“It is a humanitarian imperative and our shared responsibility to ensure that lives everywhere are protected, not only in the countries that have the means to buy protection.” –ICRC Statement 2021

Morgan Anderson

The first confirmed case of COVID-19 appeared in December 2019, with China providing the genetic sequence globally in January 2020. The global community responded by closing borders, shutting large public areas and enforcing self-isolation in the hopes that the virus could be stopped quickly. The number of cases since December 2019 totals over 446 million cases worldwide as of March 2022. The global community, to combat the virus, invested millions of dollars and months to develop the first COVID-19 vaccine candidates. The first vaccine that was approved for emergency use by the World Health Organization (WHO) was the Pfizer/BioNTech vaccine in December 2020. This emergency approval was an important moment in the global community’s attempt to stop the spread of COVID-19 and mitigate the emergence of new variants. Since the approval of the Pfizer/BioNTech vaccine the WHO has issued Emergency Use Listing (EUL) to ten additional vaccines including Moderna, AstraZeneca, and Sinovac. The first dose of a vaccine was administered in the United Kingdom on 8 December 2020– according to the WHO- with countries such as the United States, Canada and Spain following that same month. The United States had the opportunity to place an order for the Pfizer/BioNTech vaccine before it was approved by the Food and Drug Administration (FDA) or the WHO. This is important because the government was able to manufacture and distribute the vaccine immediately after its approval instead of waiting months like many countries. In contrast to that of the United States or Canada, countries such as Afghanistan, Yemen, South Sudan– active conflict zones– did not administer their first vaccines until February 2021, for Afghanistan, and April 2021, for both Yemen and South Sudan, respectively. The discrepancy in the time it took to administer a vaccine in the United States- where there was immediate access- compared to that of Yemen- a country that was already experiencing an active health crisis- exemplifies global vaccine inequality.

 

The International Red Cross and Red Crescent (ICRC) is one of many humanitarian aid organizations that is actively working towards vaccine equality in areas of conflict. This blog will look at the current status of the ICRC’s  progress towards facilitating vaccine distribution and administration in areas of conflict.

The ICRC has been an active participant in aiding countries in conflict with COVID-19 vaccine distribution and administration. There are an estimated 60 million people that reside in an area that is not included in any national vaccination programs. The ICRC has released the steps that they are taking to ensure that those left out the established vaccine programs are given the opportunity. The reason that ensuring that people in conflict areas receive the vaccine is that, as the ICRC stated in a recent press release, “…no one will be safe until everyone is safe.” There is the understanding that without vaccine equality, variants of COVID-19 will continue to mutate in areas with low vaccination rates. The question that arises is how the ICRC will help facilitate immunization programs in conflict areas or for Internally Displaced Persons (IDPs) that will result in an increase in the global vaccination rate.

COVAX allocated vaccines, now what?

COVAX– who’s aim is to accelerate vaccine distribution and manufacturing- in partnership with the WHO and Gavi, the Vaccine Alliance have been allocating vaccine doses to governments. Countries with current conflicts- such as Ethiopia, Yemen, and Afghanistan– have been supplied 39 million, 2.2 million, and 9.2 million doses respectively. The problem that the ICRC and other humanitarian organizations must address is how to efficiently distribute the doses to the clinics. The problems with programs such as COVAX is that it supplies the vaccines to countries but does not offer countries vaccine training, proper refrigeration need for the vaccines and information about combating vaccine hesitancy. This is where organizations such at the ICRC must step in to bridge the gap between the delivery of vaccines and the effective distribution to areas of conflict.

 

What logistic problems does ICRC anticipate?

            Conflict areas, pre-COVID, dealt with poor health conditions, including the lack of adequate healthcare personnel. This has transferred over to the current pandemic, making it increasingly difficult for the ICRC and other NGOs and humanitarian agencies to help facilitate immunization programs efficiently. The ICRC has listed the following as potential complications to logistics:

• Disputed borders
• Travel permission
• Reduced availability of electricity and refrigeration (Pfizer/BioNTech needs to be kept at -70 Celsius)

The ICRC has made it evident that they will use their neutral status in areas of conflict to help facilitate vaccine distribution. International COVID-19 vaccine programs such as COVAX have allocated doses to countries with conflicts, but the allocation of doses is not enough. ICRC -though their established programs and relationship- has stated that they will work to ensure that the doses make it from COVAX to the furthest vaccination clinic.

 

ICRC current COVID-19 vaccine programs  

The ICRC has begun aiding countries in distribution and administration of vaccines in areas of conflict. These country programs include Afghanistan, Myanmar, and Ethiopia where the ICRC has provided refrigeration for vaccines, funding for programs, and distribution logistics. The map below illustrates the global ICRC programs and what role they are playing in that country’s vaccination programs.

