An Advocacy Letter to the Federal Government about Global Vaccine Equity

By Kaelan Olney

This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.

December 4, 2023

Hon. Mark Holland

Minister of Health

House of Commons

Ottawa, ON K1A 0A6

Dear Minister Holland,

I am writing to you today to urge the federal government to take action to ensure global vaccine equity for any future health crisis because Canada’s leadership during the COVID-19 pandemic was not up to our traditional high standard.

Prime Minister Trudeau emphasized that global solidarity and equitable distribution of vaccines worldwide would be necessary to fight this pandemic, which was in Canada’s best interest before vaccines were released (1). However, like many other high-income countries (HICs), the Canadian government’s response to vaccine availability established and maintained vaccine inequity across the world (2). Notably, as was seen with H1N1 and monkeypox (mpox) before COVID-19, Canada chose to hoard vaccines, securing approximately 11 times more doses than the number of people living in Canada (3). Even though this over-acquisition of vaccines might initially have been understandable due to uncertainty regarding which vaccines would be approved for use, the conscientious decision to not share these doses once Canada realized it would have more than enough is not (3). Canada’s insufficient actions in ensuring equitable vaccine distribution are even further undermined by the sheer amount of waste we allowed, with over 12 million doses expiring in 2022 and 14.4 million more expiring in 2023 from the federal vaccine inventory alone (4).

In addition, regarding international operations such as COVAX and the TRIPS waiver, Canada has, again, made decisions that intentionally neglected the lives of people in lower and middle-income countries (LMICs) (2). Even though COVAX was created to ensure equitable access to COVID-19 vaccines for LMICs, its impact has been limited by vaccine nationalism (5). This was exemplified by HICs buying up available doses during limited supply and negotiating expedited vaccine delivery (6). Canada may have been one of only three countries to meet expected financial contributions for COVAX in 2021 and 2022, but the bilateral deals we made with pharmaceutical companies that had Canada’s self-interest in mind, causing delays in the reception of vaccines by LMICs undermined this generosity (3). Not to mention that while making these bilateral agreements, Canada simultaneously received over 600,000 doses of AstraZeneca from the COVAX program even though many countries were entirely reliant on this COVAX program to access vaccines (7).

Furthermore, even though Canada could not produce its own COVID-19 vaccine at the onset of the pandemic, which left Canada subject to restrictions on exports from manufacturing nations, distribution interruptions, and pharmaceutical companies’ self-interest, the Canadian government still chose to remain neutral when the TRIPS waiver was proposed for the pandemic, even with this firsthand experience on how difficult I was to procure vaccines by even a HIC like Canada (3,8). This intellectual property waiver would have allowed an equitable and international public health reaction to the pandemic (8). Yet, through its neutrality, the Canadian government contributed to delaying this waiver by nearly two years, thereby contributing to the human lives lost and socio-economic impacts that this delay caused in LMICs as well as the potential reinfection of Canadians by variants evolving in unvaccinated areas of the world (2,8).

In sending this letter, I aim not to solely criticize my government’s response to the pandemic but to call on you to ensure that these inequitable practices do not repeat themselves in future pandemics. The Canadian government must listen to the many experts who have given concrete ways for Canada to ensure better vaccine equity, which is also in our own interest. As stated beautifully by Houston et al., “Canada has the opportunity to translate overdue reforms into positive global health outcomes, not just for COVID-19 but also for other serious public health threats” (3). Namely, Canada must prioritize people over companies’ profits (3). Presently, Canada has no regulations in place to ensure that public funds invested in pharmaceutical development bring about results that can be accessed by the public rather than being unconditionally sold or licensed to private parties as the government has previously done on numerous occasions (9). Furthermore, the Canadian government must guarantee that when they are facilitating this research, the resulting intellectual property can be licensed to manufacturers that serve LMICs without legal obstacles, especially regarding technology that can be used to combat an epidemic (3). Canada also needs to have better tracking of their vaccines at all levels of government so that minimal vaccines go to waste. Suppose there is ever another outbreak where Canada accumulates such a surplus of vaccines. In that case, the Canadian government must have a publicly available policy and mechanism whereby extra doses will be donated to LMICs to, at the very least, vaccinate healthcare workers and high-risk individuals (9). Lastly, this pandemic has shown that domestic production of vaccines is necessary for Canada to be self-reliant. Still, while they are achieving this goal, they must also empower other countries to do so, especially for LICs, so that they can also be better prepared for the next pandemic (3).

