The world is on tenterhooks as we all wait for news of a Covid-19 vaccine and a return to some state or ‘normal’ social and economic life. Latest predictions are that a vaccine could be in production in a matter of weeks. But new research from Launch and Scale at Duke University suggests that people in low-income countries will be at the back of the line for vaccines. The study found that richer countries, including the UK, EU and Canada, are negotiating “side deals” for large vaccine shipments, leading to “a smaller piece of the pie available for equitable allocation”. These actions are in contrast to efforts to ensure equitable access to Covid-19 vaccines for low- and middle-income countries through the Gavi Vaccine Alliance. 

Most people in lower-income countries are likely to be waiting until 2024 for Covid-19 vaccinations if wealthy countries continue on this course, the research estimates. As recent CPAN research on the impacts of Covid-19 in Kenya and Nepal shows, economic and social disruptions are already having devastating impacts. Delaying vaccine access in low- and middle-income countries would be a moral outrage.

Life is tough at the best of times for those living in poverty in Nairobi. But we’ve heard first-hand that for many during Covid-19, it has got even worse. The cost of food is so high that family members are being sent back to rural areas. Incomes have been slashed, houses in informal settlements are being demolished by the authorities and police actions are more common than usual.

For one respondent we interviewed, the weekly 1,000 Kenyan shillings (US$9) 'Covid relief' stipend provided by the Kenyan government has been a lifeline. Prior to Covid, Solomon,* a cobbler, could earn 500 shillings a day. Once the pandemic hit and restrictions put in place - this was reduced to only 10s of shillings. Even with financial support, he is down to one meal a day of Ugali and Omena (small fish) and a banana. He is unable to support his children at secondary school in Nairobi, and they don’t have the digital tools to learn online. Solomon has many worries: he may have difficulty paying his rent, his house may be demolished, his children have missed school, customers' shoes are piled up as they have not been able to pay him for repairs. And he is facing all of this alone, as the rising cost of transport means his wife and children cannot easily travel to Nairobi. The 1,000 shillings relief stipend is keeping him going, but Solomon and his family’s struggle is likely to continue without some form of stabilisation in the local economy.  

In Nepal, we’ve heard similar challenges. Respondents tell us that they’ve struggled to find work and have had to borrow from grocery stores, friends and family to survive. We’ve heard heartbreaking stories from persons with disabilities finding it difficult to manage their livelihoods, especially if they have to shoulder the responsibility of taking care of some other member of the family.

Older people are another group being hit hard by the restrictions. One older woman we interviewed is a widow who lives with her sons and grandchildren in a rented house near Kathmandu. They haven’t been able to pay rent since the pandemic began. “We have to pay 17,000 rupees per month for rent including electricity. Since we don't have our own land, we need to buy every item such as rice and, vegetables,” she said. Her household’s income has been severely disrupted. “I have taken a loan to manage my costs… Being the head of the family it is my responsibility to look after my children. In this pandemic, I always try to give nutritious food to the children to boost their immune system”.

Key informants have expressed concerns of relief fatigue as the pandemic draws on. “During the first phase of relief, people in extreme poverty were aided by organisations and the rural municipality, mostly with food items. But the pending budget agreement... and lack of attention from the rural municipality might cause them to suffer in the near future,” says a key informant from Nepal.  

People in Nepal, Kenya and other low-income countries simply cannot wait until 2024 for a return to whatever ‘normalcy’ can be achieved with widespread vaccination. For some, it’s already too late as they’ve already fallen into, or deeper into, poverty. All countries will want to vaccinate their populations as quickly as possible, but equitable distribution is critical, and considerations need to be made for those countries suffering the harshest consequences of the pandemic.

* Interviews were carried out in September in Kibera in two regions in Kenya (Vihiga county and Nairobi) and three regions in Nepal (Banke, Dailekh, Nuwakot and Kathmandu). Names have been changed to preserve anonymity.