Medicus Mundi Spain | The roll-out of Covid-19 vaccination is in the hands of private initiative despite 2.7 billion euros of public money, As a result, more than 39 million doses of vaccines have been administered in at least 49 high-income countries. And 25 doses in one low-income country.

One year on, the COVID 19 pandemic caused by the SARS-CoV-2 virus remains a huge global health problem, affecting other sectors such as the economy and social protection. Vaccination is where we are pinning our hopes for a return to some kind of normality. Normality which, however, lies at the root of the spread of this disease, as well as the failure to encourage cooperation rather than competition. The efforts of both companies and governments to generate new vaccines have succeeded in greatly shortening the normal time needed for their development, but it is possible that we could have done better. Many countries do not know when they will receive vaccines, others, such as those in Europe, cannot follow their schedule because of stock-outs by companies. On 18 January, at the opening of the WHO Executive Board, its director, Dr Tedros, put on the table a reflection on access to vaccines: “More than 39 million doses of vaccines have been administered so far in at least 49 high-income countries. Only 25 doses have been administered in one low-income country. Not 25 million; not 25,000; only 25”. The estimated global number of people who should be vaccinated is 3.7 billion people, highlighting the effort that remains to be made.

There are four main problems with vaccination:

  1. Knowing which vaccines are really effective and safe, and when they will be available;
  2. Increasing the production of these vaccines so that they reach the majority of people in a reasonable time;
  3. Proper planning and management of vaccination campaigns to reach as many people as possible; and, finally,
  4. Improve information and education of citizens in a transparent manner to encourage their active and responsible participation.

In December 2020 there were 273 vaccines in development [1] , many of them with the same research base. Do we need so many, are we not dispersing efforts? With the world in a critical situation, no one promoted strategic alliances between companies to join forces in the development and production of a potential vaccine, with public governance to ensure equity of access. The entire vaccination network is now in the hands of private initiative, much more accustomed to competition among them than to cooperation, despite the more than 2.7 billion euros of public money invested in the research, development and production of several of these vaccines.

The WHO has promoted several tools seeking some equity in access to possible solutions to this pandemic, but with few results. The Technology Access Pool (C-TAP) [2] , or the Medicines Patent Pool (MPP) are platforms for the exchange of knowledge and patents, but, as of early February 2021, no technology, treatment or patent has been shared for this pandemic. The most successful tool is COVAX, which aims to finance equitable access to vaccines by bringing together private and public initiatives. However, Dr Tedros warned that “some countries and companies are still prioritising bilateral agreements, circumventing COVAX, driving up prices and trying to get to the front of the queue, and that is a mistake”. Due to this situation of global health “ungovernance”, most manufacturers have prioritised regulatory approval in rich countries, where profits are higher, rather than submitting full documentation to the WHO, so that all countries benefit. This strategy is ineffective, inefficient and will have less impact, delaying global recovery.

It is difficult to explain to people in wealthier countries, who are also affected, why we must go for global health that benefits all people and regions of the planet and improves the quality of life of human beings. It is easier to say “us first, then others”. The European Union, with 450 million people, has purchased more than 1.3 billion doses of vaccines even before they were operational, enough to immunise almost three times its population. The United States, with 330 million people, had secured 40 million doses in the first weeks and some 200 million more by March. The needs of 189 million people in Canada, Japan and Australia, with very few cases of COVID 19, are covered by 1 billion doses, which makes no sense. Meanwhile, 25% of the world’s population will not have access to vaccines until 2022 [3] . It is clear that the procurement of these vaccines is based on “just in case” rather than efficient and effective management. There should be a global agreement that the most effective vaccines should be produced in many different countries to ensure that production quickly meets global demand.

Access to vaccination is not only about countries having vaccines available, but we must also look at the difficulties at the local level. Logistical problems arising from the complexity of the first vaccines, plus the lack of adequate staff and facilities can be impossible barriers to overcome in many countries with weak health systems. There is a need to strengthen public health systems in these countries, including public health services, so that all these countries can start now to develop very detailed, country-specific vaccination strategies that will enable them to be effective. Approximately 60% of the population of sub-Saharan Africa lives in rural areas, which makes it extremely difficult for these people to access vaccination. In addition to improving technical capacity, we must also bear in mind what is known as cultural accessibility. It is no use having a large vaccination team if the community is then reluctant to get vaccinated, or women suffer from the barrier of equity of access and cannot decide for themselves whether to go to vaccination campaigns. Awareness campaigns must incorporate different cultural sensitivities into local strategies if they are to take ownership of the importance of vaccination. Primary Health Care, which must ensure the inclusive participation of people, is a key element that must play a key role in improving accessibility.

Authors: Carlos Mediano, president of Medicus Mundi International, and Eduardo Garcia Langarica, president of Medicus Mundi Spain. Translation by Medicus Mundi Spain. Find the Spanish original here:



[2] The COVID-19 technology access pool, called C-Tap, was launched in May 2020 to facilitate the sharing of patent-protected information in the fight against the virus, including diagnostics, therapies and trial data. The “sharing” of treatments and data would allow qualified manufacturers around the world to produce essential equipment, drugs or vaccines without fear of being sued for patent infringement.


Photo: WHO