COVID‐19 vaccine equity in doldrums: Good governance deficits

Abstract

This paper explores whether inequities in access to COVID‐19 vaccines can be attributed to governance deficits, particularly for developing and emerging countries where poor governance is widespread, but also for developed countries, where governments' performance fell short of expectations. These shared performance deficits beg questions about the impact of governance quality as well as the interplay of ethics in governance when life‐or‐death decisions must be made. It also explores the impact of COVID‐19 on development, especially in the areas of poverty and employment. The findings of the paper show that there is a positive correlation between vaccine equity and good governance, meaning that countries with higher scores in governance rankings have more access to vaccines and have vaccinated most of their populations. Similarly, countries with relatively lower scores in governance rankings have poor access to and distribution of vaccines and have only covered a limited number of their people. The paper further points to disastrous societal impacts of COVID‐19 vaccine inequity on poverty and employment, which have hindered global development.

1. INTRODUCTION

The COVID‐19 pandemic is the biggest health catastrophe in recent human history. It has gravely affected all countries across the world. As of October 2, 2021, there have been 235,328,474 people afflicted with the coronavirus globally and, of those, 4,809,784 people have died (Worldometers, 2021). There is a growing consensus among governments and epidemiologists that, in addition to the difficulty of accurately tracking a global epidemic in real time, the numbers available give a false sense of precision for reasons ranging from under reporting and inadequate data to deliberate suppression or possible manipulation of data, as well as different standards and practices of collecting and registering coronavirus data (Annaka, 2021; Norman, 2020). The first 10 most affected countries, on the basis of total number of cases as of October 2, 2021, were the USA, India, Brazil, the UK, Russia, Turkey, Iran, Argentina, and Spain (see Table 1).

TABLE 1.

Status of COVID‐19 in selected countries

Country	Total cases	Total deaths	Total recovery	Total tests	Total population
USA	44,483,993	719,638	33,864,092	644,091,641	333,426,623
India	33,812,523	448,844	33,085,992	571,994,990	1,396,938,965
Brazil	21,459,117	597,723	20,436,127	57,282,520	214,446,053
UK	7,871,014	136,910	6,387,267	304,621,001	68,331,387
Russia	7,560,767	209,028	6,710,574	192,100,000	146,012,658
Turkey	7,210,916	64,467	6,664,242	87,018,268	85,471,655
France	7,023,315	116,789	6,788,312	143,234,831	65,453,966
Iran	5,611,700	120,880	5,075,482	32,306,789	85,334,211
Argentina	5,259,352	115,239	5,121,667	24,252,818	45,713,468
Spain	4,961,128	86,463	4,755,738	64,557,887	46,777,408

Source: Prepared by the author from https://www.worldometers.info/coronavirus/, October 2, 2021.

The pandemic has clearly exposed the unpreparedness of both developed and developing countries to effectively address a global public health crisis of this magnitude, as well as the lack of capacity of governments and private health providers to deliver the needed healthcare services to treat corona patients. This observation is consistent with the 2019 Global Health Security (GHS) report, which argued that no country was fully prepared to manage epidemics or pandemics and that national health security across the globe suffered from fundamental flaws (GHS, 2019).1 Indeed, high‐income countries such as the United States as well as low‐income countries have encountered severe and sustained difficulties in both vaccination and treatment of affected populations.

The impact of the COVID‐19 pandemic on the global economy has been disastrous, pushing the world into its worst economic crisis since the 1930s Great Depression (Loayza, 2020). An early estimate for the year 2020 predicted a 2.9% loss of gross domestic product (GDP) for most major economies, an estimate raised to 3.4% (Statista, 2021). Translating this number into monetary terms results in an estimated US$ 2.96 trillion in lost economic output in 2020 alone (Statista, 2021). The gravity of the health crisis has been exacerbated by indirect impacts on key sectors for developing countries, from tourism to global logistics. The United Nations Conference on Trade and Development (UNCTAD) reported that the loss of international tourism due to the pandemic could cause a deficit of more than US$4 trillion in global GDP2 in 2020 and 2021 (UNCTAD, 2021).

It can be stated unequivocally that the most effective way to win the fight against coronavirus is through mass vaccination of populations across the world. A report published by the Organisation for Economic Co‐operation and Development (OECD) recognises that the relatively quick development of vaccines against the coronavirus has been an outcome of massive funding for research as well as collective collaborations among scientific communities (OECD, 2021). Globally, by early 2021, US$ 112 billion has been invested in developing and procuring the COVID‐19 vaccines (De Pas et al., 2022). A large part of this funding came from public sources and was primarily invested by the USA, European Union (EU), individual EU states, Japan, and South Korea (De Pas et al., 2022).

