How to ensure vaccine equity, build trust and strengthen global health systems

Just over a year since the World Health Organization declared COVID-19 a pandemic, more than a billion doses of vaccines have been administered.

But the vast majority of these have been in developed countries, meaning the pandemic continues to spread in those countries that don't have equal access to vaccines.

At an Issue Briefing held by the World Economic Forum to mark World Immunization Week, experts from around the globe discussed how can we ensure vaccine equity, build trust in COVID-19 vaccines and strengthen health systems to prepare for the next pandemic.

Panellists: Aboubacar Kampo, Director of Health Programmes, UNICEF; Heidi Larson, Professor of Anthropology, Risk and Decision Science, London School of Hygiene & Tropical Medicine; Garth Graham, Director and Global Head of Healthcare and Public Health at Google/YouTube; Julie Gerberding, Executive Vice President and Chief Patient Officer, Communications, Global Policy, and Population Health at MSD; Genya Dana, Head of Healthcare, World Economic Forum.

Here are some of the key quotes from the session:

Kampo: If you're not distributing vaccines equitably, we are not stemming new mutations. I think we need to make sure that everyone gets access, in the same manner, in an equitable manner for those vaccines, so that we avoid mutation.

Gerberding: We've never manufactured more than 2 billion doses a year, so the challenge of getting this vaccine to really address the needs of the global community is daunting. And I think the glass half full answer is that we've come a long way, but I totally agree that no one is safe until everyone is safe. And we really have to be global citizens and think through how are we going to not just get doses out there, but how are we going to support the systems and the trust necessary to get them into the arms of people.

Larson: It's not just about trust in the vaccine but trust in the system, trust in the people delivering it - the 'trust chain' is really important. Supply is one piece of that picture and clearly if you're not getting a supply you start to lose trust in the system. We also need equity in the preparedness and then the investment upfront to build people's confidence.

Larson: Trust is made of two things: basically trust in the ability of an institution or an individual to do what they say they can do and trust in the motives and that's sometimes where we've got some real doubts from people ... If we listen to them, if we engage with people with questions, they'll remember that. We are making history, right now, this is a period of time that the world will remember and if they remember that they were heard that they were engaged that's going to stick ... We have to have a lot of empathy and be there for people and they'll remember that.

Graham: We have a huge role to play [in] bringing trusted information to communities. Vaccines have been one of the greatest public health achievements that we've made in our lifetime and it's important for us to be able to make sure that communities have trust and confidence in the process, not just with COVID-19 but in health and public health in general.

Dana: There are a lot of signs that people trust their employers to deliver a lot of this kind of information which has been something that has been really very helpful for us at the Forum, to be able to mobilize Chief Health Officers, Chief Human Resource officers of companies and have them on board and helping us to spread the message … and basically explain that vaccines are one of the most effective public health interventions that there are and it's never been more true than during this period of the COVID pandemic.

Kampo: The other diseases are not taking a break just because of COVID-19 - everything else is still going on. In terms of maternal health, for example, we have a reduction in services in some countries close to 40, 50%. Immunization services have been hit very hard at the beginning of the crisis. They were the first to rebound, to get back on track, but still human resources have been shifted to other sectors.

Kampo: Even before COVID-19, we have at least 20 million children who have not received a single shot of vaccines for the other diseases as well. And what is important to notice is where you have zero-dose children, how we call them, there is a zero-dose community, this is a community where it’s not just health services, they're lacking in terms of infrastructure, education services, nutrition services, it's a complex situation of deprivations of those communities, which also feeds into the trust issues.

Kampo: I think it is high time that everyone doesn't look at health, at the health sector just as an expenditure bucket, but more as an investment bucket, as an investment sector for the future, because if we don't invest in health, if you don’t invest in the health systems, every other single programme which we are implementing becomes just more expensive or becomes verticalized, as we have seen with polio.

Gerberding: Some 28 countries or regions have temporarily suspended their measles and other childhood immunization programmes. Measles is as transmissible, if not more transmissible than SARS-CoV2 and I predict we're going to see measles outbreaks. It’s kind of the canary in the coal mine of a failing immunization system. First and foremost countries do need to reinvigorate their base case paediatric immunization programmes, and then, of course, there are adolescents and adults that are succumbing to vaccine preventable diseases or at risk for them. That's the frontline of health protection in most countries, and we need to make sure that we don't let that frontline fail, while we're working on the pandemic.

Kampo: Building back the health systems better needs basically support first of all, there needs to be commitment from those countries themselves and we talk about financial commitments of governments, in particular in low and middle-income countries to really strengthen their primary healthcare systems … We shouldn't be trading off a pandemic for another pandemic.

Watch the full session below: