Vaccine inequity has multiple causes, but wealth is a major factor.
The wealthy generally have better access to vaccines than the poor. Within countries, there may be lower rates of vaccination in racial and ethnic minority groups, in rural areas, in older adults, and among those living with disabilities or chronic conditions, in rural communities. Some countries have programs to redress this inequality. Political, economic, social, and diplomatic factors can limit vaccine availability in some countries.
Logistical difficulties are an obstacle. Hot climates, remote regions, and low-resource settings need cheap, easy-to-use vaccines. Vaccines are often not tested to see if they can survive outside a fridge or be administered in a single shot, as it is not in the financial interests of the manufacturer. Cheap vaccines are often not administered due to a lack of infrastructure funding.
- Vaccine prices; new vaccines are on-patent and expensive
- Getting vaccines to children; this is expensive and gets even more difficult in conflict zones and natural disasters
- Five clinic visits in the first year of life is often too many; for people in remote areas with many children, it can be much more costly and difficult to get to a clinic.
- Keeping vaccines cold; see cold chain.
- Age-out; children who don't get vaccinated on-schedule often have to pay for their shots. Disruption from natural disasters or conflict can mean that entire generations go unprotected.
Intellectual property law causes problems with the economics of vaccines. IP currently operates by granting pharmaceutical monopolies lasting decades. The economics of monopoly power give the monopolist a strong financial incentive to use value-based pricing and set prices that many, often most, potential customers can't afford (a pricing strategy that charges what the market will bear, unlike traditional cost-plus pricing charges the cost of production plus a markup). Price discrimination attempts to charge each person the maximum they would be willing to pay, and charges every purchaser more than they would be charged in a fully-competitive market. A vaccine monopolist has no incentive to let the rich actually subsidize the poor. Medical-product monopolists may claim that the high prices charged to the rich subsidize the lower prices charged to the poor when in fact both are being charged well over independent estimates of the cost of production (see, for instance, GeneXpert cartridges and pneumococcal vaccine).
Amnesty International, Oxfam International, and Médecins Sans Frontières (MSF; Doctors without Borders) have criticized government support of some vaccine monopolies, on the grounds that the monopolies dramatically increases prices and harm vaccine equity. During the COVID-19 pandemic, there were calls for COVID-related IP to be suspended, using the TRIPS Waiver. The waiver had support from most countries, but opposition from within the EU (especially Germany), UK, Norway, and Switzerland, among others.
Vaccine inequality has been a major concern in the COVID-19 pandemic, with most vaccines being reserved by wealthy countries, including vaccines manufactured in developing countries. Globally, the problem has been distribution; supply is adequate. Not all countries have the ability to produce the vaccine. In low-income countries, vaccination rates long remained almost zero. This has caused sickness and death.[quantify]
In September 2021, it was estimated that the world would have manufactured enough vacine to vaccinate everyone on the planet by January 2022. Vaccine hoarding, booster shots, a lack of funding for vaccination infrastructure, and other forms of inequality mean that it is expected that many countries will still have inadequate vaccination.
On August 4, 2021, the UN called for a moratorium on booster doses in high-income countries, so that low-income countries can be vaccinated. The World Health Organization repeated these criticisms of booster shots on the 18th, saying "we're planning to hand out extra life-jackets to people who already have life-jackets while we're leaving other people to drown without a single life jacket". UNICEF supported a "Donate doses now" campaign.
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