As a result of these funding sources, bilateral advance purchase agreements for vaccines against COVID‐19 have favoured the same resource‐rich countries, which have secured from 150 to 500% of their perceived needs (Ekström et al., 2021). The European Commission, the executive branch of the EU, for example, entered into a mega‐deal with Pfizer to deliver 1.8 billion doses of its vaccine over the period from 2021 to 2023, at a price of US$ 23.75 per dose (De Pas et al., 2022). Yadav (2021) reports that over 70% of the COVID‐19 vaccines produced in 2021 were bought by high‐and upper‐middle‐ income countries, and less then one percent only have gone to low‐income ones.

The broad picture painted here raises a serious question as to whether resource‐poor, low‐income countries will continue to be left behind in the race to secure the needed vaccines for their populations, not only for COVID‐19 but for pandemics that may emerge in the future. These global inequities demonstrate a need to understand not only technical factors such as time required for vaccine development (Rehman et al., 2021), but the role that countries' underlying governance structures play in both developed and developing countries (Tatar et al., 2021) and whether the current global pharmaceutical manufacturing, financing, and distribution systems for vaccines are capable of meeting global needs effectively and, equally important, equitably.

The rays of hope that the development of vaccines generated were partially dimmed by the vaccines' unequal access and distribution. UN Secretary General Antonio Guterres has publicly announced that the progress made on COVID‐19 vaccinations has been largely uneven and unfair. With a few exceptions, up until October 2, 2021, the 53 countries that have succeeded to vaccinate more than 50% of their populations (denoting two doses at that time3) are chiefly resource‐rich countries. As per the New York Times' Vaccine Tracker, data mapped from tracking vaccinations globally on October 3, 2021 showed the sharp divisions across geographical regions with regards to administering vaccines. The North America region, in spite of vaccine hesitancy and refusal, is at the head of the pack, having administered at least one dose to 66% of its population, while Africa is progressing at the slowest pace, having administered one dose to 6.8% only (The New York Times, 2021).

Evidence suggests that resource‐rich countries are taking advantage of their asset base to become vaccine‐rich countries by producing and/or hoarding a very large share of the vaccines manufactured globally. It is therefore postulated that the divide between resource‐rich and resource‐poor countries regarding access to vaccines per capita is primarily a result of vaccine politics shaped by global political order. It has become quite clear that the dynamics of global politics have erected barriers for the developing countries to procure the needed quantity of COVID‐19 vaccines. While the situation has been further aggravated at the country‐level by the poor quality of governance in the health sector and more generally, barriers to vaccine access also point to governance failures in the global health sector and in decision‐making in higher‐income countries.

Baris and Pelizzo's (2020) study shows that countries with better governance outperformed their less‐well‐governance peers in detecting and reporting of COVID‐19 cases (based on scores from the World Bank's Worldwide Governance Indicators [WGI]). Baris and Pelizzo conclude that higher levels of good governance play an effective role in reducing fatalities resulting from COVID‐19. Tatar et al. (2021) examined the role of good governance indicators in the acquisition and administration of COVID‐19 vaccines at the population level. Their study also found a connection between higher COVID‐19 vaccination rates and higher scores on governance indicators. These findings paved the way for developing a deeper understanding of the relationship between good governance and COVID‐19 vaccine inequity, as well as pointing to a need to examine how global disparities in “governance wealth” and “governance scarcity” may play a role in reducing global health equity.

The objective of this paper is to explore whether vaccine inequity is a symptom of a governance deficit in resource‐poor low‐income countries and to understand the impact of COVID‐19 on development, chiefly poverty and employment. In doing so, the research questions that the paper attempts to answer are: how and to what extent is COVID‐19 vaccine inequity a consequence of broader governance deficits? How has COVID‐19 impacted development, particularly poverty and employment?

Data and evidence used in this paper to answer the research questions were derived primarily from secondary sources, that is, refereed academic journals, books, government publications and professional reports issued by international development agencies. In addition, data were also curated from credible international newspapers and online contents (for example, Worldometer). As COVID‐19 is an ongoing [devastating] historical event, the use of secondary data helps to gain some helpful understanding about the course and impact of the pandemic and other associated issues (Pederson et al., 2020). Consequently, this paper employed secondary sources as a data collection method with an aim to acquire valuable insights about the relationship between good governance and COVID‐19 vaccine equity.

The paper is divided into four sections. Following this introduction, which sets the research context, the remainder of the paper advances as follows: Section 2 examines the relationship between vaccine equity and good governance from a theoretical and practical perspective and Section 3 briefly discusses the impact of COVID‐19 vaccine inequity on two key development issues, poverty and employment, and finally, the conclusions.

2. VACCINE EQUITY AND GOOD GOVERNANCE: THEORETICAL INSIGHTS AND THE REFLECTION OF REALITY

The COVID‐19 pandemic has revealed a complex relationship between vaccine equity and good governance. This relationship is believed to be deeply rooted within the age‐old inequalities that exist in both healthcare systems and global societies more generally (Pressman et al., 2021). The ongoing pandemic has generated a new and wide‐ranging dynamic growing out of the complexities of post‐modern inequality. This dynamic setting contributes to widening inequity in global society, which is evident in the context of COVID‐19 vaccine production, distribution, access and uptake.

