Covid-19 has shone a stark light onto inequalities between countries. So far, high-income countries have recorded the most cases and deaths, but the economic impact of Covid-19 has been disproportionately harmful to lower-income countries, where governments and citizens have fewer resources to weather the storm. Despite their declarations against ‘vaccine nationalism’, richer countries have paid to get to the front of the vaccine queue and under-committed to, and in some cases even blocked, attempts to provide vaccines to poorer countries less able to pay. Citizens of the global north can see a life approaching normalcy on the horizon. Meanwhile, a second wave of Covid-19 is surging in countries across Africa and experts predict that many developing countries will not be able to vaccinate their populations until 2024. Without access to vaccines, more people will get sick and die, restrictions on daily life will be extended, and the social and economic impacts of the pandemic will only deepen. The many initiatives, including Covax, to broaden access to vaccines, are not close to sufficient to counter this reality. Given the clear human rights implications, as well as State obligations articulated in international and regional instruments, the international human rights system must speak up.
Access to vaccines has been left to the highest bidder
In September’s general debate of the UN General Assembly, leaders from across the world pleaded for equitable vaccine access and called for the vaccine to be classified as a global public good and made universally available. Lenín Moreno, President of Ecuador, called for patent-free vaccines. Secretary-General António Guterres argued that vaccine nationalism would be ‘self-defeating’, echoed more poetically by Nana Akufo-Addo, President of Ghana, who stressed ‘We have all gone down together. We have to rise together.’
Five months later, four vaccines have been approved for full use and at least six more are in limited or emergency use in various countries. More than 150 million vaccination doses have been given. Yet as of early February, the majority of countries, including most in Africa, are yet to administer a single dose. More than three quarters of the vaccines administered are in only 10 countries. The few lower-income countries that are administering vaccines already, are mostly using the AstraZeneca, Gamaleya, Sinovac or Sinopharm vaccines. (The efficacy of the Gamaleya, Sinovac or Sinopharm vaccines has so far been reported as lower than the Moderna or Pfizer vaccines, although higher by some estimates than the AstraZeneca vaccine, but there is less publicly available information about their clinical trials.) China in particular has given priority access to low- and middle-income countries as part of its ‘vaccine diplomacy’ drive, although there is some concern about when it will deliver on its promises.
Source: Our World in Data, Coronavirus (COVID-19) Vaccinations
All nations have been more or less left to their own devices to secure vaccines. Whether rich or poor, governments will have to pay. High-income countries, representing only 13% of the world’s population, have bought up more than half of all doses being pre-sold. The relatively few middle-income countries that have managed to pre-order vaccines have still found themselves lower down the waitlist. The United States’ financial support for the development of several vaccines came with the precondition that it would get priority access. Many are concerned that lower-risk people in wealthy countries will end up being vaccinated before even those who are high-risk living in other countries. People living in middle and low-income countries – the majority of the world’s population – will suffer from the vaccine nationalism that Gutteres warned against.
High-income countries have limited efforts to broaden access to the vaccine
A number of initiatives have tried to address this problem, beginning early in the pandemic. The most prominent of these, Covax, is led by the World Health Organization in collaboration with Gavi and the Coalition for Epidemic Preparedness Innovations (CEPI) and is seeking to secure 1 billion doses for lower-income countries (and an additional billion for higher income, ‘self-financing’ countries). 190 countries (of all income levels) have signed up to the scheme and it has raised over $2 billion. Having announced the intention to withdraw from the WHO, and halting funding to the organisation, the US did not contribute to Covax under Trump. However, on Biden’s first day in office, he recommitted the US to the WHO and his administration quickly announced their intention to join Covax. Congress had approved a $4 billion funding package for Gavi in December. Covax still faces a funding shortfall of more than $5 billion for 2021, and of $27 billion for the full ACT Accelerator program. Covax’s goal is to ensure one fifth of the population of participating countries is vaccinated by the end of the year. For comparison, the UK is aiming to vaccinate a similar proportion of its population by mid-February (and is on course to achieve this target). Even if Covax achieved its ambitious target, it would not be enough to ensure those in lower-income countries are not left behind.
Other schemes that could have helped developing countries buy or produce more vaccines have also had disappointing results. A group of countries, including India and South Africa, which both have vaccine manufacturing capacity, proposed that the World Trade Organization waive intellectual property protections on the vaccines so versions of the vaccines could be produced locally. Nearly 100 countries supported the idea, but it has been repeatedly blocked by a small number of wealthy states including the US, UK and EU. This is despite the UK, US and many European states being signatories to the International Covenant on Economic, Social and Cultural Rights, which protects the right to health in article 12 (although the US has never ratified the Covenant), and affirming their support for the right to health by supporting various consensus resolutions on the right to health in the Human Rights Council over the years. The UK was even a member of the HRC when it passed a resolution by consensus, in only 2019, to ensure access to vaccines for all (A/HRC/RES/41/10).
