An editorial in The Lancet Infectious Diseases published on May 14th 2021 queries this question.
As of May 9th 2021, the COVID-19 pandemic has caused 3,277,272 deaths and disrupted the lives of billions of people.
The editorial argues that the only equitable way to mitigate the public health and economic impact of the pandemic is to offer global access to COVID 19 vaccines.
One year ago, the COVAX, co-led by the Coalition for Epidemic Preparedness Innovations, GAVI, the vaccine Alliance, and the WHO was set up to try to ensure a fair access to all the available vaccines by guaranteeing that each country would receive vaccine doses for at least 20% of their population.
COVAX has distributed so far over 59 million COVID-19 vaccine doses to 122 countries.
This is, however, far from its ambitious target of supplying at least 2 billion vaccine doses this year.
This delay is clearly problematic for poorer countries which rely on COVAX to access vaccines that they would otherwise be unable to afford.
This has resulted in vaccine availability globally being very uneven.
The editorial tells us that only 1% of available vaccine doses worldwide have been administered in Africa.
COVAX faces many problems overall such as:
- A lack of support from wealthy nations.
- A competitive market for the limited number of vaccines available
- Vaccine production problems.
Funding for COVAX, the editorial tells us, has not yet reached the required targets. This might be because it is seen more as an aid project for low income and middle income countries than as a global collaboration which governments should support to get the pandemic under control.
The WHO Director General has declared that US $35 to $45 billion are required this year to cover the remaining costs to ensure that most adults are immunised.
He also criticised wealthier nations for undermining COVAX by ordering many more doses than they need for their own populations.
The currently limited production capacity for vaccines has already threatened the efforts of COVAX to deliver vaccines worldwide. Unfortunately, the dramatic upsurge of COVID-19 cases in India has exacerbated the situation further.
The major supplier of the most widely available vaccine for COVAX, the Oxford AstraZeneca vaccine, is the Serum Institute of India.
However, since March, India has stopped the exportation of COVID-19 vaccines because of the need to use doses, already vastly insufficient for the vaccination of its own citizens.
This sudden block to vaccine exportation has resulted in the interruption of vaccine delivery to many low income countries. As a result of this, it is predicted that the Serum Institute of India will struggle to upscale vaccine production to meet the needs of its own population and it is therefore unclear where COVAX will get its supply of COVID-19 vaccines.
One possible area is that countries that have already made substantial progress in vaccinating their populations could share their surplus vaccine doses with other countries.
The editorial also cites that a further potential solution for the shortage and inequities in vaccine distribution could come from the temporary waving of intellectual property protections on COVID-19 vaccines to boost manufacturing.
This proposal was suggested by the administration of President Biden on May 5th.
However, it was originally made to the World Trade Organisation by South Africa and India last year and despite support from the WHO it was, in fact, opposed by the UK, Canada, Norway and the EU and the USA under Trump’s administration.
Vaccine developers are unsurprisingly opposed to the waiver and maintain that manufacturing capacity not intellectual property is the real bottleneck in scaling up vaccine supply.
Even if there was agreement that intellectual property could be waived, it would take a long time to build the expertise and manufacturing capacities, so in essence, this is not a solution in the short term.
The editorial suggests that the onus will fall on governments that provided public funding for COVID-19 vaccine research and development to require companies to engage in technology transfers to scale up vaccine production globally.
The editorial then goes on to consider vaccine hesitancy, which would be another hurdle which COVAX will require to overcome.
16,000 Oxford AstraZeneca vaccine doses had to be discarded in Malawi after people withdrew from vaccination as a result of the fear of blood clotting.
The editorial also suggests that vaccine availability will also depend on adequate logistics and distribution chains, which are not currently in place.
The editorial finally suggests that if vaccine production is not scaled up, COVAX will struggle to compete with the power of countries better equipped to negotiate unilateral deals.
However, considering that leaving large parts of the world’s population unvaccinated may favour the existence of SARS-CoV-2 variants that might elude the protection of existing vaccines, the editorial suggests that supporting COVAX at this stage would have wide ranging advantages for all nations.
The London General Practice, the leading London doctors’ clinic, commends the Government on its vaccination programme and urges all those who are eligible to be vaccinated.
It also suggests that all countries with high income should work together to ensure that the whole of the world’s population is vaccinated and free from disease.
Dr Paul Ettlinger
BM, DRCOG, FRCGP, FRIPH, DOccMed