These programs range from the ICRC lending support to the country’s national vaccination programs to facilitating the last mile– delivering vaccines and other supplies from local centers to citizens nationwide- and programs that combine aspects of each. The range of ICRC programs is vital to find the right program for each country or conflict area. The ICRC, through previous healthcare programs in conflict areas, have a privileged position and a level of trust built within the communities. ICRC’s work in areas under non-state armed group control in Colombia includes negotiating access for vaccination teams. Programs in Ethiopia have focuses on aiding the Regional Health Bureau (RHB) by supplying refrigerators, Personal Protective Equipment (PPE), and education materials for the community. This type of aid is just as important as the vaccine doses themselves. There are, however, pre-COVID problems that the ICRC will need to address while aiding vaccination programs.

 

Problems ICRC must address     

“What is killing us isn’t coronavirus, but war.” -Local Mali Mayor (source)

The areas of conflict that ICRC vaccination programs are aiding do not necessarily see COVID-19 as their biggest threat. The leading causes of death in conflict areas is not coronavirus, it is chronic disease, malnutrition- to name a few- something the ICRC and other groups must understand while addressing the current global pandemic. The ICRC President made a call for greater vaccine equality and in it he made it a point to express the need to ensure that the health care systems that were previously getting support from the ICRC continue to do so. During that same speech the President also called for strengthening of health systems; COVID-19 vaccine equality cannot be the only goal. The ICRC must address how their COVID-19 vaccine programs can help establish improvements in the health systems past the end of the pandemic.

The other potential problems that the ICRC must address in their vaccine programs plans is the risk that health care professionals and ICRC employees may be at in conflict areas. Humanitarian aid workers have to walk the fine line of not appearing as supporting one side of the conflict over another. This is especially important when ICRC groups are attempting to gain access to  “last-mile” areas. The ICRC understands that there is a risk when entering a conflict area; but they as an organization must do everything possible to mitigate the risk. The threat of vaccination facilities being attacked during a conflict, or the clinic workers being unable to reach the clinic due to on-going conflict is a present danger. The IRCR will need to take into consideration the active conflicts as well as the pre-COVID-19 health crises in the countries.

 

The Importance of Vaccine Equality

The quest for vaccine equality is not just a moral one, it is also a scientific one. The last two years has seen, what has been dubbed, numerous COVID waves. The most recent being Delta, first detected in October 2020 and Omicron in November 2021. The fear is that if people in conflict areas do not receive the vaccine, that new variants may begin to appear that are more dangerous than the ones that have been detected.

Healthcare worker administering COVID-19 Vaccines            

Countries such as the United States, United Kingdom, and Canada –fully vaccinated (two doses) over 65% of the population- are offering a third shot, booster, to the fully vaccinated. The United Kingdom will begin offer a fourth jab in Spring 2022 to those eligible. The populations of Yemen, Afghanistan, and South Sudan- current conflict areas- have a fully vaccinated rate of 11% and under and booster doses have not been offered. While higher income countries have the opportunity to offer three or four doses to its populations, those in lower-income and conflict areas are still trying to get their first dose. The risk of new variants emerging is ever present as evident with the most recent variant Omicron, first reported in November 2021.

 

Questions for the ICRC

• How will programs in conflict areas balance distributing COVID-19 vaccines while still ensuring that previous health related programs will continue un-interrupted?
• Will the ICRC partner with programs such as COVAX to help aid in distributing the vaccines to hard to reach- last mile- communities?
• How is ICRC preparing for the likelihood of emerging variants in areas with a low vaccination rate?
  • What programs have they put in place and how are they preparing their teams and area partners?
• Conflict is every changing- Ukraine as an example- how is the ICRC planning for the inevitable change in political climate, social climate, etc. that comes with conflict.
  • How are you ensuring that funding is not re-routed to conflicts such as Ukraine, so much so that other conflict area programs- Yemen, Myanmar, and Afghanistan- are not reduced in funding, employees, et.?

 

How will this impact future research?

This informational session with the ICRC will be beneficial to both my future career plans, and in the near future, my dissertation research on COVID-19 vaccine inequality. The work that ICRC and other humanitarian aid agencies are doing to combat the inequality will be vital to my research. I hope to be able to gain some background information regarding what the ICRC is doing to balance COVID-19 vaccine programs with the already established health programs. I understand that with COVID-19 the chance of the ICRC’s approach changing numerous times to find the balance, is a possibility. The COVID-19 pandemic is not going to go away without the aid of vaccines and conflict areas are places that have a low vaccine rate, in a world where some countries- United States, United Kingdom, Canada-  are administering their third or fourth doses. The ICRC is not a governmental agency, so no COVID-19 doses are allocated to them specifically; being able to better understand how ICRC, governments, and other agencies find a balance for each situation as to not overstep or perceive to be more supportive of one side of the conflict will be beneficial. This line of questioning would lead into my career aspirations in a humanitarian agency and how they find the balance between aiding the civilians while remaining neutral in the conflict.

 

How will this visit benefit future career goals?

            I hope, on this visit, to have the opportunity to meet with an ICRC employee that has worked on programs in conflict areas. I understand- as a large humanitarian organization- there are numerous programs occurring at once but understanding the how they are balanced would be beneficial. I believe that by visiting the agency and having the opportunity to see how each program is run would help better inform my future decisions regarding career choices. I understand that the ICRC, and the other agencies that will be visited on the trip, are political to some degree; seeing how the balance is struck between humanitarian and political decisions will aid in my future decisions.