Often, I asked myself in the past -- were pandemics real? Did these pandemics sweep away such a large number of lives? While studying public health issues in my nursing course about three decades back, I witnessed outbreaks of communicable diseases in specific districts such as Chitwan and Jumla. I also saw them while working at respective district hospitals as a Nurse. On 11 March 2020, the WHO declared COVID-19 as a pandemic, which brought us illness, hospitalizations and deaths unprecedented in our lifetime and also revealed tragic inequitiesin access to healthcare which was beyond the imagination of many of us. The devastating impact has been not only in health, but also economic and political at local, national, regional and global levels. Fortunately, the vaccines invented in such a short period of time brings hope and relief across the globe. However, the uneven distribution of life-saving vaccines raises worrisome concerns, among all of us due to the apparent inequalities among cultural and national power relationships separating peoples, communities, and countries – often referred to as the global north and south. The inequality of vaccine distribution reflects the underlying discriminatory reality.Additionally, vaccine inequityraises the alarming question of whether it is possible to efficiently fight the COVID -19 virus and its variants all around the globe.

It’s very simple to observe that vaccine penetration has significance to all sectors of the society. Particularly, vaccines allow for the reversal of all policies put in place to control the spread of COVID-19, such as travel restrictions, lockdown, social distancing, wearing masks, shifting healthcare resources to handle COVID-19 responses, curfews, etc. But the unequal access to vaccines and healthcare services by all members of society clearly provides another example of discrimination and violence against girls, women, marginalized groups, persons with disabilities, low or unpaid care workers, elders, children, people living with HIV and so on who are last in line to get access to vaccination. To correct this, the equitable distribution of vaccines at local, national, regional and global levels is urgent and more important than ever now that the COVID-19 pandemic is still in full force due to the emergence of so many variants. Our world needs to be seen as one inseparable entity.

Despite acknowledgement of the magnitude of the COVID-19 pandemic and its impacts, inequities in vaccine distribution is also providing clear evidence of unequal distribution of wealth and power before, during and after the COVID-19 outbreak. The impacts of this spreads in circular ways to all sectors and levels of society, politics and economics.

In mid-2022, the WHO set the target of 70 % vaccination across the globe irrespective of global north or global south. Practically, irrespective to country or global north or south, a virus like has the capability to infect the people anywhere the world until its eradication. Social status or wealth could not save an individual from catching the COVID-19 virus. Ethically, as a member of the planet, every individual deserved equal access to the life-saving vaccine. However, as of July 20, 2022, the United Nation’s Global Dashboard for Vaccine Equity revealed that the high income countries vaccinated 72.38% (3 in 4 people) of its citizens, whereas the low income countries vaccinated only 20.42% (1 in 5 people) - https://data.undp.org/vaccine-equity/

Of this 20%, women and marginalized populations had no access to vaccination and remain the most vulnerable for infection by COVID-19. This raises the most serious and urgent concerns for gender equality and justice. The statistics should serve to urge the global leadership to address such inequity and unveil the economic impacts. As projected by the International Monetary Fund, the economic loss due to the COVID-19 and its consequences will be $13.8tn in between 2020 to 2024.

At the global level, vaccine inequityis attributed to the limited production and distribution capacity, branding, supply, affordabilityand deployment included health systems, supply chains, data infrastructure, and human resources among the countries and within countries. In reality, a main factor of vaccine inequityis often ignored or overlooked.

Differences between males and females are not only due to gender, but also due to genetics, immunological capacity, microbiota and lifestyles and roles that impact health in many ways at macro and micro levels. This is important because the impact of COVID-19 has been different between men and women and gender minorities, who are evidencing an increase in gender based violence, mental health issues, and economic burden from unpaid domestic and community care work. Additionally, the psychological issues caused by a reluctance of some people or religions towards vaccines, including the myths, rumors towards safety and efficacy, impacts the less educated members of societies. Such issues have greater impact on the women and other marginalized communities, who have been historically deprived of higher education and opportunities for economic advancement. As a result, they less likely to get vaccine than men -- especially in global south. Cumulatively, in a gender stereotyped culture, women are less likely to get vaccinated due to preexisting roles and barriers. For instance women struggled and still struggle to get accurate informationregarding the location of vaccination centers to be able to arrange for the time and means of transportation to reach them. CARE’s revealed that women’s lack of mobility reduced access to COVID-19 vaccines by 41%.

If such conditions continue, they will impact create higher risks of infection for everyone because these population increase the spread of COVID-19 and new variants. Most importantly, inadequate national health systems, fragile, unstable politics associated with pre-existing status of health, education and civic education are equally contributing to vaccine inequity.

Now is the time to rethink and overhaul strategies for the production, supply, affordability and deployment of life-saving medications. Vaccine equity is not possible without having accurate and updated gender-specific data of population, data trackers and reporting on access to healthcare responses including vaccines. The data will confirm studies showing that vaccines have different impacts on children, elders, menstruators with peri-menopause or menopause symptoms or disabilities or people with HIV. For this, equal recruitment of all sexes and community members in developing a research plan and policies for vaccine and healthcareaccess and distribution of vaccines deserves the highest consideration.Inclusion of the woman’s point of view is critical to compiling and assessing the information about COVID-19, vaccine policy, technology, manufacture and waiver of intellectual property, and access. These issues are urgent to advance understanding of pandemics, and also critical to fulfill the 2030 agenda mission:`no one left behind’.

The measures discussed above are only possible with political will and commitment at both global, regional, national and local level.Advocacy for vaccine equity from the grassroots and up is clearly a first step to make sure these issues are prioritized.