Comment

COVID-19 vaccines: why the richest nations shouldn’t be jumping the queue

Who gets priority worldwide should be based on risk, not nations’ (in)ability to pay

Coronavirus immunisation worldwide should give priority to clinical need and reflect the fact that all lives nurses included are of equal value

There has been great news about COVID-19 vaccinations in the past few weeks.

Some countries, including the UK with its spectacularly successful vaccination programme, have raced ahead at an amazing rate, reaching millions of their citizens, especially those most at risk.

It is gratifying to see that nursing and other vital front-line healthcare staff are being treated as a priority group in many, if not most, countries.

This is something we at the

Coronavirus immunisation worldwide should give priority to clinical need and reflect the fact that all lives – nurses’ included – are of equal value

Picture: iStock

There has been great news about COVID-19 vaccinations in the past few weeks.

Some countries, including the UK with its spectacularly successful vaccination programme, have raced ahead at an amazing rate, reaching millions of their citizens, especially those most at risk.

It is gratifying to see that nursing and other vital front-line healthcare staff are being treated as a priority group in many, if not most, countries.

This is something we at the International Council of Nurses have been advocating for months.

Uneven uptake of coronavirus vaccination

But even in a high-income country such as the UK, the distribution of the vaccine has not been without its problems.

One recent study suggested that black and minority ethnic (BAME) staff at a large trust were much less likely to have had a COVID-19 vaccination than their white colleagues.

‘A coordinated, worldwide vaccination programme is the only sure way out of the pandemic’

In a separate survey, the RCN found that three quarters of the nursing staff who have not yet had the vaccine work outside the NHS, many of them in the care home sector.

This research is troubling. We know BAME staff are at a heightened risk of developing severe illness if they contract the COVID-19 virus, and people who live in care homes are also at high risk by virtue of their age and health status.

Herd immunity for the whole planet

Vaccine distribution is unequal, and this is worrying.

The reasons for this uneven take-up could be manifold, and will include personal choice.

Nobody can be forced to have a medical intervention, including a vaccination, although in some employment situations it may be deemed an essential aspect of one’s duty of care.

As we all know, a coordinated, worldwide vaccination programme is the only sure way out of the pandemic.

COVID-19 may well be with us for the foreseeable future, but just how much illness, death and misery it causes will be down to how and when governments respond.

Vaccinating everyone is not just about equity, it is about reducing the risk of new and dangerous variants.

It is about the whole planet developing herd immunity through vaccination and people getting back to that one simple thing that everybody wants – normal life.

Success of vaccines so far is cause of optimism

Encouragingly, the two leading vaccinations seem to be exceeding expectations.

It is early days, but data show they are managing to prevent infections and reduce serious illness and hospitalisations.

‘Some high-income countries have bought many times more vaccines than they will ever need’

Given how tragic the pandemic has been, this good news is heartening in these otherwise dark and distressing times.

But sadly, as is often the case, the good news is only half the story.

Historic health inequalities are revealed by national immunisation programmes

Throughout history, the equal distribution of vaccines has been a problem.

When smallpox was finally eradicated in 1980, it had been chased down until to the very last case in Somalia – at the time one of the world’s poorest, least-developed countries.

Now we are seeing a similar pattern, in that it is the poorest countries – those classified as low and low-middle income by the World Bank – struggling to get out of the starting blocks when it comes to vaccination programmes.

And there are other inequalities apparent in the vaccine distribution, related to gender, socio-economic group, immigration status and disability.

‘Pledges to donate leftover vaccines to poorer countries build in a delay for people in those nations, and fosters an “us-and-them” dynamic that echoes unhelpful historical relationships’

Our national nursing associations have provided an up-to-date snapshot that shows many countries in Africa and central and east Asia still need urgent action to start their vaccination programmes.

Wealthy nations have stock-piled vaccines

In time, there will be enough vaccines to go around, but currently some high-income countries have bought many times more vaccines than they will ever need.

Out of the seven billion vaccine doses purchased worldwide, high-income countries – representing just 16% of the world’s population – have bought 60%.

The UK, with its population of about 67 million, has ordered 457 million doses, according to the BBC. Even if every UK citizen gets two doses, that is more than three times the number of doses required.

Recently, prime minister Boris Johnson pledged any leftover vaccines in the UK would be donated to poorer countries and French president Emmanuel Macron has said similar.

But this builds in a delay for people in poorer nations, plus it fosters an ‘us and them’ dynamic that echoes unhelpful historical relationships.

Clinical need should dictate who is vaccinated first

Basing decisions about who should get vaccinated first on geography and wealth is immoral.

Some people are more at risk of severe illness. And if all lives are valued equally, then they – and the staff who will look after them when they get sick – should be prioritised, no matter where they live or how little money they have.

Wealthy governments have made commitments via the COVAX initiative to speed up the development and manufacture of coronavirus vaccines, and to guarantee fair and equitable access for every country.

Only time will tell us how effective this is going to be.


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