One year on: COVID-19 vaccines are being rolled out, but too many people are being left behind

2021 brings hope, but also concerns

We have entered 2021 with some hope. Just a year from COVID-19 being declared a pandemic, six different vaccines have already been fully approved and are being used, with a further six having received early or limited use approval, 20 in the final stages of testing and many more in the pipeline. This is a remarkable accomplishment; especially given that vaccine development normally takes several years. Within just a couple of months of the first person being vaccinated, millions of people have now received their jab, offering optimism that an end to the pandemic is in sight.  

While this achievement should of course be celebrated, unfortunately the world is not reaping the benefits equally. Unacceptably, too many countries and people are being left behind in the race to be protected from Coronavirus. The majority of vaccine doses have been rolled out in a small number of countries; while many have yet to deliver a single dose. Looking at future purchases paints an even bleaker picture, with just 19 high-income countries securing over half of the vaccine doses available. Some of these countries have pre-purchased enough vaccines to cover their population several times over, while others struggle to even vaccine their frontline health workers. While the COVAX Facility has now started to distribute vaccines in low-income countries, this is far outpaced by the rollout of doses in high-income countries.

This scramble to buy up the limited supply of vaccines very clearly highlights a key issue: there are currently not enough vaccines available to meet global demand. No single manufacturer – not even a few combined – has the capacity to produce enough vaccines for the world, especially given that we must continue to prioritise vaccines to protect people from other critical illnesses. However, not nearly enough is being done to address this issue and increase manufacturing capacity to unleash needed supply.

To make real progress on ending the pandemic – and minimise the impact on children's lives – we must address the equity gap in vaccine access as a matter of urgency.

The failure to take a global approach will undermine progress; and children’s lives will continue to be impacted

The economic arguments for a global response could not be more evident, with estimates of a US$9.2 trillion hit to the global economy if vaccine nationalism is pursued. But there is also a strong morale, rights and public health argument for such an approach. As stated by the heads of WHO and UNICEF, the failure to take a global approach will “will cost lives and livelihoods, give the virus further opportunity to mutate and evade vaccines and will undermine a global economic recovery”.

The rollout of COVID-19 vaccines is a critical step to bringing an end to the pandemic and helping children’s lives return to normal. But all countries need access to vaccines to make this happen. If only a few countries can vaccinate their populations, the divide between rich and poor countries will worsen, to the detriment of children. Children’s rights will remain under threat from interruptions to essential health and nutrition services; a worsening malnutrition crisis; continued school closures and impacts on children’s learning; and damaging impacts on children’s physical and mental health.

We need global solidarity and action

The COVAX Facility was established to help drive global equitable access to vaccines, alongside the COVID-19 technology access pool (C-TAP) to facilitate the sharing of knowledge, intellectual property and data for manufacturing scale up. Despite leaders talking of global solidarity – including their commitments through the 73^rd World Health Assembly COVID-19 resolution and pledges to COVAX – there has been insufficient action to address many of the fundamental issues. Funding is vital, but money alone will not deliver vaccines for all, especially if it is undermined by the actions of some of those same donors. More financing is certainly needed for the global response, but this must go hand in hand with action to address equitable vaccine distribution and supply.

Save the Children is calling for a comprehensive global response with bold action and accountability from ALL stakeholders to turn the rhetoric of global solidarity into reality. We must ensure action on a number of fronts, including:

• Donors should commit sufficient resources to fund COVAX to support the roll out of vaccines in low-income countries, as well as vaccine delivery in humanitarian contexts.
• Donors should prioritise fair global distribution of COVID-19 vaccines and not engage in vaccine nationalism that undermines this. They should urgently contribute a proportion of already secured doses to the COVAX Facility, upholding the ‘principles for sharing COVID-19 vaccine doses with COVAX’.
• Donors and manufacturers should back C-TAP, sharing COVID-19 health technology related knowledge, intellectual property and data, in addition to prioritising investment and collaboration with developing country manufacturers to unleash supply.
• Manufacturers should ensure full transparency around the distribution and development of COVID-19 vaccines, including clinical trial data, cost of R&D and prices.

At national level, we are advocating for governments to prioritise vaccination for the most vulnerable and high-risk groups (following WHO guidance) and to include all population groups in their vaccination plans, without discrimination.

Short-term investment must lead to a long-term benefit for children

In the pursuit of vaccinating the world with COVID-19 vaccines, children must continue to receive other life-saving immunizations and other health and nutrition services vital for their survival. Any COVID-19 investment must support long-term sustainability by building strong and resilient health systems that can prepare for, and respond to, public health emergencies, as part of Universal Health Coverage.