Jimenez (2001, p. 2201) explains that an equity lens clarifies the permanent rekindling of “inequity in the benefits of progress among the peoples of the world.” There is no denial that inequity in the distribution increases risks for health and disease, a finding largely supported by real life experience and scientific research (Jimenez, 2001). Understanding this linkage is particularly imperative in the case of the many poor countries that are currently experiencing shortages of vaccines in the amounts needed to protect their populations. This situation has not only placed the global population at high health risk, but also slowed down economic recovery (De Pas et al., 2022).

In this critical juncture, it is useful to put a conceptual meaning to vaccine equity in the context of COVID‐19. De Pas et al. (2022) explained vaccine equity in the framework of “shortfall equality” built on Ruger's (2009, 2009a) “health capability paradigm”, which was originally developed to gauge health equity. The three constitutive principles of the Paradigm are equality, priority, and threshold, which together form “shortfall equality” (Ruger, 2009, p. 269). De Pas et al. (2022) operationalised the principles in the context of COVID‐19 vaccines; the summary descriptions of each principle are presented in Table 2. The anticipated outcome of addressing shortfalls in applying these three principles would improve COVID‐19 vaccine‐related equity.

TABLE 2.

Reflections of “shortfall equality” and good governance principles to COVID‐19 vaccine equity

Shortfall equality principles	Good governance principles	COVID‐19 vaccine equity
Equality: Allocation of vaccines within and across countries based on the equality principle (De Pas et al., 2022).	Equity/inclusiveness: Ensuring that all members in a society have equal or at least fair access to the diverse range of government services and benefits (Sheng, 2014).	There has been an inadequate and inequitable allocation/distribution of vaccines globally. High‐and upper‐middle‐income countries purchased massive quantities, enabling them to vaccinate their populations even up to five times (Brown, 2022). There is also in‐country disparity of allocation/distribution of vaccines based on political preference.
Priority: Allocation of vaccines to the most vulnerable people first (De Pas et al., 2022). The salient feature of this principle is to improve the vaccine situation for the most deprived and vulnerable.	Responsiveness: Institutions and processes try to serve all stakeholders within a realistic timeframe (Sheng, 2014).	Many national governments have set priorities to responsibly vaccinate vulnerable population such as older adults with 60 years of age or above and people with pre‐existing medical conditions as per their policy. However, due to lack of transparency and openness, prioritisation did not work well in some countries as it was undermined by corruption and favouritism (Anderson & Gurazada, 2021).
Threshold view: international allocation of vaccine resources based on an agreed minimally adequate health status (De Pas et al., 2022).	Accountability: Ascertains that individuals, public agencies and the different branches of government are answerable to public for their functions (Samaratunge & Alam, 2021). In other words, it is the responsibility of public officials to perform as expected or bear the effects of failure (Kim, 2009).	The COVAX allocation plan uses a threshold allocation standard: The allocation of vaccines in the eligible poor countries is contingent upon the proportion of their population size. After each country receives vaccine doses for 20% of its population and countries' will then be considered to receive the subsequent phase of vaccine supply (Meijer et al., 2021). As a result of slow roll‐out of vaccines by COVAX, most countries have not yet fulfilled the threshold requirement. There should be concerted efforts to make the respective national governments accountable to overcome the public health challenge through an effective negotiation with COVAX and other vaccine‐rich countries.

Against the backdrop of Ruger's “shortfall equality”, there is a lack of global response to lessen the effect of COVID‐19. In the face of clear evidence that vaccines are central to overcoming this pandemic, the reality is that the production, supply and distribution of vaccines are not only monopolised but also politicised by the resource‐rich, more powerful countries (Correia, 2021). This places an insuperable obstruction in the way of lower‐income countries' access to vaccine to fight the coronavirus. The situation is further worsened by vaccine hesitancy and rejection by large populations across the world, particularly in the United States and other developed countries, emerging from issues such as misinformation, side effects and questioning of vaccine effectiveness, religious/cultural beliefs, lack of trust in government, and personal freedom concerns (see Cerda & Gercía, 2021; Pierri et al., 2022; Volvet et al., 2022).

The current vaccination status shows some countries still struggling to administer the first vaccine batches they received, while others are proceeding to administer a third booster (Meijer et al., 2021). In addition, the delay/indecision of many governments, such as Australia, has led to ineffective management of critical functions from purchasing vaccines, roll‐out, and prioritising of vulnerable groups, to frequent shifts of policies and strategies that further complicate vaccine management, let alone equity. These and other sources of despair and disparity associated with COVID‐19 need to be comprehended as an outcome of governance failures as much as resource constraints.

