IACHR and its SRESCER Call on American States to Make Public Health and Human Rights the Focus of All their Decisions and Policies Concerning the COVID-19 Vaccine

February 5, 2021

Washington, D.C.- The Inter-American Commission on Human Rights (IACHR) and its Special Rapporteurship on Economic, Social, Cultural, and Environmental Rights (SRESCER) note that vaccines are essential to overcome the COVID-19 pandemic. They therefore call on States in the Americas to prioritize public health and compliance with their own international human rights obligations when making decisions or adopting policies to approve, purchase, distribute, and provide access to these vaccines.

The COVID-19 pandemic has caused an unprecedented global healthcare, economic, and social crisis. This crisis has exceeded health system capacity and hit individuals who live in poverty, have no healthcare coverage, or face some form of discrimination particularly hard. According to data issued by the World Health Organization (WHO), the Americas are the region with the most deaths of COVID-19, at more than one million. Approving, manufacturing, and distributing safe and effective vaccines is essential to face the risks posed by the virus, reduce the excessive burden on health systems, and mitigate the effects of measures adopted to contain the spread of COVID-19.

In this context, the IACHR and its SRESCER note that universal access to vaccines and extensive immunization from the virus are a global public health good, as the World Health Assembly (WHO's main deliberative body) said in Resolution WHA73.1, which was passed unanimously on May 19, 2020. All States must therefore have free, swift access to safe, good-quality, effective, affordable, and accessible vaccines, to ensure large-scale immunization from the virus as a way to prevent, contain, and stop its spread and end the pandemic.

Experts note that at least 70% of the population needs to have been vaccinated to curtail transmission around the world. The IACHR and its SRESCER therefore observe with concern that, to date, only 17 States in the Americas have published on official platforms concrete, well-thought-out vaccination plans, in a global context marked by scarcity, rivalry, lack of transparency, and difficulties to negotiate vaccine purchases with private pharmaceutical companies who are also failing to meet demand. The urgent need for immunization is particularly evident considering the emergence of new variants of the virus, some of them potentially more contagious.

It is essential for all public policies and measures concerning vaccination to focus on public health and to adopt a comprehensive, interdependent human rights approach. It is particularly important to take into consideration the rights to life and health and the right to benefit from scientific progress, based on the best available scientific evidence and addressing the principles of a human rights approach (equality and non-discrimination, social participation, access to justice, access to information, and accountability), along with gender and intersectional perspectives.

Guaranteeing universal access to vaccines, with priorities based on public health criteria

The IACHR and its SRESCER believe that vaccines against COVID-19 need to meet availability, accessibility, acceptability, and quality standards linked to the right to health. In particular, access to safe and effective vaccines to prevent COVID-19 implies concrete obligations and measures for States. Among these, the IACHR and its SRESCER highlight the following:

1. Refraining from discrimination in access to vaccines, based on the categories that are banned in inter-American human rights instruments, and eliminating any regulatory and normative hurdles that could cause discrimination.

2. Guaranteeing affordability or financial accessibility for all people (which implies that vaccines must be free of charge at least for lower-income individuals and individuals who live in poverty, so that a person's purchasing power neither favors nor prevents their immunization).

3. Ensuring that all people under their jurisdiction can physically access vaccines, by adopting measures to provide the infrastructure needed to distribute vaccines around their territory and to guarantee access in rural areas, suburbs, and other areas that are far from cities or urban centers.

4. Ensuring access to all the relevant information on vaccines, on access to them, and on their application, protecting the right to informed consent.

In the current scarcity context, States must prioritize vaccinating the groups who are most vulnerable to COVID-19, and also ensure that people under their jurisdiction will not be discriminated against if they have not been vaccinated. Concerning the definition of priority criteria for vaccination against COVID-19, the IACHR and its SRESCER urge States to make decisions based on medical needs and on public health aspects, on the best available scientific evidence, on the national and international human rights standards they are committed to respecting, and on the applicable bioethics principles. The IACHR and its SRESCER further encourage special consideration of WHO guidelines on the issue, which recommend prioritizing healthcare workers, older persons, persons with disabilities or with pre-existing medical conditions that put them particularly at risk, and individuals who (due to underlying social or geographical factors) face higher risks during the pandemic, including individuals in human mobility contexts and people who live in poverty or extreme poverty.

To guarantee fair and universal access to vaccines for all people under their jurisdiction, States must ensure that there are no restrictions that might particularly affect groups who are particularly vulnerable or who have historically faced discrimination (including poor or homeless persons, older persons, people with disabilities or chronic diseases, indigenous peoples, Afro-descendant communities, women who are victims of gender-based violence, trans or gender-diverse persons, and people who are deprived of liberty, among others). Concerning individuals in human mobility contexts, States have a duty to grant them fair access to the vaccine, under the same conditions as each country's own citizens.

Guaranteeing access to information and effective public communications

Protecting the right to access public information and ensuring effective communications are crucial for successful mass immunization from COVID-19 and for the exercise of the right to informed consent. The Commission, its SRESCER, and its Special Rapporteurship on Freedom of Expression therefore call on States to provide sufficient scientifically grounded information to respond to concerns about vaccines, proactively providing data to address people's doubts (for instance, about adverse reactions or side effects) and investing in effective and immediate communication strategies as an adequate tool to counter misinformation, skepticism, and fake news.

States must also develop national and regional promotion programs, under the leadership of their highest authorities, with the involvement of medical and scientific institutions, civil society organizations, and professional journalists. States must ensure that individuals have up-to-date information on how to access vaccines and the mechanisms that have been set up to distribute them. All this information must be accessible for all individuals in different languages, in an inclusive, culturally appropriate way, and it must be disseminated through mass media.

