A good COVID-19 vaccine is one that works for rich and poor alike

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Vial of the Oxford COVID-19 vaccine

The Oxford-AstraZeneca COVID-19 vaccine brings good news for everyone in the world because it has been conceived with global fairness baked into its design. It is a pro-poor vaccine. We have the magic liquid and now we need to rise to the challenges of a pro-poor roll-out.

Vial of the Oxford COVID-19 vaccine
A vial of the ChadOx (ChAdOx1 nCoV-2019) vaccine. Credit: John Cairns / University of Oxford.

Seven ingredients of a pro-poor vaccine

The COVID-19 pandemic may be the first time that most politicians and most people have thought about the challenge of global vaccination campaigns, but global health workers and aid agencies have been thinking about them, and doing them, for decades. The Oxford team has used this knowledge and experience to produce a “people’s vaccine” which looks well placed to work around the world, even in its poorest and most isolated places.

There are seven key elements to a pro-poor vaccine, and the Oxford-AstraZeneca vaccine seems to score five out of seven so far:

1. All ages protection – something especially important for most cultures in the world which live in inter-generational households.

2. Heat tolerance – so it can be moved relatively easily across vast distances from factory to “last mile” clinics and vaccination sites.

3. Local manufacture – appropriate health technology that makes it easy to produce in all parts of the world.

4. Easy integration into the existing health system – a simple vaccine avoids building a one-off parallel structure and allows COVID-19 investments to upgrade the existing national system instead of creating exceptional infrastructure. So you can jab for COVID-19, measles and polio at the same time while also doing routine health checks.

5. Low cost – price really matters for low-income countries.

Where it misses (so far) is on the last two:

6. The prevention of transmission as well as disease – this is key in rural and daily wage “gig economies” where blue collar workers must work every day and cannot work safely at home like white collar bureaucrats.

7. Delivery method – jabs still need some form of health technician at delivery. Drops and sprays can be applied by volunteers or self-administered.

While the Oxford-AstraZeneca scores so well as a pro-poor vaccine, there is a big challenge ahead to manage a pro-poor roll-out. This is not a new challenge and there is a wealth of valuable experience and an impressive track record to learn from.

Global experience

Especially significant is the Polio eradication programme. This was launched in 1988 and has made amazing progress with near total global eradication. Earlier this year, while the world was dazed by the coronavirus, WHO announced that Africa is Polio free. The last two places in the world where Polio still sticks are Afghanistan and Pakistan.

But the challenge is even bigger than this because the Polio campaign only vaccinates young children and uses the much simpler drops not jabs. The COVID-19 campaign must vaccinate adults too with jabs alone, so far. That is a lot more people and process.

And here are some WHO figures from a single year’s Polio vaccination programme in India which shows the massive task of vaccination programmes. In one year, India’s programme to successfully vaccinate 172 million children required:

  • 640,000 vaccination booths
  • 2.3m vaccinators
  • 200m doses
  • 6.3m ice packs
  • 191m home visits.

This requires a well-functioning national health system, a national “cold chain” of fridges, massive community engagement, information management, logistics and, of course, first rate political leadership, operational management and lots of money.

Then there is trust

This is the hard practical side of the challenge. The softer communication challenge of mobilising people and gaining their trust in the vaccine is just as risky and a potential deal breaker.

Anti-vaxxers are not unique to the rich world. Women around the world have had terrible experiences of forced sterilization campaigns and routinely suspect them in any vaccination programme. Espionage agencies have supposedly used the cover of vaccination programmes to visit remote areas and track targets, most famously Osama Bin Laden’s family. Rumours spread much faster than truth and can stop a programme in its tracks.

Good communications must be two-way: not just telling people what to do but listening to what worries them and responding carefully. This was learnt the hard way in the Ebola response too.

And gaps…

Finally, there is the challenge of big gaps in coverage because of geography, armed conflict, violence and patriarchal control. Many people live in geographically challenging and remote areas where there are no roads or only dry season roads.

Millions of people live in the worlds 54 armed conflicts today where their enemies are happy for them to be killed and degraded by disease. Many of these people live within the control of rebel armed groups. Vaccination programmes will mean working directly with them, which will not please their government enemies. Millions of other people live under the de facto control of urban gangs in areas where government officials are reluctant to work.

And, of course, there is patriarchy. In some parts of the world, women have no control over their health. It is the men – fathers, husbands and uncles – who decide what treatment “their” women receive. Humanitarians have seen men refuse emergency caesareans for their wives. They have also seen them refuse vaccinations for women whose bodies they effectively control.

The Oxford-AstraZeneca vaccine has launched the world on a pro-poor route to fair global vaccination against COVID-19. This is wonderful news. Now we need to address the challenges of a pro-poor roll-out. A major part of this must involve all States getting behind the COVAX effort to ensure fair global access to COVID-19 vaccination tools. It is good to see the UK co-leading on this with others.

Hugo Slim is a Senior Research Fellow at the Institute of Ethics, Law and Armed Conflict (ELAC) at the Blavatnik School of Government.