Before proceeding to examine how internal and external governance failures in the global response to COVID‐19 have undermined response to the pandemic in low‐income countries, it is necessary to clarify this broad, complex, and multidimensional concept. Huther and Shah (2005, p. 40) define governance as “a multifaceted concept encompassing all aspects of the exercise of authority through formal and informal institutions in the management of the resource endowment of a state. The quality of governance is thus determined by the impact of this exercise of power on the quality of life enjoyed by its citizens.” Stoker (1998) points out that one of the key functions of governance is to create, maintain, and advance ordered rule and collective action for the benefit of citizens. In this context, Stoker (1998, p. 18) proposed five propositions on the aspects of governance:

1. Governance refers to a set of institutions and actors that are drawn from the government but also beyond government.

2. Governance identifies the blurring of boundaries and responsibilities for tackling social and economic issues.

3. Governance recognises the power dependence involved in the relationships between institutions involved in collective action.

4. Governance is about autonomous self‐governing networks of actors.

5. Governance recognises the capacity to get things done which does not rest solely on the power of government to command or use its authority. It sees government as able to use new tools and techniques to steer and guide.

The conceptualisation and propositions on governance presented by Stoker, which primarily differentiate public governance from government, were critically analysed by Peters (2018), who then advanced 10 thoughts4 grounded on the perspectives of Stoker's governance propositions. These 10 thoughts individually and collectively enrich and advance the study of governance over at least the past 2 decades with conceptual multiplicity. A salient feature of the dynamic movement of the concept from defining governance in the context of the role of non‐state actors (or at least emphasising forms of governing through those actors) is to recognise the importance of engaging both state and non‐state actors in pursuing ‘actions’ for the benefit of citizens (Ansell & Torfing, 2016; Peters, 2018). In the same vein, Koppell and Auer (2012, p. S24) highlight that public governance extends beyond the government per se in order to serve public interests and make decisions that mobilise a considerable “array of parties engaged in serving the public outside the traditional bureaucracy.”

This conceptual shift of the governance concept has been critically important for understanding the dynamics, strategies, and tensions among and between the actors (state or non‐state) for collectively deciding on courses of action to achieve a country's societal goals and to improve the quality of citizens' lives. The space where the actors interact with each other may be considered a ‘governance marketplace’, one that plays a significant role in shaping various forms and types of governance based on the nature of actors' interactions along with the prevalent politics, policy and culture.

There is proliferation of definitions of governance offered by relevant scholars and international development agencies from their strategic standing and perspectives (see Box 1). Collating and reviewing the definitions of governance presented in Box 1, they can be categorised into three intertwined but distinctive areas: (a) those denoting the ‘process’ of decision‐making, (b) those involving ‘state and non‐state actors’ for decision‐making, and (c) those exercising ‘authority’ to make and implement a decision.

Box 1: Selected definitions of governance.

“…the manner in which power is exercised in the management of a country's economic and social resources.” (World Bank, 1994, p. xiv)

“…the exercise of economic, political and administrative authority to manage a country at all levels. It comprises mechanisms, processes and institutions through which citizens and groups articulate their interests, exercise their legal rights, meet their obligations and mediate their differences.” (United Nations Development Programme [UNDP], 1997, pp. 2–3)

“…government's ability to make and enforce rules, and to deliver services, regardless of whether that government is democratic or not.” (Fukuyama, 2013, p. 350)

“Governance …is about steering society and the economy through collective action and in accordance with common goals.” (Torfing et al., 2012, p. 2)

“…the process through which individuals and state officials interact to express their interest, exercise their rights and obligations, work out their differences, and cooperate to produce public goods and services.” (Brinkerhoff & Goldsmith, 2005, p. 200)

The earlier discussion characterises governance as an ascendant driving force for achieving common goals in order to improve the quality of life of a country's citizens. In other words, governance is perceived as a non‐tangible asset,5 a product of either individual or collective human activity (Chhotray & Stoker, 2009), which one cannot visualize but feels its presence through the quality of operation of a state. This essentially begs a question why some countries perform better than others. The advent of “good governance” discourse arose in part in response to this question. It manifests as a constitutive element in differentiating the quality of operations among and between the countries. In this context, Grindle (2012, p. 259) traces the impact of governance on the millions of people worldwide who live in conditions of public insecurity, corruption, abuse of law, public service failure, poverty and inequality.

The outcome of good governance is an effective plan of operations to deliver goods and services to citizens in congruence with their needs and demands, one that is then actually implemented in an efficient and timely fashion (Pierre & Peters, 2021; Rotberg, 2014). To achieve this strategic goal, a combination of an effective use of the “government's powers in a transparent and participative way” as well as “a good and faithful exercise of power” is warranted (Addink, 2019, p. 16). In effect, Ansell and Torfing (2016, p. 2) rely on good governance to “assess and measure the quality of institutions in developing countries in terms of their stability, interaction, transparency, responsiveness, procedural fairness, effectiveness, and adherence to the rule of law.” Brinkerhoff and Goldsmith (2005, p. 201) list the constitutive elements of good governance6: “Lawmakers should be answerable for their actions and responsive to the citizens whom they represent; those citizens should have opportunities to express their views to lawmakers. The resulting laws and regulations should be applied consistently to calm investors and help business better understand its environment. There should be full disclosure of procedures and policies so the affected people can plan and act accordingly.” The constituents of good governance offered by Brinkerhoff and Goldsmith refer to the normative qualities such as accountability, rule of law, participation, and transparency/openness in managing government operations for achieving beneficial and citizen‐centric activities.

