MEXICO CITY — In the past few weeks, Britain and the US have watched with relief as their citizens began getting vaccinated against COVID-19 — but across much of Latin America, Africa, and large parts of Asia, the news has been met with a mixture of resignation and anger.
For many people in the developing world, there is still no light at the end of the tunnel.
These countries are struggling for access to the long-awaited vaccines after wealthy countries reserved enough doses to inoculate their populations several times over.
“International solidarity needs to grow,” Martha Delgado, the Mexican official in charge of negotiating the country’s vaccine contracts, told BuzzFeed News. Echoing concerns across the developing world, she warned that there will be no end to the global pandemic until everyone has access to the vaccine. She wants the US and other Western countries to think outside their own borders and their immediate needs. “No one will be safe until everyone is vaccinated,” she said.
Canada, for example, has preordered at least four times the amount it needs to vaccinate its 38 million citizens. The UK has secured enough to cover nearly three times its population. The European Union and the US could immunize almost all of their inhabitants twice with the number of vaccine doses they have reserved. Meanwhile, almost a quarter of the global population won’t have access to a vaccine until at least 2022, according to the BMJ, a medical journal.
So far, some of the poorer countries that have been hardest hit by the virus only have preorders to cover a small fraction of their population. Peru, where a dramatic oxygen shortage left the country on edge earlier this year, and El Salvador, where more than 1 in 4 people fall below the poverty line, have preordered doses for less than half their population, according to a New York Times analysis.
The countries that have preorders but don’t have political clout or economic might will have to wait longer than the big powers. Mexico, which according to its government has secured contracts with the different pharmaceutical companies to inoculate 116 million of its 126 million citizens against COVID-19, says it will not complete the operation until at least March 2022.
After Delgado told the BBC that “at least in Mexico we have the money to buy vaccines,” Xavier Tello, a Mexico City–based health policy expert, retweeted a post linking to the interview, saying that “I can have the money to buy myself a Tesla; but if someone else has already paid, I’ll likely have to be on a waitlist.”
Many in Mexico say that the country cannot wait much longer. On paper, the country has the fourth-highest number of deaths, only behind the US, Brazil, and India, but the official number — 118,598 — is likely much lower than than the real number of casualties. There have been at least 60,000 more “excess” deaths on top of these during 2020.
And Mexico’s healthcare workers say they are stretched to the limit with ongoing PPE shortages, exhaustion — and grief. More than 2,250 doctors, nurses, and medical staff have died, according to government numbers. With nearly three times the population of Mexico, some 1,500 healthcare workers have died in the US.
Who gets how many vaccines, and when, has opened an unprecedented ethical debate. Should governments prioritize their own citizens? Should the first vaccines be allocated to a certain proportion of the population of each country? Should initial doses be given to at-risk people across the world before they are distributed amongst those without comorbidities?
Arthur Caplan, head of the Division of Medical Ethics at the NYU School of Medicine, said he partly defends the first school of thought — vaccine nationalists. Countries who can afford it should take care of their own first, “plus a little more for insurance,” in case the current vaccines only offer immunity for a limited amount of time and a booster is needed in the near future.
But when it comes to making a more ethical decision, Caplan said that once a state has vaccinated its healthcare workers, older adults, and people with preexisting conditions, it should move to inoculate the same population in other countries afterward before vaccinating young adults and low-risk population.
COVID-19 has wreaked such havoc on the world that equity is not part of the decision-making when it comes to vaccine distribution among countries.
“The rich countries are in such bad shape that they’re not thinking about this,” Caplan told BuzzFeed News.
While the second option — allocating vaccines to an equal number of people in each country — may seem more equitable, it may end up being ineffective. Ignacio Mastroleo, an Argentine expert on medical ethics and part of the World Health Organization’s ethics and COVID-19 expert group, notes that giving Peru and Poland the same amount of vaccines, for example, would not take into consideration that the virus has killed 11,600 more people in the former than in the latter (their populations are 32 million and 38 million, respectively).
That option “is not sensitive to the needs of the population,” said Mastroleo, adding that the poverty rate in Peru is 10 times higher than in Poland.
Mastroleo said that if there is a silver lining it is that, unlike during the 2009 swine flu pandemic, there are efforts by international organizations to support equality in vaccine access this time around. One of those mechanisms, cofounded by the WHO and known as COVAX, is a global pool of vaccines to which poorer countries will have access. But the scheme will only supply less than 20% of the 92 low- and middle-income countries’ populations.
Unequal access to vaccines is likely to happen not just between countries, but within them, leaving millions of vulnerable people defenseless against the virus. On Monday, Colombia’s president, Iván Duque, announced during an interview with Blu Radio that there are no plans to vaccinate undocumented people, saying that if the country did, it might create a “stampede” of immigrants into Colombia. There are currently 1.7 million Venezuelans living in Colombia, and about 55% of these do not have citizenship. Most of them fled an economic meltdown and humanitarian crisis in Venezuela.
Relief for millions of people may not come until the end of 2021 or even later, when countries that have hoarded excess vaccines either sell off or donate them to poorer states, according to Delgado.
“This is the wrong strategy,” said Delgado. Relief will come sooner to the world at large when people stop “looking for their own salvation.”