Vaccine inequity is part of a larger health challenge

Emeritus Professor Tan Sri Dato' Dzulkifli Abdul Razak 
Opinion - New Straits Times 
January 10, 2022

"VACCINE inequity is a killer of people and jobs, and it undermines a global economic recovery," said World Health Organisation (WHO) chief Tedros Adhanom Ghebreyesus, who noted record numbers of people catching the new variant — rapidly outcompeting the previously dominant Delta variant.

This was highlighted in his first speech of 2022, pointing to the fact that "it had created the perfect breeding ground for the emergence of virus variants". Ninety-two of WHO's 194 member states reportedly missed the target set for 2021.

Indeed, 36 had not even jabbed the first 10 per cent due to the inability to access doses. This is far from the target of every country having 10 per cent of their population vaccinated by the end of September 2021, and 40 per cent by the end of December.

By mid-2022, the aspiration is to have 70 per cent of the population in every country jabbed.

"Booster after booster in a small number of countries will not end a pandemic while billions remain completely unprotected," Tedros was quoted as saying.

He used the term "tsunami of cases" to describe how "huge and quick" the Omicron devastation is in "overwhelming health systems around the world".

In a nation where only a small portion of the population is vaccinated, the threat is not only to itself, but the entire globe since Omicron is known to travel across borders with ease.

Within a week of emerging in Africa, the variant was detected in other continents, including those that are highly vaccinated.

Meaning, the fight against the pandemic will not end anytime soon despite progress on several technological fronts. Medically speaking, these have turned into opportunities for new variants to evolve and complicate the current predicament.

Especially in low-income nations, where the British Medical Journal estimated that a billion vaccine doses are required before the year is out. One way to alleviate this is to expand the capacity to produce more vaccines worldwide. So far, it has been directed towards the "conventional" Covid-19 and not the unpredictable variants.

Even then, only an estimated eight billion doses were said to have been manufactured, whereas to offset inequity, the number should be twice as many. What's more, the preoccupation with providing the third and now fourth booster doses!

This drives the problem of inequity to the hilt. WHO describes health inequity as "systematic differences in the health status of different population groups".

That is, certain groups experience a far worse health status, and increased difficulty in accessing healthcare as a result of the ecosystems that influence their lives.

The obvious example relates to the economic and political systems. Those born in low-income areas may have reduced access to not just healthcare (read, vaccines), but also safe housing, clean water and sanitation, healthy food and education — all of which impact health.

In the case of the pandemic, even though one has access to vaccines, poor cleanliness and sanitation, and congested living and working spaces will not keep the spread at bay.

This is seen many times when recommended standard operating procedures are violated due to socioeconomic pressures.

Umrah trips and flood-prone areas are recent cases in point. Changes in existing policy and behaviour are imperative to mitigate the situation. Hence, suspending umrah trips is a desirable policy change to deal with the predicament.

Vaccine inequity, in other words, is part of a larger health inequity on local, national and global scales, and can affect all countries. It is inclusive of systematic and potentially remediable differences among population groups — socially, economically or geographically.

Although it is more pronounced in the low-income group — affecting those from disadvantaged or historically oppressed groups most severely — invariably, it has a negative impact on everyone.

These differences are the result of unfair systems that affect people's living conditions, access to healthcare and overall health status.

Inequity can be horizontal or vertical. The former indicates that people with the same needs do not have access to the same resources. The latter exists when people with greater needs are not provided with greater resources.

Vaccine inequity can be tackled only with a whole-healthcare approach, not in piecemeal fashion, as is being attempted today.

The writer, an NST columnist for more than 20 years, is International Islamic University Malaysia rector