COVID-19 vaccines: Equitable access, vaccine hesitancy and the dilemma of emergency use approvals

Barriers to COVID-19 Health Products in Low-and Middle-Income Countries During the COVID-19 Pandemic: A Rapid Systematic Review and Evidence Synthesis

“…Even supply contracts that were made available via freedom of information acts (FOIAs) or US Securities and Exchange Commission (SEC) filings were heavily redacted (77). Terms of partnerships or agreements between originator vaccine manufacturers from HICs and contract manufacturers in LMICs were and are also still quite unclear or shrouded in secrecy (74,92). Secrecy of the pricing agreements further limits negotiation power of LMICs who already have limited purchasing power (85,103).…”

“…Political will and international solidarity/cooperation in decision-making/agenda-setting fora to fully address this barrier has been slow, however multilateral discussions ongoing at the WHO to negotiate a pandemic treaty-if successful-could unclog this and other bottlenecks at the international and regional level (47,74,81,101,106,137,138). It is important to ensure that global allocation frameworks for distributing COVID-19 health products first address institutional barriers, power imbalances and historical inequities between Global North and South countries to ensure equitable distribution (106,139).…”

“…It is important to ensure that global allocation frameworks for distributing COVID-19 health products first address institutional barriers, power imbalances and historical inequities between Global North and South countries to ensure equitable distribution (106,139). There is also a need for regional public health authorities in LMICs to develop indigenous frameworks for the ethical allocation of scarce resources (during infectious disease epidemics) that are culturally appropriate for their regions and reflect the socio-political values and realities in their contexts (74,93,102,140). The Africa Union (AU), Africa Centres for Disease Control and Prevention (Africa CDC) and WHO Regional Office for Africa's regional approach to ensuring equitable access to COVID-19 health products is to be widely encouraged and their collaborative and strong regional leadership in addressing this barrier is commendable.…”

“…The skepticism about these therapies have been reported by some authors as anti-African bias which could influence other forms of skepticism about western COVID-19 health products (80). For instance, only 64% of South Africans in a COVID-19 vaccine acceptance survey conducted for the World Economic Forum (WEF) said they would take the vaccine and over 30% of respondents in another survey conducted in Nigeria, Pakistan, Lebanon said they would not get vaccinated when a coronavirus vaccine became available (74,92,93). Skepticism or hesitancy about the vaccines were for a variety of reasons including novelty of the mRNA vaccines, speed at which the currently approved vaccines were developed sparking doubts that development of some of the vaccines did not follow regulatory due process, fear of adverse effects, fatigue and emotional detachment from a protracted outbreak, misand disinformation via conspiracy theories and rumors on social media platforms, etc (74,92,94).…”

“…For instance, only 64% of South Africans in a COVID-19 vaccine acceptance survey conducted for the World Economic Forum (WEF) said they would take the vaccine and over 30% of respondents in another survey conducted in Nigeria, Pakistan, Lebanon said they would not get vaccinated when a coronavirus vaccine became available (74,92,93). Skepticism or hesitancy about the vaccines were for a variety of reasons including novelty of the mRNA vaccines, speed at which the currently approved vaccines were developed sparking doubts that development of some of the vaccines did not follow regulatory due process, fear of adverse effects, fatigue and emotional detachment from a protracted outbreak, misand disinformation via conspiracy theories and rumors on social media platforms, etc (74,92,94). Historical or protracted distrust of governments, science, westernized health systems, experts and interventions; politicization of vaccines, and doubts about their safety and efficacy by some groups, neglect and abuse of vulnerable populations in LMICs have contributed to the current challenges of vaccine hesitancy (74,92).…”