Throughout this piece “COVID-19 vaccines” refers to all vaccines currently being manufactured worldwide irrespective of the country of manufacture or drug company.
COVAX is a global initiative whereby wealthier nations will fund vaccines for low and middle income countries. 180 countries have signed up as donors and 92 countries should benefit from the scheme. The UK government has provided £548m to the COVAX programme.
Background
As vaccine rollouts happen speedily in some countries, are dogged by politics and bureaucracy in others and are yet to begin in many, the aim to vaccinate the whole world as soon as possible for the benefit of all is yet to be realised. (1)
Drug companies are capable of producing millions of doses of vaccines - they have said they expect to produce enough vaccines for the entire world by the end of 2021 – so why is there such disparity across the globe with the vast majority of vaccinations administered so far all in wealthy nations? (2)
The total world population is around 7.8 billion people. (3)
As most vaccines require two doses, around 11 billion doses are needed to vaccinate 70 percent of the world’s population. (Scientists think that 70 percent is the minimum threshold needed to approach herd immunity from COVID-19.) (4)
According to Airfinity, an analytics company based in London, 413 million COVID-19 vaccine doses had been produced by the beginning of March 2021. They predict this could increase to 9.5 billion doses by the end of 2021. (5)
The Global Health Innovation Center at Duke University in Durham, North Carolina forecast the production of up to around 12 billion doses of vaccine by the end of 2021. (6)
So what is the hold up?
Companies may be able to make enough vaccines to vaccinate most of the world by the end of the year but this doesn’t mean they will reach every corner of the globe. With some countries already imposing export restrictions on vaccines and/or components in the vaccine supply chains, the end result will be widespread delays in distribution. At the time of writing India and the European Union have both announced restrictions on their vaccine exports.
Production is not evenly spread across the vaccine makers and the 2021 supply was set to be dominated by AstraZeneca, Pfizer-BioNTech, and Novavax but AstraZeneca has been dogged by false alarms about its safety profile and false claims about its efficacy whilst the Novavax vaccine is yet to be approved for use. (7) (8)
(Click here to read more about the AstraZeneca vaccine.)
When a vaccine is made it can need 200 or more separate components from different countries and the hold up of just one of those components can bring production to a halt.
The Irish Taoiseach Micheál Martin has called for international co-operation on vaccine supply noting that the Pfizer vaccine requires 230 different parts made by 86 different companies in 19 different countries. (9)
For the newer mRNA vaccines (Pfizer’s and Moderna’s) there is a worldwide shortage of some components, in particular some of the enzymes used in their manufacture and the liposomes (a type of fat cell) needed to carry the vaccine into the human body. Whilst other companies have the capability to make these products Pfizer and Moderna are proving slow to license them to do so.
The Pfizer plant in Belgium needs liposomes produced in the UK to make its vaccine. The EU is currently threatening to ban exports of vaccine to the UK. Should the UK choose to retaliate and not export these vital liposomes to the EU there will be a slowing down or even complete cessation of vaccine production at the Belgium Pfizer site, an outcome that benefits no-one.
AstraZeneca has contracts with 25 firms in 15 different countries to manufacture their vaccine. The largest deal is with the Serum Institute of India.
Many countries are campaigning for COVID-19 vaccine related intellectual-property rights to be temporarily waived. In October 2020 India and South Africa asked the WTO (World Trade Organization) to do this. Since then more than 100 other countries and organisations such as Amnesty International and the UN’s HIV & AIDS agency have added their voices to the campaign. (10)
Dr John Nkengasong, head of the Africa Centres for Disease Control and Prevention, says that unless the waiver is brought in history will repeat itself. When HIV & AIDS was at its height, Africa was the most severely affected continent yet it was denied access to drugs that were successfully treating it in the west. Africa imports 99% of all its vaccines and there are only three vaccine manufacturers across the entire continent.
The proposal put to the WTO is being opposed by the European Union, the United States, the United Kingdom, Switzerland and Japan who cite the argument that vaccine production is such a complex process that there would be safety issues in waiving the property rights to it.
The WHO (World Health Organisation) is calling for a “coordinated technology transfer” whereby vaccine researchers and manufacturers license their vaccines to other companies globally under the guidance of the WHO. (11)
UNICEF (United Nations International Children's Emergency Fund) has also issued a stark warning that some of the world’s poorest countries such as South Sudan and Yemen will see delays to the delivery of vaccines through the COVAX scheme because of technical problems at a South Korean manufacturing plant and the fact that India has temporarily put an export ban on the vaccines it is producing. (12)
Why we need to vaccinate the world - the science
If COVID-19 is allowed to continue spreading in the global South it is only a matter of time before new variants come back and invade a vaccinated global North. The longer the 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. (13)
We have already seen the virus mutate into forms that have proven more aggressive. Sustained community 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. Otherwise vaccinated populations will have to go back into lockdowns each time a new variant lands on their shores. (14)
Why we need to vaccinate the world - the humanitarian reasons
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!” (15)
The poorest countries will pay the highest prices of the pandemic fallout in terms of both their lives and their livelihoods. Whilst a first glance at Africa’s official COVID-19 figures would suggest that the continent has not fared as badly with the pandemic compared to Europe and the USA, the first studies to try and ascertain the true figures for Africa are not encouraging. A study carried out in Zambia and published in the British Medical Journal concluded that “the impact of COVID-19 in Africa has been vastly underestimated.” (16)
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." (17)
Why we need to vaccinate the world - the security reasons
On 17 February 2021 the United Nations Security Council met via videoconferencing.
(The Council has five permanent members: China, France, Russian Federation, the United Kingdom, and the United States and ten non-permanent members who are elected for two-year terms. The current non-permanent members are: Estonia, India, Ireland, Kenya, Mexico, Niger, Norway, Saint Vincent and the Grenadines, Tunisia and Vietnam.)
They proposed that an emergency task force be formed to help implement global vaccination including in conflict zones and refugee camps.
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 Security Council meeting 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.” (18)
In Conclusion
7 April 2021 is World Health Day and the focus will be on creating a fairer and healthier world. (19)
With the interconnectedness of countries and regions around the world, no single population lives in total seclusion. No one is safe from COVID-19 unless all are safe.
If some nations are inclined to think that once vaccinated they can lower their guard with COVID-19 and ignore what is happening elsewhere they would do well to reflect on the proverb “A chain is only as strong as its weakest leak.” (20)
