Researchers studying communities in 14 low- and middle-income countries (LMIC) and territories found that a combination of undersupply of vaccines and treatments, underfunding of health systems and poor adaptation to local needs, were among the few key drivers behind low vaccination rates.

This report from the People’s Vaccine Alliance, the International Treatment Preparedness Coalition (ITPC) and Matahari Global Solutions, contradicts the allegations from pharmaceutical companies and wealthy countries that people in lower-income countries are vaccine-hesitant, said a note on the report. The countries covered by the study include Bangladesh, Democratic Republic of the Congo, Haiti, Jamaica, Liberia, Madagascar, Nepal, Nigeria, Perú, Senegal, Somalia, Somaliland, Uganda and Ukraine.

The People’s Vaccine Alliance, a global coalition of civil society organisations campaigning for equitable access to Covid vaccines, tests and treatments, described the report as evidence of “systemic racism” in the global Coronavirus response.

According to the report, testing and vaccination sites have been inaccessible, meaning true infection and death rates are likely to be far higher than official figures.

Vaccine supply was still a major problem, with vaccines being delivered inconsistently and in insufficient numbers, leading to stock fluctuations at vaccination sites. “Doses can arrive with little or no notice or information about what kind of vaccine will be delivered or whether they are suitable to conditions in a country,” said the note. Saeed Mohamood from Somaliland’s Ministry of Health is quoted saying: “Sometimes we will find out that the Somaliland shipment is on a plane in the air, en route, and we do not know when it’s going to expire and how much resources we will have.”

Further outlining the hurdles, the report said access to antiviral treatments was non-existent in most countries surveyed. “Health Workers on the ground in some countries are not even aware that treatments like Paxlovid (from Pfizer) exist. Some countries will have access to doses through generics licensing agreements, but that is unlikely to happen this year, meaning the grave inequities experienced with the global vaccine rollout will be repeated with treatments.,” the note said, adding that Peru, among other middle-income countries, is considering overriding patents to secure access.

And even at the time of a pandemic, essential community health workers have often gone unpaid, it added. A clinician in Haiti, Marie Delcarme Petit-Homme, told researchers: “Sometimes doctors and nurses can go 6 months, a year without receiving remuneration. Lower bands have it worse, they don’t really have access to remuneration. Sometimes we are forced to leave the country if we want a better pay.”