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Legal concerns related to possible side effects complaints have prevented millions of Covid-19 vaccines from reaching displaced people around the world, documents seen by Reuters show.

According to the UN documents, and statements made by pharmaceutical bodies, fears about legal risks are preventing the dissemination of Covid-19 shots to stateless people and refugees. 

While vaccine manufacturers have required countries to indemnify them for any adverse events suffered by individuals who receive the jabs, this is not possible where governments are not in control.

Gavi, a public-private global health partnership engaged in the distribution of Covid-19 vaccines, said that because of legal concerns about sharing jabs with people outside of national inoculation programs, some 167 million people risk missing out on being vaccinated against the deadly virus. 

Unless all the manufacturers accept legal liability, “access to vaccines for some populations will remain a challenge,” the Gavi documents say, adding that demand will continue to grow among displaced populations.

A spokesperson for Gavi told Reuters that the reluctance of vaccine makers to take legal risks is “a major hurdle” in providing jabs for refugee populations. 

Three Chinese vaccine makers – SinoVac, Sinopharm and Clover Biopharmaceuticals – have said they’re ready to bear the risks, according to the Gavi document. However, the Clover shot is not yet in use and there are widespread concerns about the efficacy of other Chinese jabs. 

US company Johnson & Johnson has also confirmed its willingness to waive a requirement for indemnity for deliveries from the so-called ‘Humanitarian Buffer’ – a mechanism created by the COVAX initiative to ensure vaccines can reach people where states are failing. 

However, less than a third of vaccines are supplied to the sharing facility by the aforementioned four companies, according to COVAX data. The bulk is provided by AstraZeneca, Pfizer-BioNTech, and Moderna. 

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) – a global industry body – said “no company has refused to consider” bearing legal risk. However, the European Federation of Pharmaceutical Industries and Associations (EFPIA) told Reuters it would be hard to continually monitor vaccine safety in refugee camps and that challenges could arise while transporting and administering the shots. 

Some people may even blame vaccines for health problems that emerge after vaccination, even if they were unrelated, the body noted. “This could then lead to an increased number of litigation cases … during which the safety and efficacy of the vaccine would be publicly questioned,” it said. 

To date, Covid-19 vaccines have been disproportionately administered in wealthy nations. According to researchers, only 7% of people in low-income countries have received a dose, while displaced populations have also been left behind.