The fight for a fair COVID-19 vaccine explained

A guide to Amnesty International’s policy on COVID-19 vaccines

The race to develop a COVID-19 vaccine is gathering pace, and it seems like there may finally be light at the end of the tunnel. But as wealthy countries continue to hoard doses, the lifesaving potential of vaccines risks being undermined by inequality and corporate interests.  

Now is the time to demand that COVID-19 vaccines are available to everyone – regardless of where they live, who they are, or what they can afford. 

COVID-19 is a truly global crisis, and we will only solve it through global cooperation and respect for human rights. 

If we get this right, we can end COVID-19 and build a more just and sustainable future. Here’s what needs to happen: 

Human rights must be considered when deciding who to prioritize 

The question of who should get vaccines first is complex – we all have the right to be protected against COVID-19. But initial supplies will be limited, and we need to prioritize those who are most at risk. Health workers, older people, and people with pre-existing health conditions are among the groups being considered for priority access.  

But governments need to consider human rights factors which put some individuals and communities in a more vulnerable situation. As well as exacerbating pre-existing inequalities, the pandemic has had a disproportionate impact on people who have been historically marginalized and discriminated against. 

For example, Indigenous Amazonian communities in Ecuador often face a higher risk due to scarcity of drinking water, food sources, medical supplies, health services and COVID-19 tests. In April an oil spill polluted the food and water sources of many communities, increasing their risk of infection. 

People living in overcrowded refugee camps in unsanitary conditions are also likely to be at higher risk from infection. Furthermore, in many 

migrants and refugees without documents often do not have access to health care, including vaccines.   

There must be careful consideration of risk and exposure factors like working and living conditions, and access to sanitation, when making decisions about allocation. Narrow definitions of risk could leave the people most in need of the vaccine unable to access it. 

Similarly, early allocation to health workers must consider everybody working in the health sector – not just doctors and nurses but drivers, administrative staff, care home workers, and many more. 

Countries must work together 

Under international human rights law, countries have an obligation to work together to respond to the pandemic, and wealthier states have a special responsibility to assist states with fewer resources. But some governments have already adopted a “me first” approach that could undermine the efficacy of a future vaccine. 

Research by Oxfam found that wealthy nations, representing just 13 per cent of the global population, have already bought up more than half of future vaccines. This means more than half of the promised doses of the five leading vaccine candidates are already taken. As of November 2020, more than 80% of the planned 2021 supply of Pfizer-BioNTech and Moderna’s vaccines have already been sold to rich countries.  

As well as denying millions of people their human rights, “vaccine nationalism” is alarmingly short sighted. The World Health Organization estimates that for us to reach herd immunity, we need to vaccinate roughly 70% of the global population. Hoarding vaccines for a privileged few will not end this pandemic.  

States need to cooperate to make sure everyone has access to vaccines when they become available. This means wealthier states should refrain from making  large bilateral deals with pharmaceutical companies. They should also join and support global initiatives which aim to ensure fair vaccine access for all countries, such as the WHO’s COVAX scheme.  

Vaccine sharing schemes must be truly fair  

The COVAX Facility is a way for countries to pool their resources, to invest in and buy as many vaccines as possible, and then distribute them fairly and equitably. So far, 178 countries are engaging with COVAX – notable exceptions include the USA and Russia.  

Questions remain about how COVAX will achieve its goal of fair and equitable distribution. The scheme has faced criticism for allowing wealthier countries to request doses equivalent to 50% of their population, while lower-income countries so far can only request 20%. Wealthier countries can also pay a higher price up front to select which vaccines they prefer.  

This has created a two-tier system which could compromise COVID’s aim of  making vaccines accessible to everyone.  

States who join COVAX must push for meaningful participation from civil society and developing countries in decision-making, and follow the principles of transparency and accountability.  

Companies must put people before patents  

When new medicines are developed, the company that makes them is usually given intellectual property rights. That means they are the only company allowed to produce the drug for a period of time, and they can decide how much it should cost.  Intellectual property laws can also restrict the sharing of data related to research and development – so if one pharmaceutical company found a successful COVID-19 vaccine, they would have the right to keep that information to themselves. 

We already know how harmful it can be when companies put patents before people. For years, people living with HIV were priced out of treatments by pharmaceutical companies keeping their products scarce and charging unreasonably high prices. While these companies profited from selling their medicines in several rich countries, millions of people also were unable to access lifesaving treatment.  

International human rights standards are clear – public health takes precedence over the right of companies to protect their intellectual property.  

To encourage companies to share their know-how, WHO has set up the COVID-19 Technology Access Pool (C-TAP), where companies can share data and patents on their innovations. If companies join C-TAP, it will vastly increase the amount of publicly available research on COVID-19 vaccines, scale up production, and reduce the cost of vaccines. 

Unfortunately, to date, not one company has joined C-TAP. Oxford/AstraZeneca is the only company that has committed to selling the vaccine for no profit for the duration of the pandemic. Other companies need to follow suit, by issuing open and non-exclusive licenses, to ensure that the COVID-19 vaccines reach as many people as possible.  

Vaccines should be free at the point of care 

As part of their human rights obligations, governments must take measures to eliminate any cost barrier that people may face in accessing the right to health.  

Like all businesses, pharmaceutical companies also have human rights responsibilities. In 2008 the UN expert on the right to health published guidelines for how pharmaceutical companies should fulfil these responsibilities, including by considering ways to make their products affordable to as many people as possible. 

Cost can prevent access to health care, especially for marginalized people and at least half the world’s population today cannot afford essential healthcare. This means vaccines are likely to not be accessible to half the world unless they are free at the point of care.  

Governments must make every effort to provide these vaccines and the investment is well worth it. Vaccines are one of the most cost-effective public health interventions and COVID-19 vaccines may break the chain of transmission between people early in the cycle, avoiding further health and socio-economic impacts.  

In fact, the WHO recently estimated that an investment of $38 billion to fully fund one of these collective initiatives to support global access to COVID-19 health products would be regained through economic activity “in less than 36 hours once global mobility and trade alone are restored.” 

Vaccines must be safe and culturally acceptable 

Vaccines must comply with the scientific community’s most recent standards concerning safety and effectiveness – safety is more important than speed. Just as importantly, immunization plans must be carried out in a way that is consistent with the protection of human rights, paying special attention to informed consent.  

This means that governments should communicate clearly about the benefits of vaccination, counter misinformation, and be transparent about all stages of vaccine development.  Scientific benefits of vaccines must be explained and disseminated in a way that is understandable to everybody – in languages they understand and formats they can access.  

This is an essential component of the right to health and key to ensure maximum vaccine uptake, as people can only make informed decisions about their health when they are given accurate information and timely information.