Reaching the world's most vulnerable poses biggest challenge for COVID-19 vaccine, experts say

NEW YORK — Global health and development leaders expressed optimism during the United Nations General Assembly this week that a COVID-19 vaccine is forthcoming and can end the devastating pandemic. But many warned that equitable distribution will face additional hurdles of financing and misinformation once an effective vaccine is found.

“We will need adequate finance, and that needs to be there to ensure we leave no one behind. There are going to be limited vaccines at the beginning, but we want to make sure financing is not what is going to limit us,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance. “We also need political commitment from the pharmaceutical industry. There is global demand, and we need commitment to make sure we can supply globally and not just to the highest-price payer.”

During a high-level event Wednesday in the UNGA’s opening week, Berkley spoke alongside other public health leaders and government officials on ensuring equitable access to lifesaving immunizations. The event was co-hosted by Gavi, the World Health Organization, and the International Federation of Red Cross and Red Crescent Societies.

Ensuring timely delivery to all in need, especially the most vulnerable, is the “greatest challenge we will be facing” once a COVID-19 vaccine is approved, according to Xavier Castellanos, undersecretary-general of IFRC.

“That means putting communities at the highest risk at the center of our response to the pandemic,” he said during the webinar.

Castellanos and other experts branded the COVID-19 Vaccine Global Access — or COVAX — Facility as an “insurance policy” and an “exit plan” to help guarantee that a vaccine reaches the most vulnerable people and, eventually, ends the pandemic.

“We know the pandemic will only be fully over once all countries have access to safe and effective vaccines against COVID-19,” said Alain Berset, Switzerland’s health minister.

The COVAX Facility would guarantee a vaccine to 20% of the populations of all low- and middle-income governments participating and “if successful provide access to hundreds of millions of citizens” in these countries, wrote Elissa Prichep, precision medicine lead at the World Economic Forum, in a recent media release.

Sixty-four higher-income countries, including Norway and 27 European Union member states, have joined the COVAX Facility, the initiative announced Monday, joining 92 low- and middle-income countries that would be eligible for vaccine procurement support.

The COVAX Facility has raised around $700 million to date but is still short of its $2 billion target for seed funding needed by the end of the year to help produce 1 billion doses by the end of 2021. This fundraising campaign comes amid a growing trend of “vaccine nationalism,” as countries like the U.S. and China are buying up potential vaccines for their own populations and not participating in the facility.

“We know if wealthy countries buy up the first 2 billion vaccines, almost twice as many people could ultimately die from COVID-19. We now have over 200 vaccines in development, with nine already in the late stage of efficacy testing,” Berkley said.

“In keeping with the 2030 Agenda [for Sustainable Development], we must confront the fact that the impact of the pandemic is also not equally distributed. Probability of death increases with increasing poverty,” Berkley continued.

Health indicators unrelated to the coronavirus, including immunization rates, have been slipping during the pandemic as a result of people’s fear of contracting COVID-19 in health facilities, experts said during the webinar.

“That highlights the lack of trust in the quality of health services. On the supply side, the ongoing COVID pandemic is really constraining the health system and the provision of basic health services. To make immunization programs more resilient to such outbreaks, there is need to ensure that systems in place are able to consistently reach all children, in particular from vulnerable communities,” said Antoinette Ba-Nguz, a regional immunization coordinator in eastern and southern Africa for UNICEF.

Katherine O’Brien, an epidemiologist at Johns Hopkins University, echoed another concern voiced by Berkley and others: Global immunizations now risk dropping to levels last seen in the 1990s.

“In all countries, in all income levels, it is the poorest and most disadvantaged who are likely to miss out. We know immunization services have been disrupted in all countries. In Africa alone, 1 million fewer children were vaccinated during the first half of this year compared to 2019,” O’Brien said.

James Roscoe, deputy permanent representative for the U.K. Mission to the U.N., highlighted another issue that speaks to the complexity of an eventual vaccine rollout.

“One of the things we are particularly concerned about is the vaccine misinformation out there already,” Roscoe said, asking for plans of action to combat this trend.

Castellanos called for “collective action with a collective message” to help reach communities and individuals that might be skeptical of a vaccine.

“I think we have to connect and ensure and engage in messages for ministries of health for every country and ensure there is such a unity in messaging. The challenge is that we are not aligned in terms of the message to address issues of miscommunication,” he said.