The worldwide introduction of COVID-19 vaccines creates a “vaccine apartheid”. As of February 24, around 216 million people worldwide had been vaccinated against COVID-19. Only 8.4 percent of these are in low- and lower-middle-income countries, where almost half of the world’s population lives.

If this trend continues, young and healthy people in rich countries will be vaccinated, while older and vulnerable people in poorer countries will continue to die needlessly.

Wealthy countries have focused almost entirely on securing vaccines for their own populations, rather than investing in collaborative initiatives like Access to COVID-19 Tools (ACT) (and its vaccine pillar, COVAX) that would distribute vaccines fairly to people at risk in everyone Country of the world. In doing so, they hoard limited supplies (Canada, for example, secures almost 10 doses per capita), raise vaccine prices and displace countries with lower incomes from the vaccination race. South Africa paid twice as much as the European Union for the AstraZeneca vaccine.

Most wealthy countries will fully vaccinate their populations this year, while lower-income countries may not get mass vaccination until 2024. If this vaccine nationalism continues, the world’s poorest will be driven into more disease, poverty and death.

Vaccine nationalism is also vanquishing itself. As affluent countries adopt domestic vaccination schedules, emerging COVID-19 variants threaten their success: Recent data suggests that several vaccines currently in use may offer reduced efficacy against new variants.

As long as SARS-CoV-2 continues to circulate in poorer countries, wealthy countries are at risk despite their vaccination shields. Their economies are also at risk. The International Chamber of Commerce predicts the global economy could lose up to $ 9.2 trillion if poorer countries are not given equitable access to vaccines, around half of which would go to advanced economies. By comparison, it only takes $ 22.9 billion to fund the ACT accelerator.

A global vaccination strategy is both cheaper and safer. It’s also a moral imperative – only a truly global vaccination strategy can ensure that the lives of the rich and the poor alike are taken into account.

To do this, we need to take three urgent steps:

First, high-income countries should support the transfer of relevant technology and intellectual property (IP) so that other countries can increase vaccine production.

In 2020, South Africa and India submitted a proposal to the World Trade Organization (WTO) to temporarily waive certain provisions of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) for COVID-19-related technologies.

The waiver has been backed by nearly 100 countries, but has been reinforced by the European Union, the United States, the United Kingdom, Japan, and several other countries that have large pharmaceutical industries. Policy makers in rich countries argue that intellectual property is not a real barrier to vaccine access and that the TRIPS flexibilities that exist are sufficient.

However, IP has already become an obstacle: South Africa has faced challenges in accessing reagents for COVID-19 testing due to IP rules. In addition, the US, EU and Switzerland have historically undermined the use of TRIPS flexibilities to protect pharmaceutical profits.

IP waivers and technology transfers will not result in instant vaccination in lower income countries, but they will facilitate international collaboration and remove real barriers to local vaccine production. The TRIPS waiver will be reconsidered by the WTO in March and rich countries should support it.
Second, high-income countries should dedicate a portion (e.g., 10 percent or more) of their vaccine supply to global allocation directly through COVAX (they currently hold about 56 percent of the global COVID-19 vaccine supply but only make 16 percent of the vaccine supply from global population).

While shipping doses overseas may delay the introduction of vaccines domestically, it adds to global herd immunity, which is in everyone’s best interest. Norway committed itself to such a path last month. As wealthy nations begin to ramp up vaccine production, gradually more of their vaccines should be used in poorer countries.

Third, high-income countries should fill the entire ACT accelerator funding gap of $ 22.9 billion. This funding is necessary so that COVAX can achieve the intended population coverage in the coming years. Some lower-income countries will use doses of COVAX to secure purchases from vaccine manufacturers. Others may rely entirely on COVAX for herd immunity.

COVAX is important and needs full support, but even in its most ambitious form, it will be too slow (it aims to vaccinate 20 percent of the population in lower-income countries by the end of the year) and it does not address the issue underlying structural problems that lead to vaccine apartheid. Indeed, part of its raison d’etre might have been to bypass the TRIPS negotiations. We must take this opportunity to see that all people have equal rights to public health medicines, not just for this crisis, but for the long term. This is not a question of charity, it is a question of justice.

The COVID-19 pandemic is likely to determine how countries act in the global health arena for decades to come. Vaccine apartheid is just the latest manifestation of a colonial logic of otherness and oppression that began centuries ago. Reparative justice demands that these legacies be reversed – and a commitment to vaccine equality can mark the beginning.

The views expressed in this article are those of the authors and do not necessarily reflect the editorial stance of Al Jazeera.

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