In light of the preceding discussions and analyses, good governance may be defined, for the purpose of this study, as a complex process through which state and non‐state actors interactively engage in achieving shared common goals by employing principles of accountability, responsiveness, transparency, equality/inclusiveness, efficiency and effectiveness, control of corruption, and rule of law.

Good governance is believed to be a critical step in addressing many problems. Therefore, governments, rich or poor, should want to embrace good governance for strategic purposes as well as for the overall development of their countries. This perceived strength of good governance improves state capacity to deal with mega crises such as the COVID‐19 pandemic (de Oliveira & Berman, 2021). Peters et al. (2022) support this view. Citizens anticipate that their governments will advance citizen focused plans and policies to overcome crises, such as the pandemic. Collective efforts involving both state and non‐state actors are required for governments to direct robust responses to complex crises, and to offer clear directives to relevant human agents to achieve that (Peters, 2021).

In the perspective of earlier discussions, an attempt has been made to apply the principles of Ruger's “shortfall equality” and good governance to COVID‐19 vaccine equity. Three core principles of good governance, namely equity/inclusiveness, responsiveness, and accountability, have been chosen as the focus of this analysis due to their perceived conceptual closeness with the principles of “shortfall equality”: equality, priority, and threshold view (see Table 2). Table 2 demonstrates that the allocation and delivery of COVID‐19 vaccines does not appear to follow the principles of equality and equity/inclusiveness. Wealthy and vaccine‐rich7 countries continue to monopolise production, distribution, and delivery of vaccines and in many cases they have purchased and stocked substantial quantities of vaccines in order to fully vaccinate their population. Canada is a case in point. They have either procured or signed contracts to procure vaccine doses sufficient to immunise all Canadians over five times (Brown, 2022), seemingly ignoring the dire need of vaccines in the poor countries.

In this context, a logical yet deeply political question emerges about the expectation that any government would be willing to prioritise other people over its own citizens. The answer to this question is difficult. To overcome the perceived challenge, Jecker et al. (2021) argue the necessity of effective campaigns for the equitable global distribution of COVID‐19 vaccines, inspired by the utilitarian value of saving the most lives. In other words, if appropriate initiatives are not taken by the vaccine‐rich countries to support vaccinations in poorer, populous countries at a much higher rate than the current count, it may not be possible to fully control the spread of the coronavirus or the emergence of new, potentially more dangerous variants. Therefore, an equitable distribution of vaccines is a ‘win‐win’ strategy for both vaccine‐rich and vaccine‐poor countries. This is perhaps the most logical argument to quell the agony of the supporters of vaccine nationalism. Brown (2022) adds that an equitable distribution of vaccines globally is an ethically and morally superior approach to stop the spread of the disease, which has yet to be achieved.

There is no quick fix to the messy problem of unequal access to COVID‐19 vaccines. The gap that currently exists between vaccine‐rich and vaccine‐poor countries is not supportive of global recovery from the pandemic. For example, as of September 17, 2021, 67% of the populations of high‐income countries had taken at least one dose of the vaccine, compared to 2% in low‐income nations (Loft, 2021). In addition, the situation has been further exacerbated by the actions of wealthy nations, such as hogging vaccines, while the millions in poor nations lose their lives waiting to get them—a setting the South African government labelled as “vaccine apartheid” (Winning, 2021). It was argued that “vaccine apartheid” and “hogging of vaccines” primarily stem from the political metaphor of “vaccine nationalism” meaning “my country first” approach and the pursuit of vaccines to protect national over global interests (Bollyky & Bown, 2020; Vanderslott et al., 2021).

The reality of monopolising vaccines by the vaccine‐rich countries necessitates the immediate exploration of international regulatory mechanisms to redress this (worldwide) imbalance in order to ensure universal and equitable access to vaccines against COVID‐19 and other associated issues. Admittedly, acceptance of such mechanisms by higher‐income countries is problematic, which underscores the need to re‐examine whether global governance mechanisms are fit to purpose for emerging global threats. In addition, the implementation of the popular proposal for a temporary waiver of intellectual property protection on COVID‐19 vaccine patents, allowing more countries, particularly poor countries, to produce their own vaccines, would be a partial solution to the stand‐off of “vaccine apartheid” (Storeng et al., 2021).

