Prioritizing the poor

As the pandemic rages on, wealthy countries continue to hoard vaccines, ignoring criticism and warnings from the World Health Organization. Whereas developed nations such as the United States, the United Kingdom, Germany, France, etc have vaccinated more than 50 percent of their populations, developing ones in Africa have vaccinated less than two percent of their populations. As rich countries start to give COVID-19 ‘booster’ shots to persons already vaccinated, poorer countries still struggle with vaccine supplies, and the global inequity of vaccine access is becoming ever more apparent.

And while this is one of the most pressing challenges we face in the global response to COVID-19, we cannot turn a blind eye to what is happening locally. In many countries that face shortages of vaccines, inequity of access on a national level is also a major problem. Just as rich countries have a higher chance of accessing vaccines, so too do wealthier individuals and communities in poorer countries.

While most countries have prioritised certain high-risk populations for the vaccine – including healthcare workers and other front-line service providers, the elderly and those with significant underlying health issues – many have not kept track of who is actually receiving a shot.

As an infectious disease specialist advising the Kenyan Ministry of Health on appropriate COVID-19 management and control measures, I have often been called upon by healthcare facilities to advise on issues related to the vaccination campaign.

My colleagues and I have observed that many COVID-19 vaccine queues have been dominated by people who are not on these priority lists. In Nairobi, for example, the majority of those lining up for vaccinations are from more affluent neighbourhoods of the city, while dwellers of informal settlements have received very few vaccines.

This scenario has been replicated in many other towns across the country as official prioritisation is not well enforced.

Even though 3,990,500 vaccine doses have been administered and 967,553 in Kenya as of early October, it is notable that only about 0.5 percent of people in some of the poorest areas of the country are fully vaccinated compared with 12 percent for Nairobi. As the country aims to vaccinate 10 million people in the next year, a lot more thought will have to be put into how the vaccines will be distributed.

This is a situation that is not unique to African countries. In the US, it has been observed that individuals living in poorer counties and in more vulnerable households were less likely to have been vaccinated. Therefore, this is not just an issue of the rich elbowing the poor out of vaccine queues, it is about the state authorities removing any barriers to vaccination that the poor may face, such as inadequate access to information, misinformation, difficulty reaching vaccine centres, difficulty scheduling a vaccine appointment, etc.

Some may argue that the vaccine is available to all and individuals must take personal initiative to seek it out. But the challenges the poor experience cannot be resolved on an individual basis – they have to be tackled systematically.

In the case of Kenya, poor access to information and health advice can be addressed through the greater involvement of community health workers (CHWs). They are trusted voices and are able to dispel vaccine myths, identify the vulnerable in the community and encourage vaccination.

Excerpted: ‘Vaccine equality has to start at home’

Aljazeera.org