By Rupal Ramesh Shah

Rupal Ramesh Shah

Throughout the course of the pandemic, we have been hearing that everyone is waiting for the vaccines and everyone is eager to receive the vaccines. In the United States, according to the Centers for Disease Control and Prevention (CDC), approximately 2 million shots are administered per day. Recently, the country crossed the threshold of having 10% of the adult population fully vaccinated. The Biden-Harris administration is planning to increase the supply of vaccines, vaccinators, and locations to administer them. The administration has urged states to open up vaccine eligibility to anyone in the country that is 16 years and older by May 1.

COVAX is an effort co-led by Gavi, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization (WHO). The purpose of COVAX is to ensure that there are doses for at least 20% of the countries’ populations and that vaccines are delivered worldwide as soon as they are available.

However, even with all the efforts from the CDC, WHO, and other global agencies, the world will not become fully vaccinated because most low and middle income countries will never have full access to the vaccines. The reason for this is that we, as a global community, haven’t resolved the broader issue of accessibility to vaccines.

To elaborate, we have not ensured that every person in Pakistan receives the polio vaccine, or that every person in the Democratic Republic of Congo (DRC) receives the measles vaccine. How then, do we expect to make sure that every citizen of Pakistan, the DRC, and the rest of the world will receive the COVID-19 vaccine?

According to an article in The Lancet, as of November 2019, Pakistan had 91 cases of polio. A lone identified polio case could mean 1,000-3,000 polio infections in the community. In fact, since the pandemic there has been a decline in vaccination coverage in countries like the DRC. Data from UNICEF in January and February 2020 indicates that approximately 90,000 children in DRC have not received the oral polio vaccine, about 100,000 children have not received the yellow fever vaccines, and almost 85,000 children have not received the measles vaccine. In Haiti, tetanus is endemic. According to the WHO, approximately 100 cases have been reported annually since 2004.


Many experts have suggested various reasons for the lack of full vaccine coverage in many low and middle income countries. Some of those reasons include poor health infrastructure due to lack of funding and systemic corruption. Other factors include widespread malnutrition – people who are not fully healthy often suffer from adverse reactions to vaccinations, and therefore opt out of receiving the vaccines. Additionally, lack of widespread awareness by governments has caused government resistance to adopting vaccines, which leads to cultural resistance.

The tetanus vaccine was developed in the 1920s, the polio and yellow fever vaccine was developed in the 1950s, and the measles vaccine was developed in the 1960s. Yet most people in low and middle income countries are impacted by the lack of these basic vaccines. I have a hard time imagining that each citizen of such countries will receive the COVID-19 vaccine. If most citizens of other countries are impacted by poor healthcare systems and infrastructure, which includes water and sanitation, administering COVID-19 vaccines will remain a challenge.


As a global health community, we will have to do a lot more to ensure that everyone is vaccinated. However, first I’d like to challenge everyone to think about how we can make sure all those children in the DRC receive their necessary polio, yellow fever, and measles vaccines, and how we can advocate for all people of Pakistan to receive their polio vaccines, and all people of Haiti to receive their tetanus vaccines. Only then can we start making believable statements that suggest that the world will be vaccinated against COVID-19. And only then can we make bold declarations that the world will become fully free from COVID-19.

The truth is that until now we haven’t been thinking about the rampant spread of polio in Pakistan, the persistence of measles in the DRC, and the endemic existence of tetanus in Haiti. With the spread of COVID-19 and the need to have every person in the world vaccinated against it, public health officials should question whether enough has been done to mitigate the spread of polio, measles, and similar diseases in low and middle income countries. If not, this is a great time to pause and question the experts on why that hasn’t been done.

Locally, we can start by advocating for all people in developing countries to be offered the same vaccines that are offered in developed nations. Of course, as everyone is offered the COVID-19 vaccine, we should ensure other vaccines are also made available at the same time. For those that are not meeting the needs, it is important to think of long-term and innovative solutions.

Rupal Ramesh Shah is a third-generation Tanzanian who grew up in an ethnically Indian family in the town of Moshi, at the foot of Mount Kilimanjaro. Her family immigrated to the U.S. when she was a teenager. She has degrees in microbiology and public health and serves as Executive Director of Konbit Sante, a public health organization that partners with healthcare facilities in Haiti to provide access to healthcare services. As a Tanzanian-Indian-American, with a strong work focus in Haiti, Rupal often finds herself living at the intersection of cultures and communities. She enjoys hot cups of spiced chai, listens to Taarab music from Zanzibar, and knows where to buy the best street food in Mirebalais, Haiti. In addition to Amjambo Africa, she writes for street newspapers that advocate for the rights of people who are homeless in Boston, San Francisco, and Seattle.