As a nation we have not only the ethical imperative to pursue global vaccine equity, but the pragmatic one.
This is a matter of justice, of course, but it is also one of practical considerations.
The theme of this year’s world immunisation week – an annual event promoted by the World Health Organization – is ‘long life for all’. The WHO is quick to say this is not a promise, but an aspiration. A commitment to the vision of a world where the protective power of vaccines can empower everyone to live full, healthy, lives, whether they were born in Australia or Zimbabwe.
Unfortunately, decades of xenophobic and nationalist rhetoric stoking mistrust of the ‘foreign’, coupled with centuries-long narratives promoting national ‘us vs them’ dynamics, has taken its toll on voters and the decisions made by their representatives.
As we continue to struggle with problems here in the UK – a cost of living crisis, ongoing concern about the future of the NHS – many simply don’t feel there is space to worry about other people struggling in some distant land.
While one can choose to focus on their local population, they can’t opt out of the realities of modern life. We are all too connected to believe borders – a purely political construct – protect us from ill health. We aren’t medieval Venetians, who can demand ships from ill ports wait 40 days before landing on our harbour. A virus is across the world before a preventative measure puts on its boots.
Put simply, national health cannot remain discrete in a globalised world.
There has been no greater proof of this than the COVID-19 pandemic. Again, while it is natural in times of strife to focus on our own backyard rather than our neighbourhood – or on your national vaccination strategy before considering a global distribution of vaccines to others – one needs to consider long-term impacts of leaving huge swathes of the world without inoculations.
Having witnessed the devastation this disease has caused across the globe, even those with zero medical background can now understand the concept of virus mutations. Again and again, we’ve seen new strains emerge in one country, and waited for it to spread to ours – or watched as a strain that appeared to come from the UK travel across the seas.
Despite the vague sense of inevitability that surrounds each letter of the Greek alphabet, we know that global vaccination could help us truly tackle the pandemic on a global scale. Greater protection could lead to less breakout, and fewer new strains.
Mutations are random occurrences, most result in non-viable variants that disappear into viral history – occasionally, however, there is a more transmissible or more deadly strain. More infections and greater replication increases the chance of the next alpha, delta or omicron arising. And there is no guarantee that it will cause less severe disease.
The BMA has not been silent on this issue. The chair of council, Chaand Nagpaul, wrote to the prime minister in September calling on the UK government to make an immediate assessment of its supply of surplus vaccines, and to increase the number pledged to the COVAX programme – a project working for global equitable distribution of COVID vaccines. He wrote again in December.
We have urged the leader of this country and others to be more ambitious when it came to helping vaccinate the world, and we published a joint statement – alongside other trade unions and medical royal colleges – calling for fair global distribution of jabs. We remain a signatory to the WHO declaration on vaccine equity, encouraging countries to ensure that access to this life-preserving resource is determined by need, rather than wealth of geographical location.
We will continue to make these calls, to publicise the work of those who make these calls, and to join forces with organisations striving for universal coverage of COVID vaccines.
WHO set a target to vaccinate 70% of the world’s population by 2022. It is believed that we will fall short of this.
While COVID is a recent illustration of the need to consider immunisation as a global, rather than national, project – and while there is clearly some way to go when it comes to this particular virus – it should be recognised as a single example of disparity when it comes to vaccinations.
According to WHO, the number of completely unvaccinated children increased in 2020 by 3.4 million. Paradoxically, a focus on achieving global vaccination against the novel coronavirus, has disrupted the efforts to make progress in the immunisation of pre-COVID diseases. Even before COVID, vaccine coverage against diseases that we have seen the back of in the UK, such as diptheria, polio and tetanus, had plateaued over the last decade.
For those who aren’t concerned by the unfairness of the current situation – who don’t feel it is shocking that 23 million children under the age of one are still at risk of preventable diseases in 2020, who aren’t disturbed by the different percentages of coverages across differing areas – we’d ask them to consider this.
The sickliness of one person cannot benefit another; a child dying of an avoidable illness is a tragedy wherever they may live. We are all connected – through our economy, by flight paths, via the internet – and we cannot pretend the health of one population is of no concern to ours.
If the pandemic has taught us anything, it is how small the world is. Many of us can already find family, friends and colleagues across the world – it shouldn’t be a great leap to think of everyone else as a potential connection. In a global community, everyone can be one of our ‘own’, and it is natural to seek to protect our own people.
Accordingly, they should join the call of WHO, and doctors across the world. Increased vaccine coverage for people of all ages. Increased protection from disease, and the impact of disease.
Long and healthy life for all.
David Strain is chair of the BMA board of science and Kitty Mohan is chair of the BMA international committee