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To End the COVID-19 Pandemic in 2022, Learn & Act to Reverse 2021 Vaccine Inequities

The 2021 global COVID-19 response was marked by both tremendous advances and devastating shortfalls. Optimism was abundant at the start of the year. The first COVID-19 vaccine was administered on Dec. 8, 2020, culminating the fastest vaccine development and emergency use approval process in history. It seemed that the tide could be turning against the pandemic. 

One year later, millions of lives have been saved and hospitalizations averted from COVID-19 because of the more than 9.75 billion COVID-19 vaccine doses administered. Yet only 9.6% of people living in low- and middle-income countries (LMICs) have received at least one dose. This abject failure to equitably distribute doses to ensure those most at-risk are vaccinated represents both a moral failure and a massive challenge to end the pandemic, as variants arising in populations with little access to vaccinations continue to drive the massive spread of SARS-COV-2. 

On Wednesday, Gavi made the investment case for at least $5.2 billion in new funding needed in 2022 for the 96 LMICs participating in the Gavi COVAX Advance Market Commitment (AMC) , to “establish a Pandemic Vaccine Pool of a minimum of 600 million additional doses to address uncertainties and risks in the virus’ evolution, provide bundled finance to strengthen delivery systems in recipient countries, and cover essential ancillary costs.”  

This funding target, especially the $1 billion needed to deliver vaccines in AMC countries, simply must be met if we want to drive the end of the COVID-19 pandemic in 2022. And if we want to better respond to future pandemics, the Coalition for Epidemic Preparedness Innovations (CEPI)’s call for $3.5 billion to fund their 5-year strategy and cut the vaccine development timeline down to just 100 days must also be met in full. 

Failure to Deliver Vaccine Equity

Throughout 2020 and into 2021, global health advocates called for an equitable, need-based global vaccine distribution strategy. Sabin supported many of these calls to action, including a Global Roadmap to Vaccinate the World put forward by the Pandemic Action Network. That ideal moved further and further away, however, as high-income countries directly approached vaccine manufacturers to secure the first available doses for their populations. These advance purchase agreements cornered the vaccine market and undercut the effectiveness of COVAX. As of December 2021, only about 16% of the vaccine doses promised to COVAX had been delivered by manufacturers who are preoccupied with fulfilling orders from high-income countries. This, along with other challenges, meant that COVAX only delivered half, or 800 million, of the COVID-19 vaccine doses it had set as its original goal.  

Along with vaccine delivery targets, national leaders and policymakers also fell short on their commitments to local health workers and immunization professionals. The World Health Organization (WHO) declared 2021 the Year of Health and Care Workers. Over 1,500 global health stakeholders, including Sabin, signed-on to this campaign’s Vaccine Equity Declaration, pledging to protect and invest in health and care workers both during the COVID-19 pandemic and beyond.  

However, a WHO survey in November 2021 found that among 25 African nations, only 27% of health workers were fully vaccinated against COVID-19. In high-income countries, such as the US and the UK, vaccination rates range between 75-95%. Adequate PPE also continues to be in short supply in many LMICs. Health and care workers have had to face these workplace safety risks in addition to all the common stressors associated with the COVID-19 pandemic, including illness and death among friends and family, loss of household incomes, travel restrictions, and economic shutdowns. This has understandably taken a massive toll on the mental health and wellbeing of health and care workers. In response, many have decided to leave the work force, leaving a critical gap in the global COVID-19 response and in routine immunization campaigns. Significant declines in routine immunization rates were reported worldwide in 2020 and 2021, leading to the resurgence of vaccine preventable disease in some regions. 

Immunization professionals, health workers can end the pandemic – if we support them 

Ending the COVID-19 pandemic and reversing the backslide in routine immunizations in 2022 requires the delivery of billions of vaccines to LMICs. World leaders took an important step towards this commitment at the Global COVID-19 Summit hosted by the United States in September 2021 by highlighting the workforce and systems needs to deliver vaccines.  

The US committed an additional $250 million to health system and workforce support worldwide. This commitment was strengthened by the announcement of USAID’s Initiative for Global Vaccine Access (Global VAX) in December 2021, which takes a comprehensive approach to vaccine delivery – investing in health workforces and addressing other critical concerns such as vaccine acceptance and demand. These commitments are encouraging and provide reason for optimism.  

However, major gaps in health system needs, including the health workforce, remain and must be a top priority for governments and donors in 2022 if we have any hope of ending the pandemic and reversing the backslide in routine immunizations. 

In 2022, Sabin will use our platforms to advocate for a renewed, global commitment to health workforce strengthening. Local health and care workers must receive proper workplace protection, including priority COVID-19 vaccination and PPE to maintain the integrity of critical health services. Frontline health workforces delivering vaccines also must be supported and by expanded, equitable pay and networks to foster professional collaboration 

Finally, local health workers and immunization professionals have a unique and valuable perspective into how to combat localized barriers to vaccine access and vaccine acceptance. Sabin will continue to advocate for national and multilateral leaders to provide local health leaders permanent seats at the table when making decisions about vaccine distribution and delivery strategies.  

While the world is still focused on battling COVID-19, the next major public health emergency may not be far off. The world must invest in our health workforce and immunization professionals now to ensure that it, as our first line of defense against current and future vaccine-preventable threats, is able to respond rapidly and effectively.