“Equity”​ missing from the jargon “Vaccine Equity”​

Sanjeev Neupane

In October 2021, the World Health Organization recommended the widespread use of long awaited malaria vaccine (RTS,S) among children in sub-Saharan Africa and in other regions with moderate to high P. falciparum malaria transmission. The medical and public health fraternity around the world rejoiced the news from WHO. “Enormous step”, “Landmark achievement”, “Groundbreaking victory” or “Historical gain” whatever phrase you use it’s not enough to express in words about one of the greatest conquests in the field of medicine and public health.

But as a public health enthusiast I was haunted by some potent questions rather than being excited about the news: “Why did it take so many years for development of vaccine for a century old disease?” “Why WHO took so many years for its approval?” “Why does one disease which is just 2 years old like COVID-19 has 12 vaccine candidates and another disease (eg Malaria) that is centuries old has only one vaccine?” “Would the situation be same if malaria was occurring only in America & Europe and COVID-19 was occurring only in Asia and Africa?” “What actually drives the development of vaccine?”

Of course as a science student the most common and ubiquitous answer for all questions above would be “it all depends on the biology of the organism. The more complex the life-cycle (or the biology) of the parasite, more difficult it would be to develop the vaccine and more simple the life-cycle of the organism easier to develop the vaccine”. Technically it’s true and on superficial thinking it sounds convincing. But it’s not what it looks like. If we delve more and dissect the sociopolitical and economical dimensions of vaccine development we find different picture.

Let’s compare COVID-19 and Malaria. The first cases of COVID-19 was confirmed by WHO in China on Dec 2019. Currently there are 12 vaccine candidates against COVID-19 that have already been granted Emergency Use Listing by WHO . Similarly there are 171 vaccines in clinical development stage and 198 vaccines in pre-clinical development stage against COVID-19. When was the first Malaria case recorded in the World? ….It was in 1880. A French army doctor named Alphonse Laveran described the malarial parasite and proposed that it causes malaria in 1880. And what do we have against malaria in all these years? Only one vaccine candidate. Is there any logical answer to describe this discrepancy? Should we simply believe that “oh it’s very difficult to develop malaria vaccine because of the complex life cycle of the parasite”. Or do we simply believe in notion that malaria is endemic in some parts of the world and COVID-19 is pandemic. So we have only one candidate against malaria and many against COVID-19. If that is the case then “isn’t it time to change the old school definitions of endemic and pandemic?.”

When we talk about COVID-19, we love saying “No one is safe until everyone is safe”. But doesn’t this apply to malaria and many other neglected tropical disease?. “Vaccine equity” why does this apply only to the COVID-19 vaccine? Has anyone ever talked about vaccine equity by relating it with the malaria vaccine?

We have always been taught that developing and approving a vaccine for mass usage takes many years as it has to go through a rigorous scientific process, it has to go through many stages and evaluations. But does this apply only to the diseases that affect poor people or does it apply to all diseases. In COVID-19 the first vaccine candidate was available for use even less than a year since the appearance of first case. Why so? Because COVID-19 vaccine was on the top of every country’s wish list. The developed country were ready to pay any price to provide jab to its citizen. For pharmaceutical industry it was the most profitable business. But what about malaria vaccine? The developed country won’t buy it, the people who need it won’t have enough money to pay for these vaccines out of their pocket and the government of those countries that need to provide this vaccine to its citizens won’t bother buying these vaccines because they have many other issues to settle. So the end result is it’s not a profitable business for Pharma industry. To put in a simple way it’s nothing but a profitable business based on the basic economic principle of demand and supply. But we are compelled to ignore this basic fact and fooled by adding the epidemiological jargons and relating this with complex life cycle of parasite, long process and stages of clinical trials etc.

The COVID-19 pandemic has given chance to reflect on many aspects including the health systems around the country. Everyone in the public health field these days seems to be obsessed with the lofty terminologies like “Resilience”, “Equity”, “Equality”, “Endemic”, “Pandemic”, “Clinical Trials”, “People’s vaccine” “Vaccine Equity” etc  and seems to be using them blatantly. The COVID-19 pandemic has revealed that many of the terminologies that we were taught in the public health schools are not valid these days. Time to revive the whole epidemiology text books and change these definitions or use them correctly.

Sanjeev Neupane

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