising fever of inequality is fuelled by a chronic failure of national leaders to display true global leadership. The inward focus of most countries places the pursuit of domestic political goals above those beyond their borders. In fairness to national leaders, their decision to take a beggar-thy-neighbour stance is driven by citizens who expect their elected officials to look after them first and foremost. Many citizens want first dibs on COVID vaccine jabs.

Yet, it’s in Australia’s self-interest (and other rich nations too) to help ensure that every other country’s population is vaccinated. Until the fear of COVID-19 dissipates, trade and travel won’t return to normal. And health-wise, nobody is safe until everybody is safe. The strategy of every nation just looking out for itself is a path that most ethicists think is wrong.

The frenzied grab for vaccines is driven by the same selfish impulses that drove the hoarding of toilet paper. Coronavirus drives panic buying due to the fear of missing out and leads to the irrational stockpiling of vaccines, toilet paper and other essential items. Of course, no one wins when everyone adopts an “every-man-for-himself” attitude.

If we truly believe that life is sacred and worthy of our deepest reverence, we (as individuals and nations) would let poorer nations and those worst affected by COVID go first. Certainly, I would not have objected if the Australian government had delayed vaccinations until more needy nations had received their jabs first.

My view, of course, puts me in the minority as many Australians, as well as the federal opposition and some sections of the media, are critical that our rollout has not moved faster. Even though it shouldn’t be this way, Scott Morrison knows that his party’s fortunes depend upon giving the majority of Australians what they want – a jab in the arm and quickly!

Shame on us for letting the world’s most vulnerable people “drown” in a sea of COVID.

Regards

Paul J. Thomas
Chief Executive Officer
Ductus Consulting

4 Replies to “Why COVID vaccines are being distributed unevenly and unfairly”

  1. Hello Paul,

    Appreciate your direct and apt description of the Covid vaccine distribution situation.

    Unfortunately, this situation was predictable…..’ north-south divide’ continues as usual.

    Thank you,

    Des

  2. Paul,
    Another wonderful and incisive blog thank you.

    I know so many wonderful, intelligent, young people that are doing so many positive things for our planet.

    However the blessed holy dollar continues to over rule us all.

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