The IACHR and its Special Rapporteurships further note that, in the current healthcare crisis, States have a heightened duty to enforce inter-American standards concerning transparency, access to public information, and the fight against corruption, concerning both mechanisms to purchase, distribute, and apply vaccines and the available resources and the resources that have been deployed to ensure people have access to vaccines.

Guaranteeing compliance with obligations concerning business and human rights

Considering that scientific research and private pharmaceutical companies play a major role in the vaccination process, including vaccine development and distribution, the IACHR and its SRESCER particularly call on States, businesses, and other economic stakeholders to implement the criteria, parameters, and recommendations held in the IACHR report Business and Human Rights: Inter-American Standards. The IACHR and its SRESCER stress that States play a fundamental role to protect the right to health, by ensuring among other aspects access to medication and healthcare technology, and that they might therefore be held accountable for human rights violations perpetrated by the business sector in the absence of adequate State regulation, oversight, or auditing processes, or when States fail to adopt appropriate measures to prevent the impact of these business activities on the human rights of their citizens. Businesses, in turn, have an obligation to respect individuals' rights to health and life and must exercise due diligence concerning the impact of their activities on these rights, and ensure greater transparency in their operations and more effective accountability mechanisms in cases of violations of access to healthcare technology and medication, including vaccines against COVID-19.

The Commission and its SRESCER further ask that intellectual property schemes not prevent fair, universal access to safe and effective vaccines, in accordance with Resolution 1/2020, Pandemic and Human Rights in the Americas, and Resolution 4/2020, Human rights of Persons with COVID-19. In this context, any decisions made must support the exercise of human rights, ensuring that legal frameworks consider that vaccines and other relevant medication are public health goods. It is therefore necessary for States to make more determined use of flexibility or exception clauses in schemes to protect intellectual property, countering the negative effects on human rights of excessively high vaccine prices and patent misuse. Along similar lines, States must take measures to prevent and fight speculation, private hoarding, and wrongful use of vaccines.

The IACHR and its SRESCER note that the enforcement of States' obligations outside their own territory must be taken into particular consideration in the context of the COVID-19 vaccine. The IACHR and its SRESCER stress that measures adopted by the countries of origin of the companies who produce or market these vaccines—in terms of regulating, overseeing, preventing, or investigating the behavior of firms who are registered under their jurisdiction that affects human rights in other countries—might affect countries' international accountability for these actions. They further highlight States' duty to cooperate, noting that neither States nor other stakeholders who might influence other countries' access to vaccines should prevent that access. It is particularly important for States to comply with these obligations in the current context, with a global healthcare emergency, vaccine scarcity, and asymmetries in countries' development levels and purchasing power.

Strengthening international cooperation and existing mechanisms through regional action

The Commission and its SRESCER call on Member States of the Organization of American States (OAS) to develop strategies and mechanisms that enable shorter access gaps between countries who have more purchasing power and lower-income countries in relation to vaccines, to prevent health-related isolationism based mainly on economic or financial factors. The two institutions highlight the warning issued by the Director General of WHO concerning the urgent need to prevent "catastrophic moral failure" in the face of the nationalism and the stockpiling of vaccines by certain States, and the risks this poses both for poorer individuals and countries and for the prospects of a longer pandemic, longer restrictions to contain it, and the resulting human suffering and economic impact.

The IACHR and its SRESCER therefore call for urgent coordination of regional efforts, based on international solidarity, to ensure a permanent exchange of information on challenges and best practices, as well as healthcare technology and knowledge concerning vaccines and treatment options for COVID-19. These measures should help existing global initiatives like the COVID-19 Technology Access Pool (C-TAP), created to exchange knowledge, science, and technology, and COVAX (the vaccine element of the Access to COVID-19 Tools Accelerator), launched to supply vaccines to the countries with the fewest financial and institutional resources. These platforms aim to foster coordinated efforts and international cooperation in the field of COVID-19 vaccines, with the support of WHO and, in the Americas, the Pan American Health Organization (PAHO). An effective and supportive regional American response to the pandemic, based on human rights and on public health aspects, must start by preventing economic asymmetries among States in the region from depriving lower-income countries from fair access to vaccines.

The Commission and its Special Rapporteurships are willing to contribute to these responses and initiatives, in keeping with their own mandates, in order to ensure that human rights and public health play a central role in American States' efforts to vaccinate individuals under their jurisdiction against COVID-19. The IACHR stresses its constant monitoring and other actions in this context, coordinating all its mandates and mechanisms through the Rapid and Integrated Response Coordination Unit for COVID-19. These efforts seek to identify particularly worrying situations and patterns, foster best practices, and guide States around the region so their policies and plans concerning vaccination against COVID-19 comply with the inter-American legal framework on human rights, to favor swift economic and social recovery in all American States.

The SRESCER is a functionally independent office of the IACHR and was especially created to brace the Commission's compliance with its mandate to promote and protect economic, social, cultural, and environmental rights in the Americas.

A principal, autonomous body of the Organization of American States (OAS), the IACHR derives its mandate from the OAS Charter and the American Convention on Human Rights. The Inter-American Commission has a mandate to promote respect for and to defend human rights in the region and acts as a consultative body to the OAS in this area. The Commission is composed of seven independent members who are elected in an individual capacity by the OAS General Assembly and who do not represent their countries of origin or residence.

No. 027/21