The Canadian government needs to ensure that an equity-focused response, with the goal of health for all people, is the reality for the next health crisis and be allies for LMICs, holding itself accountable for the promises made by our prime minister (2). Not only does Canada need to recognize the role it played in creating vaccine inequity during the COVID-19 pandemic, but it must also take an active stance and have concrete plans to ensure that these mistakes are not repeated in future crises.

Throughout this letter, I have listed multiple tangible changes proposed by many different experts in Global Health that the Canadian government can implement to address this inequity. As our minister of health, I call on you to take Canada's responsibility as a Global Health leader seriously and ensure that equitable policies and practices are at the forefront of all decisions the Canadian government takes when addressing the next health crisis. This pandemic was one of inequity and injustice that took advantage of cracks already present in the world; only once these cracks are repaired can we ensure that we will be ready when the next global threat occurs (10).

Sincerely yours,

Kaelan Olney

References

1. Justin Trudeau S-WZ, Moon Jae-in, Jacinda Ardern, Cyril Ramaphosa, Pedro Sánchez Pérez-Castejón, Stefan Lofven and Elyes Fakhfakh. The international community must guarantee equal global access to a covid-19 vaccine. The Washington Post [Internet]. 2020 Jul 15 [cited 2023 Dec 4]. Available from: https://www.washingtonpost.com/opinions/2020/07/15/international-community-must-guarantee-equal-global-access-covid-19-vaccine/.

2. Bandara S. Vaccine Equity: Changing the Status Quo [Internet]. Think Global Health: Council on Foreign Relations; 2022 Apr 16 [cited 2023 DEC 4]. Available from: https://www.thinkglobalhealth.org/article/vaccine-equity-changing-status-quo.

3. Houston AR, Liu J, Habibi R, Murthy S, Pai M. Canada's role in covid-19 global vaccine equity failures. BMJ. 2023;382:e075149.

4. Kirkey S. Canada on track to waste up to 18M vaccine doses this year, with millions more ordered. National Post [Internet]. 2023 Aug 4 [cited 2023 Dec 4]. Available from: https://nationalpost.com/news/millions-more-covid-19-vaccine-doses-wasted-as-demand-dries-up.

5. Hunter DJ, Abdool Karim SS, Baden LR, Farrar JJ, Hamel MB, Longo DL, et al. Addressing Vaccine Inequity - Covid-19 Vaccines as a Global Public Good. N Engl J Med. 2022;386(12):1176-9.

6. Taylor A. Covax promised 2 billion vaccine doses to help the world’s neediest in 2021. It won’t even deliver even half that. The Washington Post [Internet]. 2021 Dec 10 [cited 2023 Dec 4]. Available from: https://www.washingtonpost.com/world/2021/12/10/covax-doses-delivered/.

7. Doctors Without Borders. MSF: Canada must commit to COVID-19 vaccines sharing [Internet]. Doctors Without Borders / Médecins Sans Frontières (MSF) Canada; 2021 May 18 [updated 2023 May 25; cited 2023 Dec 4]. Available from: https://www.doctorswithoutborders.ca/msf-canada-must-commit-to-covid-19-vaccines-sharing/?utm_source=google&utm_medium=cpc&utm_campaign=grants&s_src=22-SEM&s_subsrc=Google&gad_source=1&gclid=Cj0KCQiA67CrBhC1ARIsACKAa8Scxy1YKLO8fE3LZahYikUVJCaTaUDQSe7Q_aSJ4OftJIKqGzy_0gQaAhJwEALw_wcB.

8. Canadian Centre for Policy Alternatives. The TRIPS COVID-19 Waiver [Internet]. Canadian Centre for Policy Alternatives; [cited 2023 Dec 4]. Available from: https://policyalternatives.ca/newsroom/updates/trips-covid-19-waiver.

9. Doctors Without Borders. COVID-19 vaccines: Equitable global access is urgently needed [Internet]. Doctors Without Borders / Médecins Sans Frontières (MSF) Canada; 2021 Apr 19 [updated 2023 May 25; cited 2023 Dec 4]. Available from: https://www.doctorswithoutborders.ca/covid-19-vaccines-equitable-global-access-is-urgently-needed/.

10. Pai M. A Pandemic Of Inequity And Injustice: How Should The World Respond? [Internet]. Forbes; 2022 Jan 25 [Cited 2023 Dec 4]. Available from: https://www.forbes.com/sites/madhukarpai/2022/01/25/a-pandemic-of-inequity-and-injustice-how-should-the-world-respond/?sh=67eb99ee311d.

McGill Perspectives on Global HealthMarch 11, 2024