The last two years have been the most challenging medically and socioeconomically in recent history, leaving an extensive impact on global healthcare systems. The outbreak of the COVID-19 pandemic has caused the death of over 5 million people so far—and this number continues to rise. The impact this disease has had on people directly and indirectly means the world can never be the same again. As a doctor and frontline healthcare worker myself, the pandemic was a momentous challenge to say the least. But my life turned upside down when my beloved father tested positive for the virus on 31 December 2020. After being admitted to the intensive care unit, he was put on a ventilator for 13 days, and sadly lost his life on 27 January 2021. Being only 63 and physically fit, with no underlying medical conditions, my understanding remains clouded as to how this disease affected my father so severely. Yet we are only at the tip of the iceberg, and still attempting to make sense of how this disease affects certain individuals more seriously than others.

My story is no different than the millions of other families who have lost their loved ones or who are caring for those left with debilitating health conditions, either from contracting COVID-19 or indirectly through its consequences. We have become ominously familiar with the daily COVID-19 death rate governments publish, but these statistics may not be entirely accurate and might be substantially higher than reported. This can happen for several reasons globally. Firstly, civil registries and hospitals aren’t promptly processing certificates, causing a delay in reporting COVID-19 death toll, and thus a lag in data publication. Secondly, official statistics in several countries exclude those who did not test positive for COVID-19 before dying, which in many situations can be the result of inadequate testing due to limited access or capacity. Thirdly, inaccessibility to healthcare can delay people coming to the hospital with COVID-19, which has also contributed to overall mortality. Unfortunately, much of the above reasons remain particularly true in many low- and middle-income countries (LMICs) with substantial underreporting of COVID-19 deaths.

Fortunately, vaccines for COVID-19 have been developed quickly, protecting against severe disease and hospitalisation. I still remember discussing this with my father before he contracted COVID-19 at the end of 2020, just when the announcements of new vaccines were being made, and just before he tested positive. Sadly, he didn’t receive the vaccine in time, and never a day goes by that I wish he could have received his vaccine earlier.

The United Kingdom’s (UK) vaccination programme is considered very successful now. Like many high-income countries (HICs), we are fortunate to have an abundance of vaccines, administered in a timely manner. Without it, our hospitalisations and deaths would have been far worse. Not to mention, all the economic consequences of COVID-19 on the country, on families, and livelihoods. But I can’t help but wonder how many people feel like I do, that they were unable to save their loved ones? Despite vaccines being manufactured at a phenomenal scale, LMICs still can’t access them. By March 2021, high- and upper-middle-income countries had already secured 6 billion doses, compared to the 2.6 billion doses reserved for LMICs. This is particularly disproportionate with the fact that HICs and upper-middle-income countries constitute only one fifth of the global population. 

Inequitable vaccine distribution is leaving millions, if not billions, of people vulnerable to COVID-19. This allows for the emergence of deadly variants, which can spread globally and cause critical socioeconomic impact. An alarming eight out of ten people pushed into poverty by the pandemic will be living in the poorest countries in 2030—the majority in Africa, according to the United Nations Development Programme (UNDP). Reports of “vaccine hoarding” by HICs also remains a fundamental issue; as of November 2021, only 6.5% of people have been vaccinated with their first dose in LMICs versus 65% in HICs.

In addition, HICs only need to increase their average healthcare spending on vaccines by 0.8% compared to 56.6% for LMICs to cover 70% of their population—a stark difference. Without global financial support, many LMICs will be unable to vaccinate sufficient population numbers. Organisations like COVAX have been set up to deliver better COVID-19 testing, treatment, and vaccines in LMICs, but unfortunately these efforts only tackle a few of the challenges. Delivering vaccines to countries is only one obstacle; being able to administer these vaccines on the ground to communities with poorly resourced healthcare is another obstacle altogether. Needless to say, this remains a challenge that also affects certain underserved communities in HICs. We must do better in overcoming these hurdles and making vaccine availability equal to all. 

As the United Nations quotes, “no matter how rich or how poor, an infectious disease like COVID-19 will remain a threat globally, as long as it exists anywhere in the world”. We must therefore tackle this pandemic with a united global effort—enabling good healthcare, provision of affordable essential medicines, and availability of vaccines for the protection of everyone.