The radically unequal distribution of Covid-19 vaccinations: a predictable yet avoidable symptom of the fundamental causes of inequality

Abstract

The Covid-19 pandemic-and its social and economic fallout-has thrust social and health-related inequalities into the spotlight. The pandemic, and our response to it, has induced new inequalities both within and between nations. However, now that highly efficacious vaccines are available, one might reasonably presume that we have in our hands the tools to address pandemicassociated inequalities. Nevertheless, two prominent social science theories, fundamental cause theory and diffusion of innovation theory suggest otherwise. Together, these theories predict that better resourced individuals and countries will jockey to harness the greatest vaccine benefit for themselves, leaving large populations of disadvantaged people unprotected. While many other life-saving prevention measures have been distributed unequally in ways these theories would predict, the COVID-19 vaccines represent a different kind of case. As the disease is so highly infectious and because mutations lead to new variants so rapidly, any inequality-generating process that leaves disadvantaged individuals and countries behind acts to put everyone-rich and poor-at risk. It is time that we ensure the equitable distribution of this life-saving benefit. As the fundamental cause and diffusion of innovation theories help illuminate processes that regularly produce inequities, we turn to them to reason about the rollout of the COVID-19 vaccines. Specifically, employ them to suggest countermoves that may be necessary to avoid an irrational and inequitable vaccine rollout that ends up unfavorably affecting all people.

Relative vaccine effectiveness of the booster dose of COVID-19 vaccine for preventing death in individuals with a primary regimen based on the BBIBP-CorV, ChAdOx1-S, or BNT162b2 vaccines during the Omicron wave in Peru: A nested case-control study using national population data

“…Amid the pandemic, vaccination against COVID-19 has proven to be a crucial public policy in controlling the pandemic disaster [5] , [6] . However, dealing with high demand and reduced supply worldwide, there have been variations in COVID-19 vaccination regimes and coverage between countries, especially in low-and middle-income countries [7] , [8] .…”

Leveraging South African HIV research to define SARS‐CoV‐2 immunity triggered by sequential variants of concern

“…Unfortunately, access and subsequent distribution of vaccines in low‐ and middle‐income countries (LMICs) has been unequal and insufficient in comparison to high‐income countries (HICs). 122 Apart from access to vaccines, LMICs such as South Africa face unique challenges with regard to the maintenance of the cold chain during the transport and storage of vaccines, which has made use of the mRNA vaccines in these regions difficult. Lastly, relatively low community engagement has resulted in a large fraction of individuals who are vaccine hesitant due to concerns about vaccine safety.…”

“…Vaccines to combat SARS‐CoV‐2 illness have resulted in the easing up of restrictions and non‐pharmaceutical interventions and a start to the return to pre‐pandemic life. Unfortunately, access and subsequent distribution of vaccines in low‐ and middle‐income countries (LMICs) has been unequal and insufficient in comparison to high‐income countries (HICs) 122 . Apart from access to vaccines, LMICs such as South Africa face unique challenges with regard to the maintenance of the cold chain during the transport and storage of vaccines, which has made use of the mRNA vaccines in these regions difficult.…”

COVID19 in Latin America: informal settlements and the politics of urbicide

“…After two years of profound health, social and economic impacts due to the COVID-19 pandemic, community-based coronavirus transmission is still of concern at the micro-level in the Global South, whilst the macro-level still fights against a humanitarian crisis on a global scale (Rydland et al, 2022;Ahrend et al, 2022;Manderson and Levine, 2020), taking some problems already faced in other contexts and epidemic outbreaks to a new level (Allen et al, 2017;Corburn & Riley, 2016;Quesada et al, 2011;Satterthwaite et al, 2019). Along with the uneven progress of immunization between the North and the South countries, the debate and research is expanding into other areas of knowledge, moving away from the initial concentration in epidemiology and public health.…”