Henry Bergles, Editor
The current COVID-19 vaccine distribution efforts are no exception to the division in access to resources between higher income countries and lower and middle-income countries. As of March 19, high income countries have purchased over 4.6 billion doses of COVID-19 vaccine, which is more than the amount of vaccines purchased by countries classified as upper-middle income (1.5 billion doses purchased), middle income (700 million doses purchased), and lower income (670 million doses purchased) combined.  Higher income countries have purchased enough vaccine doses so that even groups not at risk for severe COVID-19 symptoms are able to get vaccinated. This unequal distribution means that health workers and elderly and immunocompromised people living in lower and middle-income countries would be less likely to receive vaccines than young, healthy citizens of high-income countries.
World Health Organization director Tedros Adhanom Ghebreyesus stated that the inequitable distribution of vaccines worldwide was “a moral outrage” and that the gap in vaccine access was “growing every single day, and becoming more grotesque every day.”  One example of this egregious inequity in vaccine distribution based on geopolitical difference is in Palestine and Israel.
Israel is an occupying power in Palestine. Even in land nominally controlled by the Palestinian authority, there are Israeli settlements and strictly controlled borders that monitor all traffic coming in and out of the West Bank and Gaza Strip. While many portions of the West Bank are militarily occupied by Israel, the Gaza Strip is blockaded, preventing Palestinians living there from accessing many resources that would be available to Israeli citizens. 
As of March 25, 2021, over half of Israeli citizens have been vaccinated with both doses while Palestine has only received 120,000 vaccines total, excluding Palestinian workers that work in Israel, who were vaccinated by the Israeli government.  This immense disparity is in line with many other Israeli policies that involve occupying land militarily and refusing to recognize the rights of the Palestinians already living on the land. Israel has distributed vaccines to allies across the globe that have moved their embassy to Jerusalem, Honduras and Guatemala, but will not provide vaccines to the people in the land it occupies.  It seems that even in the case of vaccination for an extremely infectious disease, the Israeli government is far more willing to give vaccines to its allies for nationalistic, political, and diplomatic reasons rather than display humanitarianism by providing Palestinians with vaccines.
These Israeli policies have had drastic effects on the health of Palestinian communities. As of March 24, 2020, MSF reported that its main hospital in Dura was over capacity with 71 patients.  Alarmingly, one in three patients in the Dura MSF hospital were in the 25-64 age range.  Even if eventually all Palestinians become vaccinated, the damage has clearly already been done. Israeli policies and prioritization of diplomatic vaccine shipments and vaccinating young, healthy Israelis rather than helping elderly and immunocompromised Palestinians has undoubtedly contributed to many unnecessary deaths and hospitalizations.
The vaccine distribution in Israel and Palestine is a microcosm of the unequal distribution of vaccines between high income and low income countries. Residents of an Israeli settlement are far more likely to receive the vaccine much earlier than residents living only a short distance away in a Palestinian town. Israel claims that it is not obligated to distribute vaccines to Palestinian citizens, arguing that the Oslo Peace Accords make it so that the Palestinian Authority is responsible for its own citizens.  Despite this, Israel still militarily occupies the majority of land in the West Bank where many Palestinians live. The Palestinian Authority is still responsible for obtaining vaccines for Palestinians in land it does not fully control. The disparity in vaccine access is just one aspect of the institutional separation between Israelis and Palestinians. This system of separation is fundamentally untenable from both a public health perspective and a social justice perspective and will continue to take the lives of Palestinians unless significant change is made.
 “Vaccine Procurement,” Launch and Scale Speedometer, 2020, https://launchandscalefaster.org/covid-19/vaccineprocurement.
 “Inequity of COVID-19 Vaccines Grows ‘More Grotesque Every Day’ – WHO Chief,” UN News, March 22, 2021, https://news.un.org/en/story/2021/03/1087992.
 Diana Buttu, “COVID-19 Vaccinations Are Proof of Israel’s Medical Apartheid,” Aljazeera.com (Al Jazeera, March 23, 2021), https://www.aljazeera.com/opinions/2021/3/23/covid-19-vaccinations-are-proof-of-israels-medical-apartheid.
 Daniel Estrin, “Israeli Health Officials to Government: Vaccinate All Palestinians,” NPR.org, March 2021, https://www.npr.org/sections/coronavirus-live-updates/2021/03/01/972573521/israeli-health-officials-to-government-vaccinate-all-palestinians.
 Diana Buttu, “COVID-19 Vaccinations Are Proof of Israel’s Medical Apartheid.”
 “Vaccines Needed as Palestine Struggles under COVID-19 Surge,” Médecins Sans Frontières (MSF) International, 2021, https://www.msf.org/vaccines-needed-palestine-struggles-under-covid-19-surge.
 Daniel Estrin, “Israeli Health Officials to Government: Vaccinate All Palestinians.”