House of Commons’ Standing Committee on Foreign Affairs and International Development: CARE Canada Opening Statement  

STUDY ON VACCINE EQUITY, 28 APRIL 2022
WITNESSES:
DR ILHAS ALTINCI, CARE TURKEY (NORTHWEST SYRIA), SEXUAL AND REPRODUCTIVE HEALTH TECHNICAL ADVISOR
NICOLE TOBIN, CARE CANADA, HEAD OF GLOBAL HEALTH 

From our offices on the unceded territory of the Algonquin Anishinabe Nation, we thank the Committee for inviting us to appear as part of this study. Gender justice is at the heart of all humanitarian and development work we do as the CARE Confederation. Health gains have been threatened by intersecting crises of COVID, conflict and climate, and women’s leadership is essential to rebuild health systems that ensure access to lifesaving services for all. 

We join Canadian civil society in calling on Canada to work for consensus at the WTO to improve the compromise TRIPS waiver proposal that was recently tabled. Addressing intellectual property rights to improve global access to supplies is essential, AND this must be accompanied by investments in health systems and health workers to deliver those supplies. Today, we are invited to testify regarding the equitable delivery of vaccine supplies, focused on gender. 

For context, the CARE International Confederation has reached 15.7 million people in 53 countries with our COVID programming. Though each context varies, CARE’s analysis indicates that the true cost is often much higher than the global estimates account for, when factoring for health workforce and community readiness costs. 

Vaccine equity requires targeted and increased investments in delivery. In April, CARE testified to the UN Security Council on vaccine equity gaps in humanitarian settings. Today, I will provide testimony with Northwest Syria as a case study, regarding our work on vaccine equity focused on awareness-raising.

Compared to the global and Canadian populations, few Syrians have been vaccinated. About 9% of the total population has received one dose. Only about 5% of the total Syrian population is fully vaccinated.  

In Syria, COVID is at the bottom of the list of priorities. People face so many hardships including shelling, violence, and lack food and shelter, let alone COVID masks. They live in tents or improvised shelters, and cannot social distance. In the Syrian context, it is positive that 70% of health and humanitarian workers in Syria are now fully vaccinated. 

However, there is a critical shortage of all health staff. They work long hours in difficult conditions. Most health facilities are “improvised” (in a house, abandoned building, or school). These are not equipped hospital facilities. The health and safety of these workers is constantly at risk. They lack consistent access to personal protective equipment (PPE). Early in the pandemic, they lacked paid sick leave, and sometimes staff would conceal symptoms so they would not lose pay. Some are threatened, beaten, even stabbed. 

Yet health workers—over 70% of whom are women, at the global level—are the key to equitable vaccine delivery. Trusted providers can reach underserved communities, doing door to door in-person communication to build vaccine acceptance. They are trusted because they meet families’ holistic health needs, including childhood immunizations and reproductive and maternal health care. It's very important to have women vaccinators, who are more likely to be trusted by women patients.  

To achieve vaccine equity, my key recommendations are as follows. It is critically important that all actors invest in equitable health systems delivery. We ask that Canada: 

  1. Adequately and consistently fund frontline and community healthcare workers, and the organizations they work for.

  2. Ensure there are consistent norms and standards to ensure fair pay and safe and supportive working conditions for all health workers, including in humanitarian response. Ensure they have access to PPE, testing and treatment, vaccines and paid sick leave.
     
  3. Ensure that health workers and their organizations have meaningful roles in COVID vaccine rollout. Their leadership and expertise must drive decision-making for health care delivery in crisis settings. They can address hesitancy and gender-related disparities in access to COVID information and services—including collecting and using sex, age, gender disaggregated data, developing strategies to specifically reach women and other marginalized populations.