Although fundamental, prioritising vulnerable population for the purpose of COVID‐19 vaccination remains complex (Persad et al., 2020). Manifold inter‐dependent dimensions of vulnerability have been identified, such as socio‐economic deprivation and oppression, higher risk of death in earlier life, and clinical/medical vulnerability (Persad et al., 2020). Jecker et al. (2021) found that vaccines save more lives when timely distributed to older people and others at higher risk of death if infected. Moreover, Wright and Merritt (2020) argue that coronavirus is infecting and killing African Americans in the United States at disproportionately high rates compared to other communities, signaling the need to faithfully maintain social equity in public service responses to the pandemic. This observation further strengthens the importance of prioritising vulnerable populations across all communities/nationalities for COVID‐19 vaccines. In this regard, Table 2 shows that many national governments have prioritised immunising the vulnerable population first as provided for in their respective domestic policies and plans. The implementation of prioritisation policy provides mixed results. In some countries the vulnerable were responsively prioritised following inclusive norms and they received (and are still receiving) vaccines without experiencing any major challenges. In others, the prioritisation process was undermined through various unfair means, which has negatively impacted vaccines roll‐out as well as exposing the vulnerable population to a grave health crisis. Such actions on the part of some governments are unbecoming on both ethical and moral grounds.

In order to partially overcome the dearth of vaccines in low‐income countries, an international initiative known as the COVID‐19 Global Vaccine Access (COVAX) was established, co‐led by the Global Alliance for Vaccines and Immunizations (GAVI), the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovation (CEPI), and the WHO. One of the immediate goals of COVAX is to donate a sufficient number of doses to bring 30% of the populations of 92 low‐income countries under vaccine coverage in 2021‐22 (Loft, 2021, p. 5).8 This function of COVAX reflects the third “shortfall equality” principle, that is, the threshold view. Gostin et al. (2021) and UN (2021) note that COVAX suffers from implementation challenges, particularly inadequate financial resources, which impede it from reaching a wider section of people in low‐income countries. Given the current situation, particularly in the wake of the surge of the Omicron variant of coronavirus, it is very uncertain if COVAX will achieve its self‐imposed target of vaccinating the targeted portion of populations within the given timeframe. It was also observed that there is no formal mechanism in place to hold the wealthy and vaccine‐rich countries as well as relevant institutions such as COVAX accountable to ensure they invest adequate financial and technical resources to distribute vaccines widely and equitably. It is unacceptable that the challenges and obstacles that low‐income countries are facing in accessing COVID‐19 vaccine emerge largely from a financial shortfall of high‐ and middle‐income countries' support that in turn arises more from their internal political interests and their attitude towards the former, rather from a rational assessment of what is needed to control coronavirus, even where rich countries' own interests are not served by the further spread of COVID nor the increased risk of new variants that entails.

Werlin (2003) argues that the difference between poor countries and rich countries has to do with governance rather than resources. This assertion has gained considerable acceptability among both scholarly and practice communities. It is evident that most lower‐income countries currently experiencing severe challenges in accessing vaccines are also poorly ranked by widely used World Bank WGI, namely in control of corruption; government effectiveness; political stability and absence of violence; regulatory quality; rule of law; and voice and accountability (for details on the WGI, see Kaufmann et al., 2009). Table 3 reveals that rich countries (USA, UK, France, and Spain), which have scored high in governance indicators have high access rates to vaccine against the coronavirus, at or above 50%. On the other hand, low‐and some medium‐income countries (India, Brazil, Turkey, Russia, Argentina, and Iran), as shown in Table 3, have scored poorly in most (or all) governance indicators as well as in access to vaccines, suggesting a relationship between the two, which merits closer examination.

TABLE 3.

WGI ranking and vaccine access in selected countries

WGI (2020)	USA	India	Brazil	UK	Russia	Turkey	France	Iran	Argentina	Spain
Control of corruption	82.7	46.6	43.8	94.2	19.2	44.2	84.6	14.4	50.0	76.4
Government effectiveness	87.0	66.8	36.5	89.4	54.8	52.4	86.5	14.9	43.3	77.9
Political stability	46.2	17.0	32.1	61.3	20.8	11.8	56.6	7.5	48.6	58.0
Regulatory quality	87.5	47.6	46.2	92.3	36.1	51.9	85.6	6.7	31.7	73.6
Rule of law	88.5	54.3	48.1	89.9	22.6	40.4	88.0	20.2	34.6	78.4
Voice and accountability	72.9	53.1	56.5	89.4	19.8	23.7	82.6	8.2	65.7	80.7
Access to vaccine (fully vaccinated) (%)	56	18	43	67	28.9 a	54	66	19	50	78

Note: Country scores are based on percentile ranks, with higher values (ranging between 0 and 100) denoting better quality of governance.

^a Collected from Statista (as on October 1, 2021), available at statista.com/statistics/1239299/covid‐19‐vaccination‐rate‐in‐russia/, October 7, 2021.

Sources: Compiled by the author from WGI metadata available at databank.worldbank.org/source/worldwide‐governance‐indicators, retrieved October 7, 2021. The vaccine accessing data compiled from the COVID vaccination tracker of the New York Times, https://www.nytimes.com/interactive/2021/world/covid‐vaccinations‐tracker.html, October 3, 2021.

In summary, the canvas painted here reflects a disconnect between wealthy and low‐income countries in terms of administering COVID‐19 vaccines. On their part, wealthy countries have grossly neglected their responsibilities to support low‐income countries in overcoming poor or no accessibility to vaccines, which is de rigueur to defeat the current human catastrophe, itself deeply anchored in social inequity. The overall evidence suggests that good governance deficits along with social inequity accelerated the trend to vaccine inequity, which has reached a tragic level.

