Canada needs to fulfill its promises on vaccines and become part of the solution
By Shashika Bandara
In June 2021, at the G7 summit, Canadian Prime Minister Justin Trudeau declared his government’s commitment to vaccinate the world saying, “we’re going to be able to share around the world as we see Canadians getting vaccinated to higher and higher levels, and we simply do not need those doses.” Canada had already made headlines by procuring five times the number of vaccines they need to vaccinate their population. Given the nationalistic nature of vaccine procurement, the thought followed that as vaccine coverage increased within Canada more effort will be made to vaccinate the world. Yet, Canada remains woefully behind its target, contributing to global vaccine inequity and elongating the pandemic. Of the 200 million doses committed to the COVAX initiative, only 6.4 million has been delivered so far – which is a mere 3 percent of what was promised. There is a growing disappointment around Canada’s actions that continues to directly impact global vaccine inequity and many of the experts are voicing their concern.
“It is disappointing to see the slow pace at which Canada has shared the vaccine doses pledged to COVAX. Every week of delay could mean lives lost and livelihoods destroyed,” says Professor Madhukar Pai Canada Research Chair in Epidemiology and Global Health at McGill University.
This lack of efficiency in delivering vaccines to poorer countries contrasts with the national-level plans; Canada just approved a booster dose (a third vaccination dose) for the general population while many of the low-income country citizens including frontline healthcare workers remain unvaccinated. These policy actions also go against the guidance of the World Health Organization and global health experts who clearly point out that the only way out of this pandemic is to vaccinate the world.
“Vaccinating the world is the best hope for ending this global crisis and for making sure the world is back on track for meeting the 2030 Sustainable Development Goals. Canada has a key role to play here, given the huge surplus vaccines we have procured. In addition to rapidly donating the pledged vaccines, Canada must actively support the TRIPS IP waiver, so that more companies can produce the vaccines to meet the global target of vaccinating 70% of the world’s population by mid 2022,” says Professor Pai highlighting the importance of Canada’s role.
This pattern of over procuring, declaring charity models to bridge the gap of vaccines, and underdelivering is reflected in many high-income country efforts to address vaccine inequity. Additionally, due to active blocking or inaction by high-income countries, intellectual property rights and knowledge sharing also remain out of reach as a solution. Experts point out that the vaccine stockpiling by high-income countries as the main reason for the continued imbalance in access to vaccines. A recent analysis by AirFinity – an independent London-based analytics company - shows that last month alone approximately 1.5 billion vaccines were produced, a majority of which was produced in China. However, of those produced outside of China, just under 60 percent of vaccines are going to the United States, the United Kingdom, the European Union nations, Canada, and Japan.
Adam Houston, Medical and Policy Advocacy Officer of Doctors without Borders, Canada stresses that Canada’s stockpiling has been a concern from the beginning of the pandemic. “Back in August, Canada promised it would maintain a stockpile of four million doses while sharing the surplus. In reality, from the time of that announcement up until last week, Canada’s Central Vaccine Inventory never held less than nine million doses, and that’s not counting doses being held by the provinces.”
In addition to stockpiling vaccines that can be shared, there is a real concern over vaccine wastage as well. “Keeping doses in freezers rather than putting them in arms doesn’t help anybody; even worse, there’s a real risk some of these doses will expire before they can be used at all,” says Houston. He also asks the question would Canada act the same way if their vaccines were delayed for their country: “back in the summer, Canada received as many doses in a single week as it has delivered to COVAX in total; there is no way Canada would accept this delivery schedule for itself, but now, delivery of the very same doses from the very same contracts is occurring at a snail’s pace and being met with a shrug in Ottawa.”
Figure 1: Global vaccine inequity analysis by UNDP; Data source: Our World In Data
The results of stockpiling is reflected in the latest analysis by the United National Development Program (UNDP) where only just 4 out of 100 people have received vaccines in low-income countries in contrast with 133 out of 100 being vaccinated in high-income countries. The impact of such vaccine inequity runs deep and is not limited to COVID-19 health outcomes. “While many may see boosters and stockpiling vaccines in countries such as Canada a small drop in the vaccine bucket, in reality, hoarding of vaccines in high-income countries with already high vaccine rates will have detrimental effects on global vaccine rollout,” points out Dr. Zain Chagla, an Associate Professor of Medicine at McMaster University. “We can expect not only human suffering from death, but disability from COVID, orphaned children, health systems collapse, economic upheaval, and a further loss of global health efforts.”
