Where you live should not determine whether you live

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Exactly one year ago, our prime minister along with the leaders of seven other countries co-authored a powerful article in the Washington Post. They knew that the fastest way of ending this pandemic was through the simple idea that “global solidarity is central to saving lives.”

It was July 2020, and Canadians were in between waves of a global pandemic, crushed by tragic deaths of grandparents in nursing homes and worried about the risk of infections among healthcare workers. However, vaccines were on the horizon. We were encouraged by the voices of those global leaders calling attention to the fact that “we must urgently ensure that vaccines will be distributed according to a set of transparent, equitable, and scientifically sound principles.” We would face this pandemic together and come out stronger as a nation and an international community. Or so we thought.

Over this past year, the government of Canada worked hard to secure supplies of vaccine. To ensure there was equity in the response, we prioritized older and at-risk adults, underserved communities, and healthcare workers. However, our solidarity and sense of equity seemed to stop at the border.

Canada has made generous financial contributions to the international coordination initiative COVAX, and this week announced the release of millions of AstraZeneca vaccines we no longer wish to use because of our national preference for the mRNA vaccines. But such charitable approaches alone, even if multilateral through the COVAX model, may actually reinforce existing inequities and could be used to distract from efforts to address the structural causes of those inequities.

Through bilateral trade deals with manufacturers, Canada and other countries have prevented less-wealthy nations from accessing vaccines. Canada went against the pleas of the WHO and struck deals with manufacturers such as the Serum Institute of India, the primary supplier to COVAX. We also drew vaccines directly from COVAX itself, further hindering the program from meeting its early targets in low-income countries. Finally, Canada has undermined efforts to expand the global vaccine supply, most notably by not joining other countries in supporting a waiver on intellectual property at the World Trade Organization.

In contrast to the calls from July 2020, we are using the limited global supply of vaccines to increase inequities between countries. With current supplies, all children in high-income countries could be vaccinated in the coming months before healthcare workers, vulnerable parents and older adults in low-income countries with a higher risk of death. We collectively applied the principles of prioritizing these individuals nationally — we should do the same internationally. As our prime minister wrote: “Where you live should not determine whether you live.

The inequities in access to life-saving treatments are not new or unique to COVID-19. We have been socialized to accept many terrible inequities in the world as unavoidable. However, the COVID-19 pandemic highlights an element of self-interest in their timely and effective distribution, globally. High rates of transmission drive mutations, and novel variants are emerging that may be more transmissible, cause more severe disease in younger people, and potentially compromise vaccine efficacy. By obstructing access to vaccines in other parts of the world, not only do we risk contributing to avoidable deaths in those regions, we risk prolonging the pandemic here at home.

Now, as Canada moves to declare the outbreak over in our country and starts to remove public health restrictions, a large wave of infections is appearing in other parts of the world. The recent focus on booster vaccines and variant-tailored vaccines to protect ourselves, when the lack of vaccines elsewhere is the root cause of those issues is unsettling. That vaccine manufacturers could shift efforts toward booster shots in wealthy countries rather than helping expand capacity for the rest of the world underscores the failings of our current system.

Last July, our prime minister was right: We should urgently distribute the vaccines we have on a scientific basis. We still have an opportunity to respond to the pandemic and meaningfully address global inequities. Whether we chose to do so is now largely a political choice.

Alissa Wright and Jan Hajek are infectious diseases physicians at Vancouver General Hospital; Srinivas Murthy is in the department of pediatrics at University of B.C.

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