A fair and equitable allocation of safe and effective COVID-19 vaccines contributes to social and health equity and is an opportunity to reduce long standing social disparities in Europe.
As current manufacturing and supply challenges undermine the success of the EU joint procurement initiative of COVID-19 vaccines (also known as the EU Vaccines Strategy) and complicate the vaccine rollout across the Union, the prioritization of groups for vaccination within countries while supply is limited becomes ever more important.
This is the time for national governments and the European Commission to ensure that EU guidelines and national COVID-19 vaccination plans turn equitable access to vaccination into a tangible reality for all in Europe. This will be achieved by firstly acknowledging, including and prioritizing persons with physical and learning disabilities, mental health problems, refugees and asylum seekers, (undocumented) migrants, people experiencing homelessness, living in poverty, people with addiction, prisoners and minorities (including Roma).
Public health means protection of the population as a whole and health for all. It is not only a question of fairness, but also failure to vaccinate certain social groups, who are often more susceptible because of pre-existing health conditions or their living environment, has repercussions for the rest of the community. Nevertheless, many of these groups lack proper documentation and remain invisible in the eyes of public administrations in many parts of Europe. This is at the core of the problem as well as a ticking bomb for the handling of the pandemic itself. Digital tools can help governments overcome the problem of identification barriers and ensure that vaccines reach marginalized populations.
There is growing political recognition that the prioritization of marginalized groups deserves attention. Interim guidance by the UK’s Joint Committee on Vaccination and Immunisation notes that allocation programmes “will need to ensure every effort is made to get good coverage in black, Asian and minority ethnic (BAME) groups. Vulnerable groups and the difficulties they face are mentioned under three broad priority groups “vulnerable population due to chronic diseases, co-morbidities and other underlying conditions,” “communities unable to physically distance,” “vulnerable socioeconomic groups and other groups at higher risk” in the October 2020 Communication from the Commission with guidelines for COVID-19 vaccination strategies and vaccine deployment in EU countries.
The recent ECDC guidelines are a step in the right direction because national authorities are indeed encouraged to prioritise disadvantaged groups. On a similar note, the Council of Europe came up with a list of actionable recommendations on access and uptake of vaccines.
These are all welcome developments but they are not enough. More needs to be done as the reality on the ground for worse-off groups is much harsher than for the rest of society. To start with, the uptake of these vaccines is a key issue.
Appropriate education and information awareness campaigns are necessary to counter vaccine hesitancy and boost confidence in immunization programmes. These would need to be tailored to the specificities of these groups. The EU needs to facilitate and enable the exchange of best practices (in terms of national vaccination plans prioritizing vulnerable groups) amongst Member States to feed into practical strategies that promote equity. Moreover, Member States need to proactively reach out to these groups. To this end, civil society groups can work with national authorities to reach these population groups and administer the vaccines. A joining of forces will be conducive to developing the right educational messages to build trust in partnership with local communities to fight misinformation and disinformation. These populations need to have access to information about their entitlements and benefits including available vaccine programmes and how they can access them. This is all more important. In light of ongoing discussions on how to best use the (for now) still limited vaccine doses available by tweaking dosing schedules in a bid to get as many people vaccinated as possible.
To sum up, it is important to recall that the WHO framework urges that unjust disparities should be reduced when allocating vaccines and in the words of WHO Regional Director for Europe Hans Kluge “the promise of a vaccine is great but its full potential will not be realized without strong preparedness and community acceptance.”