Unequal Access to Vaccines Will Exacerbate Other Inequalities

Abstract

The COVID-19 pandemic has changed the world. In addition to disrupting health care systems, it has negatively affected the economic and social life of countries. According to the United Nations, the economic cost of this pandemic is estimated to be at least US$1 trillion for the year 2020, with global economic growth slowing down to 2%.1 The economic disruption has been driven by restrictions imposed to control the spread of the virus, and “buy time” for the development of a vaccine. There is a consensus that a vaccine, and the immunity that it confers, is required for countries to lift their restrictions and restart their economies. This has led to countries competing for supplies of potential COVID-19 vaccines.2 A corresponding surge of activism has occurred to ensure that vaccines will be equitably distributed. Equal access to a vaccine will be needed to prevent the development of health disparities between the vaccinated and unvaccinated. Unfair access to vaccines will also create inequalities in rights and freedom. There are numerous reports of communities who are perceived to be at higher risk of being infected, being targets of discrimination, and having their rights curtailed. It requires no stretch of the imagination to see how unequal access to a vaccine will result in the rise of a 2-caste system: the clean, who are immune and noncontagious, and the untouchables, who are nonimmune and a feared source of infection. Those who are unable to obtain the vaccine may find their privacy threatened with temporary monitoring measures becoming permanent fixtures in the lives of the unvaccinated, exposing details of their movements and activities. The unvaccinated may also find themselves restricted from travel, public areas, and health care facilities. Their children may be restricted from nurseries. Employment opportunities may be closed for them, as employers may preferentially hire those who can demonstrate documented vaccinations and immunity to COVID-19. This may seem farfetched, but we know that these things can happen—we saw it happen to people living with HIV/AIDS.3 Unequal access to a vaccine may create rifts between nations with higher rates of vaccination and those with lower rates. People living in the latter countries may be refused entry into the former and may face additional discrimination from the global community. We saw this happen to Chinese nationals at the early stages of the pandemic, as well as people coming from African countries during the last Ebola epidemic.4,5 If equal access to an effective vaccine cannot be provided, the economic and social disadvantages of being unvaccinated will create an incentive for people to try and obtain a vaccine or an immunity status by unlawful means. We can then expect to see the rise of black market or fake vaccines or perhaps the sale of false documents that certify vaccinations. All of these will further threaten public health as well as the rise in crime. It has been said that the novel coronavirus does not discriminate. We must ensure that access to vaccination is the same.