No major pharmaceutical companies have joined the WHO’s Covid-19 Technology Access Pool (C-TAP), which calls for the voluntary sharing of intellectual property and knowledge related to Covid-19. Only 40 of 194 WHO Member States have endorsed the call, including some European States, but not the US, UK, China, Russia or India. Moderna pledged to not enforce its patents during the pandemic but this is in doubt since its CEO also told investors it ‘retains worldwide rights to develop and commercialize’ its vaccine. Under the terms of its deal with the University of Oxford (a public institution), AstraZeneca committed to providing vaccine doses at cost-price during the pandemic, and on an ongoing basis to low-and middle-income countries. However, there has been concern about the details of these confidential deals, with findings that in one agreement AstraZeneca reserved the right to define when the pandemic is over.
Limiting access to Covid vaccines is an infringement upon human rights
With these barriers to access, it has been predicted that many developing countries will not be able to fully vaccinate their populations until 2024. This delay will not only increase inequality between nations, but have major ramifications for the human rights of people living in low- and middle-income countries.
As more people continue to contract Covid-19, their right to health and even to life will be threatened. These rights will be doubly impacted as healthcare systems continue to feel the strain of the pandemic, and so struggle to treat other conditions or provide routine immunisations. If the virus remains present for longer, these countries will also take longer to fully ‘open back up’ and the economic devastation already wrought will deepen while richer countries recover. Economic, social, and cultural rights such as to work, education, and an adequate standard of living, each also determinants of health, will be further threatened.
The most comprehensive statement on the right to health in international human rights law is in article 12 of the International Covenant on Economic, Social and Cultural Rights by which States Parties recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.’ It then calls on States Parties to take the necessary steps for the ‘prevention, treatment and control of epidemic, endemic, occupational and other diseases.’ General Comment No. 14, adopted by the Committee on Economic, Social and Cultural Rights in 2000, further clarified this right. Most of the core obligations of the right to health, the Comment explains, are obligations of State Parties to their own people. But it does also impose some international obligations: ‘States should facilitate access to essential health facilities, goods and services in other countries’, ‘take steps to ensure that these instruments [international agreements] do not adversely impact upon the right to health,’ and ‘The economically developed States parties have a special responsibility and interest to assist the poorer developing States’ especially through economic and technical cooperation.
Various regional human rights instruments also recognise the right to health, including the European Social Charter (article 11), the African Charter on Human and Peoples’ Rights of 1981 (article 16), and the Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights of 1988 (article 10). Article 25.1 of the Universal Declaration of Human Rights addresses the determinants of health, stating that ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.’
According to article 27 of the Universal Declaration of Human Rights and article 15 of the International Covenant on Economic, Social and Cultural Rights, everyone also has a right to enjoy the benefits from scientific progress. This places obligations on states to also ensure that international trade agreements “do not adversely impact upon the right to health.” Both companies and other States blocking or limiting broader access to vaccines are acting in contravention of these rights, and in effect, interfering with other countries’ abilities to fulfil their human rights obligations. UN human rights experts have repeatedly pointed this out. A joint statement from nine Special Procedures’ experts in November reminded States that ‘Under international human rights law, access to any COVID-19 vaccine and treatment must be made available to all who need them, within and across countries, especially those in vulnerable situations or living in poverty.’ But their calls have apparently been to little effect.
The international human rights system must defend equitable access to the vaccine and call out those blocking it
In September, Moon Jae-in, President of South Korea, said that ensuring equitable access to Covid vaccines for all countries will be a test of the UN. So far, it is failing. Despite sentiments to the contrary, the pandemic has not been marked by a coordinated global response. Each nation has largely been left to manage its response on its own, with some support from international organisations and donor countries. Human rights experts and the UN system have been calling for a human rights-based response to the pandemic since it began. Access to the vaccine should be no different.
Those within the international human rights system should continue to make statements calling for open access to vaccines, denouncing vaccine nationalism, and encouraging countries to join and financially support Covax. They could also do more to emphasise the responsibility of individual pharmaceutical companies and States, pushing further than abstract concerns and general calls for cooperation. The human rights organs of the UN should also continue to work with the WHO and WTO to ensure human rights are emphasised in public health and trade messages too. Covax has proposed proportional allocation of vaccines based on population size. There could also be a role for human rights experts to work alongside public health experts in pushing for a more rights based approach, determining which States actually have a greater need for vaccines based on the harm caused by Covid (as others have suggested). Human Rights Council members should call out those States under review in the 37th, 28th and 39th sessions of Universal Periodic Review, that fail to meet their national and international obligations with regards to ensuring access to the vaccine.
In his Call to Action for Human Rights, Secretary-General António Guterres said that the commitment to ‘no one left behind’ ‘obliges us to address inequality in all its dimensions.’ He argued that ‘advances in technologies… must not be used to erode human rights, deepen inequality or exacerbate existing discrimination.’ Yet this is exactly what we are seeing with Covid-19 vaccines, each in itself a technological breakthrough. The human rights implications of this must be made clear.
Featured photo: Source: Shutterstock/ManoejPaateel
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