The current course of action by Canada does not reflect its declared role as a promoter of democracy and a country that supports those in need highlights Dr. Sanjay Ruparelia, an Associate Professor of Politics and the Jarislowsky Democracy Chair at Ryerson University. He adds to that saying “we have reportedly hoarded more vaccines than any other country in the world on a per capita basis. Considering booster shots for non-vulnerable members of our eligible population, before the rest of the world receives critical first doses, is not only incredibly selfish -- it does not respect leading scientific advice, which we tell our citizens to follow.”
Dr. Ruparelia stresses that there is a strong need to translate rhetoric into action which is vital for not only health outcomes but safeguarding human rights. “Canada likes to see itself as part of the solution. But during the pandemic, we are a big part of the problem. We clearly place a far higher premium on the lives of our citizens than the lives of billions in the global South. Forget the rhetoric: our vaccine nationalism trumps any professed commitment to liberal values and universal human rights.”
There is a vacuum of leadership within high-income countries to take the necessary steps to shift the current status quo and end vaccine inequity. Canada could perhaps take this opportunity to fill this gap in leadership within high-income countries on vaccine equity and start by increasing the efficiency of their donation delivery to COVAX. However, relying on donations is not sustainable and is only a temporary solution highlights global vaccine advocate Safia Ibrahim. "To be a true global leader, Canada needs to support and strengthen the capacity for COVID-19 vaccine production and distribution worldwide; especially in low and middle income countries, and we can do this by accelerating the transfer of technologies. We cannot afford to rely only on donations of vaccines when we can empower countries by supporting the TRIPS IP waiver, which would help ensure a rapid, equitable, and truly global public health response to COVID-19. Unfortunately, Canada, while claiming that it does not oppose the waiver, has not supported it either,” says Ibrahim.
Echoing the views of global health experts from around the world Ibrahim stresses the importance of vaccinating all and especially the vulnerable as a key strategy to start returning to normalcy. “A successful strategy requires vaccinating the whole world and right now about 75% of all the vaccines delivered across the globe have been sent to 10 countries. Yes, it’s great news that some communities are getting vaccinated. But it is also vital to recognize that if we don’t vaccinate the most poor and vulnerable communities, everyone will continue to be at risk, and right now there are still dozens of countries that haven’t received a single dose of the covid-19 vaccine.”
The current pandemic should also be a learning experience and as we look to end the current pandemic, we also should look to the future and take note of our systemic failures says Dr. Robyn Waite, Director of Policy and Advocacy of Results Canada stating “glaring vaccine inequities and the failure to respond to a global challenge with a globally coordinated response has made it abundantly clear that systems of governance are not fit for purpose.” In order to build a better response, there is some introspection required argues Dr. Waite. “We must think bigger by calling into question why lower-income countries are having to rely on high-income countries donating vaccines anyways? Why aren’t advanced economies like Canada saying yes to heads of states throughout the African continent who are asking World Trade Organization members to waive intellectual property? To prevent a repeat of this march of folly on a global scale the reality of multilateralism and international relations must move beyond models of charity and colonialism. G7 governments like Canada, and their citizens, like me and you, have much work to do.”
As we reach 20 months since the onset of the pandemic, it is safe to say that despite remarkable progress in science, we have failed to uphold our commitments to global goals and human rights. At the center of it remains wealthy countries such as Canada, who continue to exacerbate the existing inequities. As highlighted above, experts from multiple sectors including global health, international development, and global governance have time and again pointed the correct way forward. So, let this be a call to action for the government of Canada. Step up and lead the way in ending vaccine inequity in order to end the biggest global health crisis of our generation.
Acknowledgments:
The author wishes to thank Madhukar Pai of McGill University, Adam Houston of Médecins Sans Frontières (MSF) / Doctors Without Borders, Canada, Zain Chagla of McMaster University, Sanjay Ruparelia of Ryerson University, Global Vaccine Advocate Safia Ibrahim, and Robyn Waite of Results Canada for sharing their expert opinions and recommendations.
About the Author
Shashika Bandara is the Editor-in-Chief of McGill Global Health Perspectives. He is a doctoral student focusing on global health policy at McGill University. He holds a master’s in global health from Duke University and is formerly a policy associate at the Center for Policy Impact in Global Health at the Duke Global Health Institute. He tweets @ShashikaLB.
Thumbnail image is by Marco Verch used under Creative Commons 2.0 license. No changes were made to the image.