In the forests of Jambi Province, on the Indonesian island of Sumatra, more than half the indigenous Orang Rimba community lacks government-issued identification cards. Until mid-August, that meant its members could not receive COVID-19 vaccines, since the government required anyone seeking a dose to have a state-issued ID number. Even now that the rule has been changed, many Orang Rimba have not had a chance to get a shot, because like most indigenous people in Indonesia, they live in a remote area, hours away from the nearest vaccination site.

Such barriers have impeded vaccine access for indigenous communities across Indonesia. According to Rukka Sombolinggi, the secretary-general of the Indigenous Peoples Alliance of the Archipelago, just 20,000 of Indonesia’s 20 million indigenous people—or 0.1 percent—had received their first dose of a COVID-19 vaccine as of August 4.

By contrast, more than one-third of Indonesia’s general population has received at least one dose, and the government is distributing nearly 1.5 million doses each day. This tremendous progress has been mirrored in many other developing countries that initially struggled to source vaccines from wealthier nations. Yet the progress has obscured a disturbing global trend: marginalized groups, including indigenous people, people of African descent, and people with disabilities, have been last in line to get inoculated everywhere in the world.

Simply increasing the global supply of doses cannot ensure equal access to vaccines, either between or within countries. Governments and international organizations must therefore work together with donors, civil society groups, and local leaders to ensure that vaccines make their way to marginalized communities. Otherwise, millions of vulnerable people will remain unvaccinated—and the whole world will remain at risk.

INTERNAL INEQUITIES

Calls to address vaccine inequity have abounded since the first COVID-19 vaccines hit the market late last year, and the world has a long way to go to ensure equitable global vaccine production, pricing, and distribution. Gaps between rich and poor countries have been slow to close. Yet thanks in part to the tireless advocacy of philanthropists and civil society leaders, vaccines are starting to reach developing countries in meaningful quantities. There is now hope where there was none before.

But getting doses to low- and middle-income countries is only half the battle. After months of waiting in line behind rich countries to secure vaccine supplies, many developing countries are now struggling to address internal vaccine inequities—in particular, between affluent urban populations and rural, often marginalized ones. The disparities stem from a series of cascading inequalities that have only intensified over the course of the pandemic. Misinformation has spread like wildfire over social media, discouraging many marginalized populations from seeking vaccines. Unemployment and economic hardship have widened the gaps between rich and poor. And already struggling civil society organizations, so often the main bridge between government services and marginalized communities, are stretched thinner than ever.

Simply increasing the global supply of doses cannot ensure equal access to vaccines.

Consider Colombia, where armed groups and criminal networks have flourished during the pandemic, threatening the local leaders and organizations that are vital to public health outreach. Especially in areas where the state has a minimal presence, such as those that are home to indigenous and Afro-descendant communities, armed groups have seriously disrupted vaccine distribution by impeding the access of public health officials and restricting the flow of necessary supplies. Making matters worse, the crisis in neighboring Venezuela has pushed the number of Venezuelan migrants in Colombia up to nearly 1.8 million, putting additional pressure on the already fragile health system and complicating vaccine distribution plans.

As of October, approximately 40 percent of Colombia’s population was fully vaccinated, and more than half the residents of major cities—63 percent in the capital of Bogotá—had received at least one dose. But in areas of the country that are home to predominantly Afro-descendant and indigenous communities, those percentages are cut nearly in half. In the heavily Afro-Colombian northwestern territory of Chocó, for instance, only about 26 percent of the population is fully vaccinated.

To address these inequalities and to speed the pace of global recovery, the world needs an equitable distribution plan, one that coordinates the efforts of governments, international organizations, donors, and local communities to deploy urgently needed resources and infrastructure. One country that has made significant progress on equitable distribution and that might serve as a model is South Africa, which was slow to roll out vaccines (thanks in part to hoarding by rich countries) but is now doing so faster than most low- and middle-income countries. South Africa’s public health officials and civil society organizations have found a variety of creative solutions to reach the country’s remotest populations, including setting up health-care hubs and vaccine pop-up sites in rural areas to meet people where they are. The government has even dispatched a “vaccine train” stocked with hundreds of thousands of doses to villages across the country.

GLOBAL ASSISTANCE, LOCAL SOLUTIONS

Of course, not every country can or should field a vaccine train—especially those without adequate rail lines—but the international community should help all countries overcome disparities in vaccine access. The most effective solutions are usually ones that are tailored to local conditions. That said, three overarching principles apply to every successful vaccine-distribution model—and to the infrastructure that supports it.

First, efforts should be locally driven and community oriented. Time and again, top-down solutions have failed to meaningfully alter human behavior or bring about lasting change. Donors and international civil society organizations should therefore leverage partnerships with groups that already have deep roots in marginalized communities and empower local leaders to create solutions based on their lived experience.

For example, the Kenyan nonprofit Shining Hope for Communities, which has a long track record of working in informal settlements (including with grants from the Ford Foundation, where I serve as president), has helped curb rampant misinformation about COVID-19 by disseminating public health information through trusted local leaders. Building on their established relationships with local communities, these leaders are disrupting social media conspiracies and educating their neighbors about the importance of vaccines.

The only way to prevent another pandemic is to strengthen public health infrastructure across the developing world.

Second, improving vaccine equity requires removing barriers between people and shots. Here, civil society organizations and other watchdog groups have a vital role to play in monitoring local, national, and international officials—and calling out disparities and discrimination. By fully funding these groups, international donors can help them reduce barriers—such as registration requirements—to vaccinating marginalized communities. The Indigenous Peoples Alliance of the Archipelago and the Indonesian Women with Disability Association, both partners of the Ford Foundation, are doing exactly that. In late July, they collaborated with over 200 Indonesian civil society groups to advocate for the rights of indigenous Indonesians and Indonesians with disabilities. It was in response to their public pressure campaign that the government began to offer alternatives to the identity card requirement, which had previously barred so many marginalized communities from seeking vaccination.

Finally, and perhaps most important, international institutions such as the United Nations and the G-20 must support local efforts. These institutions have the power to identify new solutions, scale up proven ones, and support the governments of low- and middle-income countries as they create equitable rollout plans. International institutions must use every tool at their disposal to speed this process along, freeing up governments across the developing world of the need to fight for doses so that they can focus their resources and energy on tackling distribution. By applying local knowledge and solutions on a global scale, international organizations can act as partners to civil society groups and nonprofits, ushering in a more cohesive era of vaccine diplomacy and collective action.

Taken together, these steps will transform the way the world distributes lifesaving public goods, replacing the prevailing top-down model with grassroots ones. Ultimately, the only way to prevent another global pandemic the magnitude of COVID-19 is to strengthen the public health infrastructure across the developing world, especially in communities that have long been neglected, exploited, and oppressed. Inequality must be tackled head-on—not only because morality demands it but because public health and safety do, as well.

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