Over the course of the past year, the COVID-19 pandemic has repeatedly demonstrated its ability to exploit preexisting inequities. Vulnerable and disadvantaged communities have been hit hardest by the pandemic, and in several cases the disparities that put them at this heightened risk have only been exacerbated.
The impact of COVID-19 has been most felt by those living in poverty – those who are unable to work and live in socially-distanced environment, have a higher risk of chronic and preexisting conditions and have difficulty accessing both preventative measures and treatment for COVID-19. Disparate rates of COVID-19 disease and death based on multiple sociodemographic factors have been revealed through data in countries across the world. In addition to in-country vaccination strategies, this trend demonstrates that it will be particularly critical to focus global vaccination efforts in low- and middle-income countries (LMICs) to mitigate the number of COVID-19 cases and deaths worldwide.
As an organization dedicated to expanding access to vaccines globally and making sure they reach the most vulnerable, the Sabin Vaccine Institute (Sabin) leadership felt it was important to speak up and contribute our staff’s collective experience and expertise to this matter. That is why we released our statement on COVID-19 vaccine equity earlier this month.
Sabin engages directly with immunization professionals from LMICs through our Boost Community. These professionals’ on-the-ground knowledge and experience are often the best source of information and guidance for expanding vaccine access and uptake within the communities they serve. That is why the fifth recommendation in our statement calls for ensuring that local immunization professionals from LMICs have the opportunity to contribute to and influence vaccine allocation and distribution decisions made at both the national and global level and are regarded as equals to other officials within those forums.
While the statement reflects Sabin’s understanding of what COVID-19 vaccine equity means and what actions must be taken in order to achieve it, the organization also acknowledges its perception of the current situation is limited by our location in Washington, D.C.
“We rely on our diverse network of Boost Community members, made up of over 1,400 members from nearly 130 countries, to help us appreciate what is happening on the ground in real time,” said Jennifer Siler, Vice President of Global Community Engagement at Sabin. “These learnings help inform policies and decisions at the global level, drive scale of best practices across contexts and allow our community to define the features and support they need from us in the midst of COVID-19 vaccine introduction.”
Throughout the pandemic, we have been engaging with Boost Community members and our partners from all over the world to understand their perspectives. Back in November 2020, we asked Boost members to share what COVID-19 vaccine equity meant to them. What followed was a robust discussion between Boost members from multiple countries, including Nigeria, Kenya, Somalia, Pakistan and India. Below are some key takeaways from that conversation:
- LMICs having a seat at the global table of immunization stakeholders is not only important, but essential. “We might not have the economic and scientific might, but we are definitely involved in the discussions on how to make [an effective COVID-19 vaccine] a reality,” – Immunization Consultant, Nigeria.
- Gathering data is key to prioritizing vulnerable populations. “An equitable approach to introducing a COVID-19 vaccine should be done by reviewing global and country/district specific evidence for identifying the most vulnerable population,” – Public Health Specialist, India.
- Vaccine equity means reaching every person despite challenges such as vaccine hesitancy. “What needs to be in place first is scientific justification on the vaccine being safe [which] will… help in accepting the vaccine, [and] for the larger religious and community leaders… to be taken along for their buy-in of the vaccine,” – Immunization Professional, Nigeria.
More recently, we reached out to some Boost members to ask whether they perceive vaccine rollout is meeting these high standards of equity both at the global scale and within their own communities.
Boost member Alain Blaise Tatsinkou, Senior Technical Officer at JSI, described for us the current approach to vaccine equity in Cameroon by the national Ministry of Health, which exists both through planning and implementation of COVID-19 vaccine introduction
During planning, target populations are prioritized based on epidemiologic patterns of the pandemic, with health care and social workers selected for the first phase. Next, micro-plans are developed to map out and identify vulnerable populations such as refugees, migrants and those individuals living in rural areas. Civil society organizations are also engaged to assist with identifying these populations to be vaccinated.
Moving to the implementation stage, the government deploys vaccines to eligible districts using a combination of vaccine delivery and communication strategies. For example, mobile teams are formed to reach individuals in remote areas. These teams consist of at least two community health workers who are trained to sensitize community members on COVID-19 vaccines using tailored messages.
Boost member Emmanuel Musa, an immunization consultant in Nigeria, describes a similar approach in his home country. Regarding prioritization, he agrees that health care workers need to be prioritized. “The health workers are classified as front-liners because they are most times the first place a sick person goes to at the sign of any kind of illness. They need to be protected in all ramifications of our communities in order to reduce the rate of infection and to also keep them healthy so that they [can] help the people in need of health services.”
He went on to describe the primary health care system as a vital player in controlling vaccine preventable diseases through routine immunization. However, the pandemic may overshadow these ongoing services, especially in terms of funding. Musa emphasized just “how necessary it is for the primary health care system to be supported via targeted investment that can last beyond the COVID-19 era.”
Perhaps underscoring this entire equitable approach to COVID-19 vaccine introduction is Musa’s notion that, “all individual[s] at increased risk of COVID-19 infection should have the same access to the vaccination process [delivery & distribution] regardless of their status or geographical location.”
These perspectives demonstrate that local immunization professionals view equitable access to COVID-19 vaccines as a critical step towards ending the pandemic. All stakeholders, whether at the local, national or global level must work together to achieve vaccine equity and elevate the voice of those working on the frontlines of immunization efforts, particularly those serving in LMICs. Sabin is committed to doing our part to make sure that COVID-19 vaccines reach vulnerable communities all around the world and that those communities are strengthened to be better prepared for the future.