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Vaccinating the world

The Week Staff

16 May 2021

To beat COVID-19, the world needs about 7 billion doses of vaccine. How do we get there? Here's everything you need to know:

How is vaccination going?

Very unevenly. Wealthy countries are well on their way to vaccinating a majority of their populations against COVID-19, while poor countries are scrambling to get any doses at all. Of the more than 1.25 billion doses that have made it into arms, only 0.3 percent of those were administered in poor countries. Among countries of more than 2 million people, Israel leads the world with more than 60 percent having received at least one dose, followed by the U.K. with 53 percent and the U.S. with roughly 45 percent. Countries such as Syria and Cameroon are well under 1 percent. There are still nearly 7 billion people waiting, and while vaccination is already dramatically reducing new infections and deaths in the U.S. and Europe, the coronavirus is ravaging the poorer countries of Asia and Latin America and beginning to move across Africa. By next month, the world COVID death toll for 2021 will already exceed the 1.8 million who died of the disease in 2020.

Why is the West so far ahead?

Western governments had the money to strike early deals with top vaccine makers headquartered in their countries, preordering many different vaccines. By January 2021, rich countries had already bought up 96 percent of the doses Pfizer is scheduled to make for this year, and 100 percent of Moderna's. The world's richest countries, representing 16 percent of the global population, have collectively bought 1 billion more doses than they need. Anticipating such a grab, last year the World Health Organization set up an international effort known as Covax to try to ensure vaccine access for all. Covax has delivered nearly 50 million doses and aims for 2 billion by the end of the year. But it has a funding shortfall of some $40 billion, and even if it makes its goal, that rate of vaccination would mean the world would not be covered until late 2023 or 2024.

Who is exporting vaccines?

Russia and China are leading the way in "vaccine diplomacy," providing millions of doses to other countries. Russia's Sputnik V is made using a deactivated adenovirus — a cold virus — to which a bit of modified COVID-19 DNA has been added, and is reportedly 92 percent effective. Russia has already signed contracts to provide 100 million doses to some 50 countries. China has also been exporting its two vaccines, made by Sinovac and Sinopharm, having shipped 240 million doses and committed to another 500 million this year. But there's no published, peer-reviewed studies on their effectiveness. The U.S., meanwhile, just agreed to send 60 million unused AstraZeneca doses primarily to India, but like other Western countries, it has prioritized its own population. Complicating things is that the two-dose AstraZeneca and one-dose Johnson & Johnson vaccines have had problems with production and a rare side effect of deadly blood clots. Meanwhile, Pfizer and Moderna say every lab that can make their cutting-edge mRNA vaccines is already running at full capacity.

Will waiving patents help?

In the long term, yes, but in the short term, no. The Biden administration endorsed waiving patents last week, but the European Union is opposed, so the World Trade Organization will continue debating the issue for months. And knowing the recipe is only the first step toward actually producing these extremely complicated vaccines. Labs must be purpose-built using highly specialized equipment, and there is a shortage of the necessary cell lines and other raw materials. Technicians must be trained in the proprietary techniques. All that could take a year, although developing countries say they could ramp up sooner.

What can be done in the meantime?

For the more traditional adenovirus vaccines, which are easier to make than the mRNA vaccines, governments can pressure companies into "technology transfer" agreements that would see patent holders license rival companies to produce their vaccines for a small cut of the revenues. AstraZeneca has already made such deals to facilitate large-scale production in India and Japan. Governments can also lift export curbs on raw ingredients and other materials, such as glass vials, filters, bioreactor bags, and cold-storage devices.

How else can the U.S. help?

Because the U.S. government contributed some $2.5 billion toward the development of the Moderna vaccine, it has a great deal of leverage over how the vaccine is made and distributed. The nonprofit PrEP4All has recommended that the U.S. shift to a public production model for Moderna, to rapidly scale up vaccine-manufacturing capacity here in the U.S. for subsidized export to the rest of the world. Aside from the moral imperative to save millions of human lives, it is in the interest of rich countries like the U.S. to prevent uncontrolled spread of the virus in poor countries, so that vaccine-resistant variants do not evolve and boomerang back to their own populations. "No one will ever be truly safe," says U.N. Deputy Secretary-General Amina Mohammed, "until everyone is safe."

India's missed opportunity

Before the pandemic, India was by far the world's biggest manufacturer of vaccines, through world leader Serum Institute of India (SII) and myriad smaller companies. The SII struck an early deal last year to manufacture AstraZeneca's vaccine under the name Covishield and took $300 million from the Gates Foundation and other donors to provide 200 million doses for the global Covax effort. But production has been inexplicably slow, and SII has so far delivered just 60 million shots. The Indian government, meanwhile, failed to preorder its own supply, and as late as February had asked SII for a mere 21 million doses for a population of 1.4 billion. When India's devastating COVID surge began in late March, Delhi abruptly ordered a freeze on all vaccine exports, reserving SII's output for Indian hospitals and depriving waiting African nations. Given the scale of India's outbreak, though, Africans have been forgiving. "You'd have to be very inhuman, very unreasonable to say anything against India," said Kenyan analyst Herman Manyora, "even if they stop supplying you."

Dear Patients/Colleagues

The theme of my commentaries this week has been the inequalities in health care systems and the ability to vaccinate populations. There is an ongoing geopolitical struggle between the haves and the have nots. The wealthy versus the poorer countries.

The Week Staff provide an overview of how the current status quo developed where the rich countries are far outperforming the poorer countries. Of the 1.25 billion doses of vaccines which have been administered, only 0.3% have occurred in poorer countries.

There is a multifactorial background as to why the western countries, representing 16% of the global population, are so far ahead. Having initiated rapid vaccine development, they preordered production runs and collectively bought 1 billion more doses than they actually needed to vaccinate their citizens. Covax set up by the WHO, to offset vaccine hoarding and to ensure vaccine access for all, has delivered nearly 50 million doses and aims for 2 billion by the end of this year.

It is only Russia (Sputnik V vaccine) and China (Sinovac & Sinopharm vaccines) who have been exporting millions of doses to other countries leading the way in ‘vaccine diplomacy’. The USA meanwhile has just agreed to send 60 million unused Oxford AstraZeneca (OxAZ) doses primarily to India. Ironically, India was viewed as the global leader in vaccine manufacturing, and it was exporting their vaccines initially. While the technology developed in the UK to produce the OxAZ vaccine was transferred to Serum, the principal manufacturing vaccine plant in India, the roll out of only 60 million doses has been disappointing and inexplicably slow. Since the onset of the ravages of the second wave of COVID-19 infections, all exports from India, including those to African nations, have been stopped.

I have mentioned previously that the Biden administration is in favour of waiving the patents for vaccine manufacture. While this may help in the longer term as all the logistics necessary to produce these vaccines are acquired by other countries, it will certainly not help in the shorter term.

The Week Staff propose some short-term solutions. The USA and other wealthy nations can help ease the burden of global vaccination. There is a moral imperative not simply to inwardly look at their own citizens but to recognize and act in the global communities’ interest to slow the spread of the virus. This intervention is needed to reduce the evolving number of variants that will inevitably occur, and may re-enter the vaccinated population who may not be immune to these new mutations.

It is a Catch 22 situation of global proportions. The dilemma facing Western governments is how to balance the scales of inequality, and how to judge the apportioning of finite resources between their own population and that of aiding the poorer countries. These countries simply do not have ease of access to vaccines and secondly, they have a major fiscal problem of funding and purchase.

This is a four-minute read which provides the reader with a current status quo of the inequalities in global vaccine distribution and possible remedies which can be undertaken in the shorter term.

Doctor Donald Greig


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