In the last eighteen months, the world has been shaken by a deadly disease – but even a global pandemic hasn’t proved enough to disrupt global inequality. The impact of the virus on rich countries has been met with an unprecedented and rapid response, but contrary to narratives about the ‘world’s response’, these have remained steadfastly circumscribed by national lines.

The push we saw in 2020 and early 2021 for vaccine development, funded through large state subsidies, led to the development of several effective Covid-19 vaccines in a short timeframe. Despite this, the subsequent vaccine production and distribution has exposed and intensified global inequality in what is now being called a ‘vaccine apartheid’. By this summer 87 percent of adults in the UK were at least partially vaccinated, but research from Oxford University found that only one percent of people in low-income countries had received one of the 1.3 billion vaccine doses injected across the world.

Three underlying drivers of this division stand out. The first is vaccine stockpiling by rich countries in the Global North. In February, Reuters reported that rich countries were on track to amass a billion more vaccine doses than they actually needed as many poorer countries struggled to roll out a first round. The second is the rigorous defence of patent rights in the interest of profits. South Africa and India’s World Trade Organisation proposal for a global Intellectual Property waiver was backed by Biden in May, but remained blocked by other wealthy governments including Germany and the UK. The third is the use by countries in the Global North of vaccine distribution to promote both nationalism and diplomatic ‘soft power’ – something which has acted to reinforce old colonial dependencies.

In place of an all-out waiver, countries in the Global North have instead favoured COVAX – the multinational body which is tasked with ensuring the fair distribution of vaccines around the world through resource pooling. At June’s G7 summit, Boris Johnson called for a faster vaccine development process and more support for COVAX, which was, at least in part, an effort to circumvent the growing criticism of vaccine nationalism. The G7 nations made a grand commitment to donate at least 870 million doses—with at least half to be delivered by the end of 2021—but campaigners have pointed out that this isn’t enough. Eleven billion doses would be needed to vaccinate the entire world, and without a global programme the virus will continue to spread and mutate.

COVAX has its own structural problems. The World Health Organisation (WHO) scheme—which is heavily dependent on supplies from pharmaceutical giant India—aims to distribute two billion doses by the end of the year, but the recent Covid-19 wave in that country meant it was only able to hit a quarter of its April goal of 235 million. Its 2021 target has now been adjusted to around one third of the original. This is a lesson to wealthier nations: even high vaccination rates won’t necessarily protect you if regional outbreaks increase the likelihood of more dangerous variants – in the worst case, leading to a feedback loop of vaccine resistance which would undercut the effort to control the virus time and time again.

The answer is not as simple as delivering more vaccines. The same issues are being replicated throughout Latin America, Asia, and the Caribbean. In addition to failing to source enough doses, there have been logistical difficulties with delivery, problems with healthcare infrastructure, and, in some countries, hesitancy towards vaccines too. The fight against this persistent inequality has also come at a time when the prospect of booster Covid-19 shots appears increasingly likely – in part driven by the emerging variants arising from populations without vaccine access.

Alternative vaccine candidates are being developed elsewhere, with the potential to ease the current shortages, including those developed in China and Russia, and the ones in development in India and Cuba. Concerns have been raised about the adequacy of testing and regulatory approval, but even when these vaccine candidates have gone through the ‘proper’ processes and are found to be safe and effective, there are further hurdles to their international acceptance.

It has become more apparent that the WHO’s approval process is skewed in favour of vaccines developed in the Global North, despite usual regulatory standards being greatly relaxed across the world. The regulatory authorities it depends on for quality control are only found in Europe, the US, Canada, Australia, and Japan; for the rest of the world, the Covid-19 vaccine candidates are required to go through ‘prequalification’ – a more complicated process which prolongs approval time.

Even if the WHO feels that many countries’ regulatory standards are less robust than their own, it could still work with different national regulatory authorities to ensure all vaccine candidates are treated on an equal footing. Given global scarcity, proactivity shouldn’t fall to global health activists, grassroots organisers, and civil society groups. The WHO has a responsibility to take a progressive approach, circumventing the stranglehold of Big Pharma profiteering.

We cannot change the experience of the last eighteen months, or the failure of governments to make Covid vaccines global public goods. But we must continue to apply pressure in order to break from a cycle of catastrophe. Life-saving medicines must be shared openly, through a global action plan to scale up production. We need to build a global health system based on the values of solidarity and collectivity, for the good of all: that future is entirely within our grasp, if we can overcome the greed of the world’s wealthiest.