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The COVID-19 pandemic is being prolonged by a “scandalous inequity” in which wealthy countries are vaccinating children and other low-risk groups at the expense of front-line health workers in poorer countries, the head of the World Health Organization has warned.

“There is no diplomatic way to say it: A small group of countries that make and buy the majority of the world’s vaccines control the fate of the rest of the world,” WHO Director-General Tedros Adhanom Ghebreyesus told the annual assembly of delegates from the agency’s 194 member states.

Last week, low-income countries in Africa and elsewhere were hit with disastrous news when they learned that the world’s biggest vaccine maker, the Serum Institute of India, would suspend all exports until the end of the year at the earliest.

The Serum Institute has been the largest supplier of vaccines to the COVAX program, the main source of vaccines for the world’s poorest countries. But the manufacturer says it must focus on domestic needs in hard-hit India for the rest of this year.

In Africa, less than 2 per cent of the population has received even a single dose of any COVID-19 vaccine so far, compared to Canada where more than 50 per cent of the population has received at least one.

More than three-quarters of the world’s vaccines have been administered in just 10 countries, Dr. Tedros told the World Health Assembly on Monday.

“The number of doses administered globally so far would have been enough to cover all health workers and older people, if they had been distributed equitably,” the WHO Director-General said.

“We could have been in a much better situation,” he said. “Countries that vaccinate children and other low-risk groups now do so at the expense of health workers and high-risk groups in other countries. That’s the reality. ... The ongoing vaccine crisis is a scandalous inequity that is perpetuating the pandemic.”

While the COVAX program has delivered 72 million vaccine doses this year, those doses are sufficient for barely 1 per cent of the population in the countries that received the shipments, Dr. Tedros said.

The world remains in a “very dangerous situation,” with the number of COVID-19 deaths this year now projected to overtake the total number from all of last year within the next three weeks, he said.

Dr. Tedros called on vaccine manufacturers to allocate half of their production to COVAX for the rest of this year, or to give COVAX the first right of refusal on their new supplies.

“And we need every country that receives vaccines to use them as quickly as possible,” he said. “No dose can lay idle, or worse, be thrown away.”

United Nations Secretary-General Antonio Guterres told the assembly that the “two-speed global response” will not work.

“Sadly, unless we act now, we face a situation in which rich countries vaccinate the majority of their people and open their economies, while the virus continues to cause deep suffering by circling and mutating in the poorest countries,” Mr. Guterres said.

“Further spikes and surges could claim hundreds of thousands of lives and slow the global economic recovery,” he said. “COVID-19 cannot be beaten one country at a time.”

Officially, the virus has killed more than 3.4 million people worldwide. But a new assessment by the WHO, released last week, concluded the true number of deaths is at least two or three times higher, based on estimates of excess mortality.

Dr. Tedros announced two new goals for the health agency’s member states: He wants at least 10 per cent of the population of every country in the world to be vaccinated by September, and 30 per cent to be vaccinated by the end of the year.

This will require at least a further 250 million people to be vaccinated in low-income and middle-income countries over the next four months.

“This is crucial to stop severe disease and death, keep our health workers safe and reopen our societies and economies,” he said.

To reach this goal, vaccine manufacturing will have to be substantially boosted, with producers sharing their licences and technology, he said. “I find it difficult to understand why this has not happened yet.”

He supported a proposal at the World Trade Organization for a temporary waiver on patents on COVID-19 products, including vaccines.

“Ultimately, the pandemic has shown clearly that in an emergency, low- and lower-middle-income countries cannot rely on imports from vaccine-producing countries.”

South African President Cyril Ramaphosa, one of the two original sponsors of the patent waiver plan at the WTO, told the health assembly that there is a “huge divide” in access to vaccines globally, with billions of people in poorer countries still vulnerable to disease and death as they wait for vaccines.

“We all need to work together to correct this,” he said. “This is not only a moral imperative. Effective and comprehensive global vaccination is vital to ending the pandemic. None of us can hope to be safe unless we are all safe.”

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