The announcement at their conference on 11-13 June 2021 that the G7 countries (UK, USA, Canada, Japan, France, Germany & Italy) would donate a billion COVID-19 vaccines for low and middle income countries was a welcome move. However, it should be noted that this is a pledge by the G7 group, there are not a billion vaccines available for immediate shipment.
The US will contribute 500 million doses with the UK promising more than 100 million doses over the next year. The remaining G7 countries will donate the rest.
The first 200 million US doses will be distributed by the end of 2021 with a further 300 million doses promised by June 2022.
The UK says it will donate 5 million doses by September 2021 with another 25 million by the end of the year. (1)
Given that virtually all vaccines require two doses (the exception is Johnson’s and Johnson’s which is one dose) a billion vaccines is enough for 500 million people, a fraction of the 5 billion people who live in low and middle income countries. (2)
How Will Vaccines be Donated?
The vaccines will primarily be sent through the COVAX vaccine scheme - a WHO-backed international agreement whereby richer countries have pledged to help lower income countries access the vaccine. A total of 92 low and middle income countries are eligible to receive COVID-19 vaccines through COVAX. (3)
COVAX is struggling to meet its aim to distribute 2 billion doses of vaccine by the end of 2021. COVAX has only provided 4% of all vaccine doses given globally so far. Whilst wealthier nations were expected to donate both money and vaccines to the scheme the reality is that they bought up vaccine supplies for themselves, often ahead of them even being approved by drug regulators.
The supply of COVID-19 vaccines to Africa has “ground to a halt” according to WHO health officials. The head of the World Health Organization, Tedros Ghebreyesus, in his response to the G7 pledge said: "We need more, and we need them faster, many other countries are now facing a surge in cases - and they are facing it without vaccines." (4)
Although an initial 600 million doses had been promised to Africa by COVAX, the reality is that only a tiny amount has been delivered through the scheme. Only 50m doses of vaccine have reached Africa so far for a population across the continent of more than a billion.
Supplies of the AZ (AstraZeneca) vaccine were to be manufactured and sent by the Serum Institute of India but, in the face of its own horrific second wave of COVID-19, the Indian government has placed an export ban on all vaccines produced in the country. COVAX was relying on India to provide more than half of its vaccine doses and had ordered 1.1 billion doses but just 30 million doses from the Serum Institute have reached COVAX. The Serum Institute does not expect to start exporting vaccine again until the end of 2021 at the earliest. (5) (6)
It is not just supply of vaccine that is impeding the rollout of jabs. Only half of the doses shipped to the African continent have been administered so far.
Vaccine hesitancy, fuelled in part by political and media scare-mongering over vaccines, most notably Astra-Zeneca’s, means that supplies that reached some African nations were not used in time.
Malawi destroyed 20,000 doses of the AZ vaccine which had not been administered by their use-by dates. South Sudan destroyed 59,000 doses and handed a further 72,000 back to COVAX. (7)
The situation was not helped earlier in the pandemic when the then US President, Donald Trump refused to contribute to COVAX. His successor, President Biden, has now reversed that decision and promised that the US will play a major role in vaccine donations. Had input from the US been available sooner, COVAX would have been able to make deals with vaccine manufacturers sooner.
The Politics of Vaccination
This blog focuses on the scientific world rather than the political but any discussion about global vaccine must of necessity include the political backdrop that it is being played out against.
Whilst waiting for the vaccine doses from COVAX, many low and middle income countries began striking their own deals with both the drugs companies and other nations.
China has donated its own Sinovac and Sinopharm vaccines across Africa, Asia and Latin America but has been criticised for engaging in so called “vaccine diplomacy” because the donations came only in exchange for political influence in the recipient country. (8)
Another growing concern is that the Sinovac vaccine is not effective. Countries that have used it in their vaccine programmes are seeing their COVID-19 cases and deaths continue to rise rapidly. (9)
Russia too has been accused of engaging in vaccine diplomacy. (10)
Alongside this, early claims about the safety and efficacy of the Russian vaccine, Sputnik V, are now being disputed by scientists with concerns that raw data from the clinical trials is not available for analysis outside of the country. (11)
Neither the EU nor the WHO have approved Sputnik V at the time of writing. (12) (13)
It is clear why President Biden was keen to make the point that: “The United States is providing these half billion doses with no strings attached. No strings attached. Our vaccine donations don’t include pressure for favours, or potential concessions. We’re doing this to save lives, to end this pandemic, and that’s it.” (14)
He has also backed a proposal by India and South Africa that intellectual property rights for COVID-19 vaccines should be temporarily lifted, a move continually resisted by drug companies and yet to be backed by either the EU or the UK. (15)
Why we need to vaccinate the whole world
The longer the COVID-19 virus remains in unmitigated transmission the more opportunity it has to mutate. The emergence of new variants will challenge and undermine the existing vaccines. The UK is anticipating administering an autumn booster dose in light of this. (16)
Sustained spread allows the virus ongoing opportunities to mutate and increase the chances of being able to re-infect a vaccinated population. Given how inter-connected the world is it will be easy for vaccinated populations to acquire these new mutations through travel, especially as lockdown restrictions in the northern hemisphere ease and people begin travelling again overseas for business or holidays.
If the vast majority of the world’s people are vaccinated, there are fewer targets for the virus to infect. The virus cannot survive long outside of its human host and only widespread vaccination can halt its ongoing transmission (17)
The WHO (World Health Organisation) has warned that the world faces a "catastrophic moral failure" because of unequal COVID-19 vaccine policies.
The head of the WHO, Dr Tedros Adhanom Ghebreyesus, said: “We have the means to achieve vaccine equity, but the gap between the number of vaccines administered in rich countries versus via COVAX is growing every single day and becoming more grotesque. We appeal to countries to share COVID-19 vaccines out of self-interest, if nothing else!” (18)
Whilst not negating the fact that many in the UK have seen financial hardship over the past year, primarily because of the economic effects of lockdowns, the furlough scheme and welfare benefits system helped support many people. The UK also has a health service that is free to all.
In poorer nations many people live a hand to mouth existence with that day’s wages buying the food for that night’s meal. With no financial support available to them during lockdowns and a lack of healthcare infrastructure in many places, many have no resources to fall back on when ill or in need. As Dr Tedros warns, “there will be prolonged human and economic suffering." (19)
The pandemic may have affected every nation but in areas where there was already conflict and instability these have only been exacerbated. Alongside this, many charities and NGOs have had their work curtailed or stopped because of the virus. In places affected by conflict, provision of healthcare can be fragile at best but further disruption compounds the deprivation people are living under and is a driving force for displacement as people try and find better conditions elsewhere. It also creates the kind of environment extremist groups target for recruitment.
At the UN Security Council meeting in February 2021 Simon Coveney, Minister for Foreign Affairs and Defence of Ireland, made the following observation: “How we travel from here will have far-reaching implications for peace and security, for global equality and for the sustainability of our shared future. For all to be safe, all countries must be able to vaccinate their people..... Hunger will trigger forced migration, displacement and recruitment by extremist groups, which, in turn, will drive more conflict and deepen humanitarian needs.” (20)
In Conclusion
With the interconnectedness of countries and regions around the world, no single population lives in total seclusion. If some nations are inclined to think that once vaccinated they can lower their guard against COVID-19 and ignore what is happening elsewhere they would do well to reflect on the fact we will not be safe from COVID-19 until all are safe.
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