Ethical tradeoffs in SARS-CoV-2 vaccine development: Assuring fair availability for low-income countries

Ethical concerns associated with the pressing need for rapid and ethically fair development of safe and effective SARS-CoV-2 vaccines were elaborately discussed in a recent Vaccine article by Grady et al. [1]. Yet, a crucial ethics aspect of SARS-CoV-2 vaccine development, tightly associated with economics aspects, remains little-addressed in academic discussion: assuring fair allocation of vaccines for low-income countries. This topic was covered by a detailed Nature News article by Ewen Callaway (published online on August 24, 2020) [2]. According to this article, as of late August 2020, developed countries have already secured pre-orders for more than two billion vaccine doses, pending their approval. This figure represents about 5 vaccine doses per capita for the population of the UK and the USA, and 3 doses per capita for the entire EU. In sharp contrast, only about one billion vaccine doses were meanwhile secured for 92 low- and middle-income countries, representing nearly half the global population. This means that the secured vaccines could allow two vaccine doses for roughly 5% of the population in these countries [2]. The World Health Organization (WHO) is addressing this unmet need with its COVAX initiative, co-led (in addition two WHO) by the European Commission, Gavi (https://www.gavi.org/covid19/covax-facility) and the Coalition for Epidemic Preparedness Innovations (CEPI; https://cepi.net/). As stated by the WHO, COVAX aims to “accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world” [3]. The COVAX initiative negotiates vaccine purchases by participating countries already prior to their final approval, and plans to assure the delivery of at least 2 billion vaccine doses by the end of 2021.

India is taking some steps for assuring sufficient vaccines for its citizens, and people of other developing countries, including public funding for vaccine development and clinical trials [4]. However, coverage on this topic is limited to the general media, and no clear government policy has been published. Indeed, health policy researchers in Indian academia have called upon their government to publish a detailed White Paper on panned COVID-19 vaccine distribution priorities and policies [5]. Similar transparency of vaccine distribution plans is called for in both developed and developing countries.

This real-world situation of the SARS-CoV-2 vaccine development and fair allocation to citizens of less affluent countries is worrying. It requires the attention and generous assistance from governments and charities in developed countries, with support and sympathy from their citizens. The COVID-19 pandemic will not be over unless it is assured that vaccines are made available everywhere.

Declaration of Competing Interest

The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.