Vaccine equity is when every individual has a fair and just opportunity to be vaccinated, regardless of socioeconomic status, race, ethnicity, geographic location, or other determinants of health. Barriers to vaccine equity include decisions on which vaccines are developed, affordability of vaccination, production, allocation, logistics of deployment, and effective communications to impacted populations.
Establishing and Defining Vaccine Equity
Vaccine equity means ensuring that everyone in the world has equal access to vaccines. The importance of vaccine equity has been emphasized by researchers and public health experts during the COVID-19 pandemic but is relevant to other illnesses and vaccines as well. Historically, world-wide immunization campaigns have led to the eradication of smallpox and significantly reduced polio, measles, tuberculosis, diphtheria, whooping cough, and tetanus.
Establishing global vaccine equity is imperative to mitigate the spread of global pandemics. There are multiple factors that contribute to the emergence and spread of pandemics, including the ability of people to travel long distances and therefore widely transmit viruses. A virus that remains in circulation in one location is likely to spread and recur in other areas. As a virus becomes more widespread and affects larger and more diverse populations, it is more likely it is to evolve to be increasingly transmissible, virulent, and vaccine resistant. Vaccine equity is essential to stop both the spread and the evolution of a disease. Ensuring that all populations receive access to vaccines is a pragmatic means towards achieving global public health. Failing to do so increases the likelihood of further occurrences of a disease. Infectious diseases are disproportionately likely to affect those in low and middle-income neighborhoods and countries (LMICs), making vaccine equity an issue for local and national public health and for foreign policy. Ethically and morally, access for all to essential medicines such as vaccines is fundamentally related to the human right to health, which is well-founded in international law. Economically, vaccine inequity damages the global economy. Supply chains cross borders: areas with very high vaccination rates still depend on areas with lower vaccination rates for goods and services. Achieving vaccine equity requires addressing inequalities and roadblocks in the production, trade, and health care delivery of vaccines. Challenges include scaling-up of technology transfer and production, costs of production, safety profiles of vaccines, and anti-vaccine disinformation and aggression. Barriers to vaccine equity also involve consistent misinformation and lack of clear language within attempts to educate general populations on vaccine benefits and vaccines themselves, especially in rural areas and populations.
Patterns of vaccine inequality The wealthy generally have better access to vaccines than the poor, both between and within countries. Within countries, there may be lower rates of vaccination in racial and ethnic minority groups, in older adults, in families headed by vaccine skeptics, and among those living with disabilities or chronic conditions. The distribution and accessibility of vaccines show significant disparities between urban and rural areas especially in low- and middle-income countries. Some countries have programs to redress this inequality. Political, economic, social, and diplomatic factors can limit vaccine availability in some countries.
Factors Achieving control of a disease (such as COVID-19) requires more than just developing and licensing vaccines. It also involves producing them at scale, pricing them so they are globally affordable, allocating them where and when needed, and deploying them to local communities. An effective global approach to achieving vaccine equity must address challenges in the dimensions of vaccine production, allocation, affordability, and deployment. Doctors Without Borders (MSF) lists five major obstacles to vaccine equity, taking into account that many of those to be vaccinated are children:
Vaccine prices; new vaccines are on-patent and expensive (affordability) Getting vaccines to children; this is expensive and gets even more difficult in conflict zones and natural disasters (affordability, deployment) Five clinic visits in the first year of life is often too many; for people in remote areas with many children, it can be much more costly and difficult to get to a clinic. (deployment) Keeping vaccines cold; see cold chain. (deployment) Age-out; children who don't get vaccinated on-schedule often have to pay for their shots. Disruption from natural disasters or conflict can mean that entire generations go unprotected.(affordability, deployment) Achieving vaccine equity depends on having a sufficient supply of affordable vaccines available for global use. Ideally, a vaccine that is suitable for global use will be based on established technology; will have multiple available suppliers of the materials and equipment needed for production; be appropriate to the regions where it is to be produced or deployed, in terms of scalability of production and storage conditions; and be supported by local infrastructure for its production, delivery and regulation.
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