Science and need – not wealth or nationality – should guide vaccine allocation and prioritization, experts say – ScienceDaily

Ensuring access to the COVID-19 vaccine for refugee and displaced populations and addressing health inequalities is essential for an effective response to the pandemic. Yet vaccine allocation and distribution has been neither equitable nor inclusive, although world leaders have stressed this is a critical aspect of overcoming the pandemic globally, according to an article. published by Columbia University Mailman School of Public Health. Read “Leaving no one behind: ensuring access to COVID-19 vaccines for refugees and displaced populations” in the newspaper Nature medicine.

As of April 1, high- and upper-middle-income countries were receiving 86 percent of vaccine doses delivered globally, while only 0.1 percent of doses had been delivered in low-income countries. Globally, more than 80 percent of refugees and nearly all internally displaced people are hosted in low- and middle-income countries – countries bottom line for COVID-19 vaccine doses.

“As the world grapples with supply challenges and inequitable access to vaccines locally and globally, marginalized groups, especially refugees, internally displaced persons and stateless persons, face a double access burden, even in countries themselves marginalized on the global stage, ”said Monette Zard, MA, Allan Rosenfield, associate professor of forced migration and health and director of the forced migration and health program at Columbia Mailman School. “Legal status should not have a place in decisions about access to vaccines, and relying on regularization as a route of vaccination will unacceptably delay the protective effects for migrants and refugees, especially in high risk groups. “

In fragile contexts with weak governance, competition for scarce COVID-19 vaccines can exacerbate tensions and exacerbate conflict, while uneven access increases the prospect of people displacing in order to access vaccines that are not available in their country or region, according to the authors. .

The COVAX facility allocates around 5% of the total vaccine doses available for humanitarian use, including vaccination of refugees, but the 2 billion vaccine doses targeted by the end of 2021 will only cover 20% at most. populations of participating countries. Poorer countries may not be able to widely immunize their populations until 2023.

To create an equitable and inclusive COVID-19 vaccination strategy, Zard and his co-authors believe that lessons can also be learned from the experience of managing conditions such as HIV and TB among mobile populations, as well as previous large-scale vaccination campaigns in humanitarian settings. They highlight how the global community is addressing the COVID-19 vaccination can further reinforce the inequalities and mistrust experienced by refugees and displaced populations around the world or is a chance to build stronger and more just health systems that are better prepared to respond to COVID-19 and future health emergencies. “Involve, listen and mobilize trusted community and religious leaders – it is vital to involve the community, including displaced populations, in immunization activities,” Zard noted.

“Decision-makers must seize the opportunity of the pandemic to strengthen health systems in a broader and more sustainable way, in order to better respond to the challenges of COVID-19, while meeting the overall health needs of refugees and host populations”, observes one of the authors S Patrick Kachur, MD, professor of population and family health at Columbia Mailman School. “As the world faces one of the most daunting public health challenges in recent history, how we respond today will not only determine the course of this pandemic, but also who will benefit from the progress of the disease. public health for years to come. “

The co-authors are: Ling San Lau, Goleen Samari, Rachel Moresky, Mhd Nour Audi and Claire Greene, Program on Forced Migration and Health, Columbia Mailman School; Diana M. Bowser and Donald Shepard, Brandeis University; Fouad M. Fouad, American University of Beirut; Diego Lucumí and Arturo Harker, Universidad de los Andes; and Wu Zeng, Georgetown University.

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