3. THE IMPACT OF COVID‐19 VACCINE INEQUITY ON DEVELOPMENT

The impact of COVID‐19 on the world economy has been both unprecedented in modern times and severe. As a result, it has not only paralysed people's lives and livelihoods but also inhibited global development. The failure to address global vaccine inequity casts a further shadow over the world economy. This section briefly describes the effect of COVID‐19 vaccine inequity on two key development issues, poverty and employment.

Over the past few decades, particularly between 1980 and 2016, the average income of the world's poor, the bottom 50% of the global population, nearly doubled. This contributed to a sustained drop since 1990 in the population living in “extreme poverty,”9 which fell from nearly two billion to 700 million (Banerjee & Duflo, 2020). The rapid decrease of the extremely poor made Sachs (2015) hopeful that the world would see the “end of poverty” by the year 2025. Yunus (2017) envisioned the possibility of achieving a world of “zero poverty” for everyone's benefit.

Against such positive predictions, the rise of COVID‐19 poses a blatant challenge to maintaining, much less continuing, the decline in global poverty. A 2021 World Bank report forecasts that COVID‐19 has caused the number of the “new poor” to grow in 2020 to between 119 and 124 million globally and to rise further in 2021, to reach 143 to 163 million (Lanker et al., 2021).

This reality necessitates accelerated efforts to more effectively support poor people, particularly through expanded social protection benefits. The 2020–2022 World Social Protection Report issued by the International Labour Organization (ILO) reveals that only 47% of the global population are covered by one or more social protection schemes, while 4.1 billion people (53%) remain unprotected from income insecurity by their national protection systems (ILO, 2021a). The ILO report further shows significant coverage gaps in social protection systems in different regions: 84% of the people in Europe and Central Asia are covered by at least one benefit, as are 64.3% of those in the Americas, 44% in Asia and the Pacific, 40% in the Arab States; and 17.4% in Africa. Children and women with newborns remain largely out of social protection benefits in many countries, moreover. The lack of formal protection further deepens the already existing social inequity at the global level.

Available data show that countries spend, on average, 12.8% of their GDP on social protection, excluding health (ILO, 2021a). Although most national governments have allocated significant amounts of financial resources to cover the cost of COVID‐19‐related social protection benefits, their budget remains inadequate as huge numbers of people in developing regions remain entirely unprotected. The lack of public spending on social protection schemes during the pandemic swiftly moves people in low‐income countries towards pauperisation and thus further widens the existing inequality between the rich and the poor. This situation is further vexed as a result of the COVID‐19 vaccine inequity. Rouw et al. (2021) projected that almost 90% of people living in low‐ and middle‐income economies would not receive vaccination by the end of 2021, which stands correct. Clearly, social inequity contributes to vaccine inequity.

The evidence and examples presented earlier point to the fact that the COVID‐19 pandemic has affected some groups more than others. Needless to say, the current vaccine inequity is primarily harming people in the lower socio‐economic strata of society and doing so through various mechanisms. In this connection, Hyder et al. (2021) explain that many families have experienced either the death of main bread winners or loss of jobs caused by the coronavirus, leaving them financially crippled. To ease the financial burden, many members of this group, in both developed and developing countries, have no choice but to expand informal work, placing themselves and their families under increased risk of infection by the coronavirus. Even in the United States about 71% of the population does not have the opportunity of working from home so they more easily become victims of coronavirus (Hyder et al., 2021). This reflection coincides with the findings of several empirical studies affirming that racial minorities, immigrants, and the socio‐economically disadvantaged have had disproportionately higher rate of coronavirus infection case as well as fatality (Choi, Denice, Haan, & Zajacova, 2021; Choi, Denice, & Ramaj, 2021; Wrigley‐Field et al., 2020). Given these consideration, it can be expected that the mutual relationship between vaccine inequity and poverty reduction in the current context will be ruinous, driving several groups within the population either to become members of the “new poor” or to remain trapped in vicious poverty.

With the continued onslaught of COVID‐19 in an environment of vaccine injustice, the employment sector continues to be one of the most severely affected areas globally. A 2021 ILO report summarises the profound impact of COVID‐19 on various aspects of global labour markets in 2020 (ILO, 2021b, pp. 1–2):

• i)Working hour losses10: 8.8% of global working hours, equivalent to 255 million full‐time jobs.
• ii)Employment loss: 114 million (of which 33 million shifted to unemployment and 81 million shifted to inactivity).11
• iii)Working‐hour reduction within employment: 50% of previous total working hours lost (equivalent to 127 million full‐time jobs).
• iv)Labour income loss (before income support): US$ 3.7 trillion.

