The Middle East is a microcosm of this global problem.
The first Arab countries to start vaccinating their citizens and residents were also the richest: Saudi Arabia, the United Arab Emirates, Qatar, Kuwait, Bahrain and Oman.
Regional states affected by the war have no concrete plans to acquire and distribute vaccines, even when international organizations intervene to help.
Arnaud Bernaert, head of the global health and health sectors at the World Economic Forum (WEF), said the world should not be “naive” about these inequalities.
“High-income countries have political and legal reliability, which allows them to organize plans as quickly as possible to protect their populations,” he said. “It will always be like this.”
“[Gulf Arab] countries have smaller populations, larger amounts of funds and strong health systems, so they are in a better position to start their implementation earlier, and that’s a fact, “Dr. Yvan Hutin, director of communicable diseases at the World Health Organization (WHO) Eastern Mediterranean Regional Office said.
“The Middle East is simply categorized by great inequality.”
For non-Arab countries in the Gulf, plagued by poverty, endemic corruption or conflict, vaccination plans are complicated not only by poor management, but by a deep distrust of political leadership.
“You need to have a clear view of the plan [to vaccinate a population], which requires strong governance as well as ability to pay, “Hutin told CNN.” Most countries in the region do not. “
In Lebanon, a ruling elite widely accused of corruption has bled the country’s resources for decades, culminating in a downward financial spiral last year. The medical system was not spared and doubled due to the shortage of medicines and the exodus of health professionals. The Beirut port explosion last August, which damaged some major hospitals, exacerbated what the country’s president called a complete “state of emergency”.
Despite having one of the lowest case numbers in the region in the first months of the pandemic, Lebanon now leads the Arab world in cases per million inhabitants.
Two million doses of the Pfizer / BioNTech vaccine are expected to arrive in early February, but are expected to cover only about 20% of the country’s population. On the streets of Lebanon, few people believe that the deployment is imminent or that it will be conducted safely.
It is a similar story in Iraq and Jordan, countries that are experiencing economic turmoil and where people have regularly protested to demand political reforms.
Jordan’s free Pfizer / BioNTech vaccination program is already underway, but only a very small percentage of the population has signed up to receive it, claiming a lack of trust, according to health officials. In Iraq, only 1.5 million doses of the Pfizer / BioNTech vaccine will be available for its population of 40 million people, despite the country having faced repeated outbreaks of Covid cases last year.
But where governments falter, the international community says it is trying to fill in the gaps. WHO is organizing distribution plans for low- and middle-income countries through programs such as the COVAX alliance, a global initiative with 190 participating nations that aims to work with manufacturers to provide countries around the world with equitable access to vaccines.
Bernaert says he expects a quick launch, despite numerous challenges. “Although there is a delay in vaccinating low-income countries against Covid-19, it will be much shorter than what we have seen in the past,” he said.
Iran and Egypt are the two most populous countries in the region, with Iran with almost 85 million inhabitants and Egypt with more than 100 million – complicating the distribution to two states that have faced economic difficulties in recent years.
Egypt began vaccinating its people, starting with medical workers, with Sinopharm shot on January 24. GAVI, the vaccine alliance that co-leads COVAX, will also supply vaccines to 20% of the population, while the Egyptian government said it has signed a deal with 20 million doses of the AstraZeneca vaccine, covering an additional 10% of the state’s inhabitants North African.
Resisting sanctions imposed by former U.S. President Donald Trump, Iran is the country most affected by the virus in the region. It has had more than 1 million cases and more than 50,000 deaths.
But Iran is the only regional state that claims to have plans to produce its own vaccine. Officials say the country also plans to import nearly 2 million doses from India, Russia and China by the end of the first quarter of 2021. Imported vaccines will barely cover 2% of the population.
Conflict zones with a vague vaccine perspective
In conflict zones in the region, governments are unable to buy their own vaccines, or even distribute them in territories intersected by armed factions and competing spheres of political control. They must rely almost entirely on international organizations to do so.
COVAX has secured nearly 2 billion doses of Covid-19 vaccines to be distributed in all 190 participating countries. But Hutin says that is not enough.
“We would very much like to have more to offer,” he said. “We are working to guarantee more doses, but that is not going to happen tomorrow.”
Syria, already on its knees after almost a decade of civil war, faces an economic crisis. The country’s president, Bashar al-Assad, does not control all of his territory – much of it has been pulled out of his regime by opposition groups during the conflict. The government in Damascus – repeatedly accused of war crimes and human rights abuses – will rely on GAVI, the vaccine alliance that co-leads COVAX. Opposition groups in northeastern Syria, largely Kurdish, and rebel-controlled northwest will do the same.
In war-torn Yemen, which is suffering a devastating humanitarian crisis, rival governments in the south and north of the country seem to have only a vague sense of what the vaccine will be like.
In Israel and the Palestinian territories, vaccine disparities across the region also come into focus. Israel’s world-leading vaccination campaign, which is underway to meet the government’s goal of inoculating the entire country by the end of March, leaves at least 4.5 million Palestinians living in the West Bank and Gaza behind.
According to United Nations experts, an immunization policy that differentiates those with an Israeli identity from those without an identity is “unacceptable”.
A report by a UN expert, published by the United Nations High Commissioner for Human Rights in January, says that Israel is the occupying power in and over Gaza and the West Bank, and has been since 1967, and is therefore ultimately responsible for health care for those living under occupation.
Israel disagrees, pointing to the Oslo agreements, signed in the mid-1990s with the Palestine Liberation Organization, which led to the creation of the Palestinian Authority (PA). Included in the first of these agreements is a clause that makes the PA responsible for the health of all Palestinians under their civilian administration.
Israeli Health Minister Yuli Edelstein told CNN: “If we get to the situation where everyone in the country who wants to be vaccinated is vaccinated, we will be more than ready to share the vaccines with our neighbors.”
Palestinian Authority Health Minister Dr. Mai Al-Kaileh said he hopes to receive the Covid-19 vaccine by the end of March, but there is still no specific date for its arrival. The ministry claims to have contracts with four companies producing the vaccine. These vaccines will cover 70% of the Palestinian population and WHO will provide doses for another 20%, the AP said in a January 9 statement.
‘The beginning of a new era’
According to Hutin, WHO approached rich countries, including those in the Gulf, to share their doses, which they have fulfilled, but which is still a work in progress.
The Abu Dhabi Department of Health has launched a local collaboration called the Hope Consortium, which is expected to deliver 18 billion doses of vaccines worldwide by the end of 2021.
Department undersecretary Jamal Mohamed Al Kabbi told Becky Anderson of CNN that the plan represents a complete supply chain solution to address and facilitate the availability of vaccines worldwide.
Bernaert told CNN that despite the delay in vaccinations in low-income countries, he is more optimistic than he was a few months ago.
“Will we be able to vaccinate everyone in 2021? No, I don’t think so. The vaccination story will continue in 2022 or even in 2023? Yes, I think so. But what we’ve managed to do so far is a sign that we can be in the beginning of a new era. “
CNN’s Mostafa Salem in Abu Dhabi, Aqeel Najm in Baghdad, Eyad Kourdi in Gaziantep, Gul Tuysuz in Istanbul and Andrew Carey, Sam Kiley and Abeer Salman in Jerusalem contributed to this report.