The last to receive COVID vaccines are the hardest and most critical to reach

Right from the very beginning, we knew that vaccinating the world against COVID-19 was never going to be easy. 

Until now the biggest challenge of this effort — the largest and most complex global deployment of vaccines ever — has been securing equitable access to global vaccine supplies. After all, countries can’t vaccinate people if they can’t get doses. But now, for the first time since this pandemic began, supply is finally exceeding demand, and that has brought into sharper focus what was arguably always going to be one of the toughest challenges: getting shots into the arms of billions of people in some of the most resource-poor and difficult to reach places in the world.

It’s hard to do justice to the scale of this task. Even well-resourced, wealthy countries have struggled with their COVID-19 vaccine programs. But in lower-income countries, where there are often highly complex and fragile political scenarios and multiple public health priorities, health systems were often weak even before the pandemic. So even with doses now able to flow at scale to these countries, some are struggling to turn those vaccines into vaccinations. 

Why? Because these aren’t just the last people to be reached, they are also some of the hardest to reach.

So, if we want to bring this pandemic to an end, then it’s absolutely critical we reach them. Even though the risk of death from COVID-19 has declined and many countries are now relaxing restrictions — thanks largely to vaccines — the threat of resurgence (as we’re seeing in China and South Africa) and the emergence of dangerous new variants still hangs over us. With 2.7 billion people still unvaccinated, the vast majority in lower-income countries, the virus still has plenty of room to spread and mutate. That means, with a new variant of concern emerging roughly every four to six months, until coverage (particularly in the high-risk populations) increases in these countries and they achieve their national vaccination targets, there’s no reason to believe that trend won’t continue.

Currently, nearly 60 percent of people on the planet are fully vaccinated as opposed to 45 percent in low- and lower middle-income countries, but these figures mask the true picture and the huge inequities in vaccine access that have played out since they were first made available. Indeed, while many wealthy nations now have coverage of around 80 percent or above and are now offering fourth booster shots, many low-income countries — 18 at the last count (although down from 34 countries at the beginning of the year) — have still yet to reach 10 percent of their population with two doses, and more than 160 million of the most vulnerable people in humanitarian settings remain unreached by vaccines.

Given the additional challenges these low-income countries face, they need all the support they can get, which is why COVAX, the global effort to make doses equitably available, is accelerating its country-centric approach, doubling down on its support to countries with low coverage. Thanks to the generosity and ongoing support of the donor governments and the international community, including the United States, we now have the funds and innovative financing we need to ensure they get the right vaccines, in the right volumes at the right time.

That means providing countries with the support they need to scale up their delivery systems and increase their absorptive capacity and demand, with a particular focus on high-risk groups, so more people can be reached. In addition, we’re providing support to cover ancillary costs for essential equipment such as syringes, transportation and insurance to ensure that donated doses reach people. This support to low-income countries will help advance our collective global effort to control COVID-19 and, simultaneously, prepare for future health emergencies.

With our supply secure for now, COVAX is in the strongest position it has ever been in to make all this possible. But it won’t happen overnight, which is why it is so important to ensure that supply keeps flowing to COVAX, no matter what the future holds. Because all it would take is fresh resurgences or a new variant of concern, and in a blink of an eye, the cycle of inequity would continue if once again countries with high coverage race to roll out additional boosters or new variant adapted vaccines. Global demand could once again suddenly outstrip supply. 

That is why COVAX recently launched its Pandemic Vaccine Pool — to protect its supply, not just from potential future disruptions to global vaccine supply, but also to ensure that if the need arises for additional coverage, boosters or perhaps new variant-specific vaccines we continue to provide countries with the doses they need.

During a time when the growing public perception is that COVID no longer poses a threat and that the pandemic is over, taking such precautions against disruptions that may not even occur might seem like overkill. But which side of history do we want to be on? Ensuring that we are ready for whatever else COVID throws at us is the right way to end this crisis, and it’s the right way to prepare for future pandemics. What’s more, the investments we’re making in helping struggling countries improve their health systems to enable them to reach more of their citizens will not only help to defeat COVID but will pay dividends in terms of future pandemic preparedness. 

Because ultimately, almost by definition, in terms of global health security and future pandemic preparedness, the hardest to reach are one of the biggest blind spots in our early warning system.

Seth Berkley, is CEO of Gavi, the Vaccine Alliance and cofounder of COVAX.