It is nearly two years since the first case of COVID-19 was detected and the outbreak exploded into the deadliest pandemic in living memory. Are we able to see light at the end of the tunnel? Is there a realistic hope that the pandemic will end soon? What are we learning that will help us take steps to ensure that we will not face such a crisis ever again? These are some of the questions that we will address at the Regional Conversation on Equitable Access to Vaccines, Diagnostics and Therapeutics on 30 November 2021.
There is a silver lining to the dark cloud of the pandemic. Vaccines, diagnostics and medicines have been developed at unprecedented speed, with the private and public sectors working closely together. However, as the world races towards vaccinating at least 70 per cent of its population by the middle of 2022, large inequities between rich and poor countries have emerged. The figures present a stark picture: as of November 2021, 100 per cent of high-income countries (HIC) and 78 per cent of upper middle income countries (UMICs) are on track to vaccinate 40 per cent of their populations by the end of 2021, compared to only 4 per cent of low-income countries (LICs) and 33 per cent of lower middle income countries (LMICs). This inequity has been brought about by, among other factors, the concentration of vaccine manufacturing in a few countries (mainly developed), procurement of vaccines disproportionate to their needs by HICs, restrictions on export of vaccines by some countries and limited supply of vaccines to the WHO COVAX facility. While some improvements have been seen recently, with more types of vaccines being approved and new production sites coming online, considerable supply inequities will remain in 2022. About 92 per cent of HICs have procured enough vaccines to inoculate 70 per cent of their populations by mid-2022, compared to only 7 per cent of LICs. For this vast gap to be closed, the COVAX facility must receive vaccines on a priority basis, without precluding bilateral arrangements between LICs and manufacturers.
Getting the vaccines into the arms of the population is an additional challenge. It requires well designed and resourced vaccination strategies at national level, with clear and transparent criteria for prioritizing populations in vulnerable situations, including older persons, persons with disabilities and health workers, many of them women. Certain vaccines require storage at extremely low temperatures, and systems that maintain cold chains and reduce wastage are essential. Many countries in the Asia-Pacific region have successfully and efficiently used digital platforms linked to national identity cards to manage vaccination programmes in an efficient manner, including for registration, allocation of vaccine doses as per demand, distribution and certification. However, the needs of the sections of the population having limited or no access to digital technology must be kept in mind in such cases to prevent their exclusion.
Even in countries with abundant supply of vaccines, vaccine hesitancy has led to a slowing of vaccination rates. This has contributed to a “fourth wave,” for example, in several European countries, where, according to WHO data, infections have soared by 55 per cent over the last month, and several countries have recorded all-time highs in infections and fatalities. Vaccine hesitancy must be addressed by a combination of advocacy, communication strategies and legislative measures. Timely and accurate information and explanation about the benefits of vaccination is required, including on possible side effects, to combat disinformation and fear.
The mutation of the COVID-19 virus into more communicable and virulent strains as well as potential reduction of vaccine efficacy over time have highlighted the need to avoid putting all eggs in the vaccine basket. While vaccines are an important defence in our fight against the virus, developing more rapid, accurate and cheaper diagnostic tools and ensuring access to new and affordable treatment options are equally important. Moreover, preventive measures, such as social distancing and mask-wearing, while the pandemic is still rampant, remain very important.
A sustainable response to the COVID-19 pandemic must be built around the three pillars of vaccines, diagnostics and therapeutics.
In the medium and long term, a number of countries in the Asia-Pacific region without manufacturing facilities are striving to set up local facilities to secure supplies in case of future pandemics. This may be easier said than done, as it may neither be feasible nor efficient for every country in the region to manufacture vaccines on its own in view of capacity and resource constraints. Regional cooperation plays an important role with countries pooling resources for vaccine research and manufacturing. Surge capacity could be created to be put into immediate operation when required. Regional cooperation could also play a key role in harmonizing drug approval and sharing technology and information. However, it is equally important that trust and solidarity be built within and between countries to ensure that such arrangements do not collapse at the first sign of stress.
Underpinning all the above is an urgent need for increased investment in strengthening health systems to ensure universal health coverage and making health systems more agile. While the average expenditure on health as a proportion of GDP across the region is around 6.7 per cent, many countries spend well below 5 per cent of GDP. In many countries, therefore, people rely on out-of-pocket payments for health care. This pandemic has provided a political impetus and momentum to increase funding for health systems at all levels, including the community level. However, it is not just about spending more but about also spending wisely to make health systems more resilient and able to respond to risks faster and better.
No one is safe unless everyone is safe, and we cannot afford to leave any one behind in our response to the pandemic.