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Stan Houston is professor emeritus in the Faculty of Medicine and Dentistry & School of Public Health at University of Alberta. Stephanie Yanow is a professor of global health at the University of Alberta’s School of Public Health.

The prevalence of COVID-19 in low- and middle-income countries as a result of vaccine inequity is not a problem that high-income countries can ignore.

It’s not only a humanitarian emergency, but also an epidemiologic priority, since populations with uncontrolled infection are the likely source of future COVID variants. In that context, Canada can and should do much more to increase vaccine coverage in these parts of the world.

The impact of the pandemic on many low- and middle-income countries has been devastating. For example, despite having fewer elderly citizens and lower rates of such risk factors as obesity and diabetes, Bolivia and Lesotho are among the five countries in the world with the highest per-capita rates of COVID-related excess mortality, according to a recent article in The Lancet.

Many low-income countries also have limited resources that are necessary to provide care to COVID-19 patients, including supplies of oxygen. Moreover, the pandemic’s disruption of often fragile health systems has affected core services such as childhood vaccination and tuberculosis treatment.

The Omicron variant, which has spread explosively and challenged health systems worldwide, was first seen in southern Africa. Continued high levels of viral circulation in under-vaccinated populations is the most likely source of the next global variant, which will inevitably reach Canada with unpredictable but potentially serious results.

While Canada implemented a relatively swift and effective national vaccine rollout and is (appropriately) recommending third and now fourth doses, only about 15 per cent of the population of the world’s poorest countries have received a single dose.

Though Canada has made significant pledges to provide vaccines to low- and middle-income countries, it has completed relatively few deliveries. While we secured the most doses per capita of any country in the world, we only just passed the mark of 15 million doses delivered by COVAX, the worldwide vaccine-distribution mechanism. That means we can only show the receipts for less than 8 per cent of our promise to provide 200 million doses by the end of the year.

The vaccine-delivery challenges faced by low-income countries do not end when a vaccine shipment arrives at the airport. Supply management, meeting specialized storage requirements and vaccine distribution, along with education and training of health care staff, are less glamorous but nonetheless critical areas where Canada should continue to have a major role.

With federal funding support, Canadian scientists have contributed significantly to the development of new diagnostics, therapeutics and vaccines against COVID-19. For example, researchers at the University of British Columbia played a key role in the development of the nanoparticle technology that is central to the mRNA vaccines. COVID-19 has reminded us of the need to retain these skills and strengthen our vaccine-related capacity.

On the other hand, Canada has failed to promote constructive policies around the rules governing access to vaccine technology in international forums such as the World Trade Organization. We even undermined the COVAX process by cutting a bilateral deal with an Indian supplier contrary to the specific request of the World Health Organization.

Canada has a long history of investing in global health, and that needs to continue with this pandemic. A clear demonstration of Canadian leadership in promoting health equity and curbing the impact of the pandemic globally and here at home is overdue. As the Canadian government has repeatedly stated, this crisis isn’t over anywhere until it is over everywhere. It is time we backed up words with the requisite action.

So, what are the lessons we should learn in relation to the COVID-19 pandemic and future infectious-disease health emergencies?

Canada must strengthen and support our vaccine-related capacity, from basic science to vaccine production. When vaccines are developed with public funding, we must be able to ensure that those vaccines can be made available to the broader global public at a price that prioritizes public health over private dividends. We need to maintain and expand support for the critical program elements of vaccine storage and distribution in countries with limited infrastructure.

Last but not least, Canada must have the courage to support changes to the international regime that empower low- and middle-income countries to contribute to their own vaccine requirements, despite objections on the part of the pharmaceutical industry.

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