Similarly, a 2021 McKinsey Global Institute report identified short‐term impacts of the pandemic as leading to millions of people being furloughed or losing their jobs, with only a small group swiftly and decisively transitioning to working from home as offices closed (Lund et al., 2021). High‐income countries were able to save the jobs of segments of their population by relocating to remote work, which was not the case for low‐income countries due to the high prevalence of informal work and lack of access to teleworking (Patterson & Dhaliwal, 2021). Patterson and Dhaliwal cite a 2021 ILO report highlighting that, in 2020, two billion informal workers, constituting over half the world's workforce, experienced a 60% reduction of their earnings due to COVID‐19. The situation was further aggravated by the slow progress in vaccination drives in low‐income countries (see Figure 1), leaving the poor not only to continue to suffer from lost income but also from continuing exposure to health hazards, particularly as they are generally more exposed to infection in their places of work and residence.

FIGURE 1.

Status of vaccine roll‐out in low‐income countries until October 2021. OWD stands for Our World in Data (https://ourworldindata.org/). Source: https://public.flourish.studio/story/912193/

There is a close link between poverty reduction and employment. The latter is considered of the strategy with the most impact on poverty. Baker (2016) argued that one of the most effective but challenging ways to reduce poverty is to maintain a full employment economy. Baker further explores how a strong labour market offers more employment opportunities to job seekers, including disadvantaged workers, with the potential for higher wages. Employment opportunities improve the purchasing power of workers, helping to move them and their families out of poverty.

The employment and earnings data briefly highlighted above demonstrates how starkly the world's labour market has shrunk as a result of COVID‐19 in combination with inequitable access to vaccines, sharply decreasing employment and employability opportunities, together driving an upsurge in global poverty. Over 2 years into the pandemic, the challenges posed by the pandemic itself are compounded by governance failures that have worsened prospects for poverty reduction and restoring employment, as well as for tackling the spread of coronavirus itself.

Bakker et al. (2008, p. 1894) report findings from an empirical study that governance failures preserve systemic biases against the poor, because decision‐making structures and related institutions sustain biases against the poor, despite their official positions favouring pro‐poor policies. The implications of this dichotomy in the current pandemic suggest a need to address two distinct orders of governance failure identified by Howlett and Ramesh (2014). These authors identified first order governance failures, that is, operational failures caused by “fundamental mismatches between the governance mode in place and the nature of the problem it is expected to address,” (p. 322) and second order failures caused by governance capacity/resource failures. Based on the preceding discussions, it is evident that COVID‐19 vaccine inequity has been shaped by both types of governance failures, and, in turn, negatively impacts poverty and employment, closely linked to social inequity.

In summary, COVID‐19 vaccine inequity exacerbates poverty and undermines employment, placing additional barriers in the way of making development work. Drawing on the evidence presented, we can identify how vaccine inequity, an outcome of governance failures at both the national and global levels, has evolved into a source of further barriers to progress on many issues. It has significantly affected the “new poor,” worsened income losses, undercut employment, and generated public health crises.

4. CONCLUSION

The COVID‐19 pandemic continues to take a toll on human lives and livelihoods globally, developed and developing countries alike. In order to overcome this unprecedented problem, vaccines must be made available to mitigate the severe damage inflicted on communities by the novel coronavirus. This paper explored how vaccine inequities have transformed a vital life‐saving medical innovation into an instrument for exacerbating disparities not only between resource‐rich and resource‐poor communities but also between countries rich and poor. The paper argued that the COVID‐19 vaccine became a “new” determinant of health and income disparities, sharpening distinctions between “vaccine‐rich” and “vaccine‐poor” countries. The paper argued that the relationship between these groups could be further explained through use of a good governance perspective. Both theoretical considerations and preliminary analysis of secondary data suggest an association between coronavirus vaccine equity and governance. The paper has shown that, among other things, vaccine‐poor low‐income countries have also ranked poorly on the global measures of governance, while the opposite was true in the case of vaccine‐rich countries.

The paper also explored the impact of COVID‐19 vaccine inequity on development in the areas of poverty and employment, continuing to ever‐increasing social inequity globally. The evidence provided suggests that there has been a significant rise of global poverty as a result of loss of income and increasing strains on government income, leading to deterioration in effective social protection benefits for a large number of people across the world. Similarly, COVID‐19's impact on employment has been devastating. For example, in 2020 alone, 8.8% of global working hours were lost through various mechanisms, amounting to a loss of US$ 3.7 trillion in income (ILO, 2021b).

In the midst of such multi‐faceted challenges, COVID‐19 has nonetheless ushered in opportunities for the global public administration and policy communities to explore and understand the root causes of the unpreparedness (more appropriately failure) of nation states and global institutions to effectively confront the pandemic in lower income countries. COVID sends a message that academics, practitioners, and governments must work together to develop an inclusive governance design capable of dealing responsibly not only with the pandemic but with the range of health, environment, and economic mega‐crises and resulting social equity challenges likely to arise in the future.

Bhuiyan, S. (2022). COVID‐19 vaccine equity in doldrums: Good governance deficits. Public Administration and Development, 42(5), 293–304. 10.1002/pad.1999

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.