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The race by governments to develop and procure vaccines to limit the spread of COVID19 has become a major social and economic challenge across the world. Safe COVID-19 vaccines will provide effective prevention and protection of individuals and communities such as frontline workers, including healthcare professionals but also certain population groups whose health conditions make them greatly vulnerable to COVID-19 and its devastating effects. At the same time, limiting the virus’ spread contributes to lessening the social and economic impact of the pandemic, which has disproportionately affected the most vulnerable. 

As part of its response to the pandemic, “Vulnerable socioeconomic groups and other groups at higher risk” have been identified as “possible priority groups” together with frontline workers within the EU Vaccines Strategy presented in June 2020 by the European Commission. This political attention can be considered as a positive step towards vaccine equity; however, the lower availability of the COVID-19 vaccine in EU Member States pushes national policy makers to make choices which are not always equitable.

Health and social divides are long-standing and complex issues observed in EU Member States demonstrating the difficulties in achieving health equity and social fairness. Such inequalities continue to be observed in COVID-19 vaccination and the process of prioritisation at national level. Evidence shows persistent health disparities among homeless people, prisoners, refugees and asylum seekers, undocumented migrants, sex workers, people using drugs, people with disabilities, Roma population, LGBTQI+. The recent Marmot Review has shown a link between health inequalities and increased risk from COVID-19 highlighting the need for better protection of vulnerable groups. Nevertheless, equal access to prevention, including COVID-19 vaccines might not be ensured for many of those individuals and communities who are already struggling to access healthcare and prevention service and in most of the cases they do not belong  to the priority groups who will get the vaccine first.

Severe barriers for accessing healthcare and prevention include poverty and social exclusion reducing communities’ capacities to afford healthcare; discrimination and lower human rights protection of marginalized groups; forced evictions and homelessness are and these might impact further the vaccination process. A new report foresees, for example, some the ways the Roma community might be specifically affected as the vaccines are rolled out across Europe.

Similarly, COVID-19 vaccine inequalities can be observed across the world between wealthier and low income countries, with the World Health Organization highlighting the consequences of such disparities on global health equity. The economic benefits generated by COVID-19 vaccines have also become a source of inequalities in vaccine procurement across the WHO European Region, reducing the doses available in low income countries, which then have to deploy significant resources to afford and secure a sufficient number of vaccines to protect their populations.

A similar social and health divide can be observed between regions within European countries, raising further obstacles for ensuring effective COVID-19 vaccination and limiting the virus spread. The lack of sufficient doses of the vaccine, the specific conditions of vaccine storage, which in some cases require very low temperatures and the procurement of adequate equipment might further reduce the vaccine availability in regions with higher poverty rates and places experiencing health workforce deficit. Also, it may take a long time until sufficient doses are available for massive vaccination against COVID-19. Meanwhile, these regions have to deal with the pandemic outbreaks, creating further financial strains on their public health systems, further exacerbating health inequalities.  

The pandemic has taught us harsh lessons about the impact of health and social inequalities and we should not forget how fragile our societies can be. Equitable distribution of COVID-19 vaccines is not only a public health challenge, but also a solidarity test for policy and decision makers. Guaranteeing equal access to COVID-19 vaccines regardless of social, administrative or legal status is of utmost importance for ensuring effective prevention within countries but it requires strong political commitment to invest in vulnerable groups and their access to healthcare and prevention services. Similarly, equitable distribution of vaccine doses between rich and low incomes countries needs policy efforts, including cooperation to reduce inequalities and advance health equity.