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The Global Vaccine Drive Is Failing. Can It Be Saved?

The Global Vaccine Drive Is Failing. Can It Be Saved?

Thursday, 16 September, 2021 - 05:00

On Monday night, The Washington Post reported that President Biden next week will host a virtual summit at which he plans to call on world leaders to recommit to ending the coronavirus pandemic, chiefly by vaccinating 70 percent of the global population by next September.

Those leaders have their work cut out for them: Nine months after the first Covid vaccine was approved for use, most of the world’s 7.8 billion people have yet to receive even a single shot.

Why is it taking so long to vaccinate the world, and how could it be done faster? Here’s what people are saying.

When will there be enough doses?

From the beginning, a shortage of doses has been the key constraint on the global vaccination drive. Vaccine makers around the world, including those in Russia, China and India, have predicted that they will produce a total of 12 billion doses by the end of 2021, according to Duke University’s Global Health Innovation Center. And if those 12 billion doses were actually made and distributed equitably, Biden’s goal could be met. But, the Duke institute wrote, “those are both big ifs.”

Where things stand: So far, just 5.76 billion doses have been administered. In June, Biden announced an effort to expand manufacturing capacity, most of it in the United States, to “vastly increase supply for the rest of the world.” But as of August, the administration had spent less than 1 percent of the money that Congress appropriated for that purpose, an analysis by the AIDS advocacy group PrEP4All found.

“This lack of attention to executing a robust vaccination strategy abroad is arguably one of their biggest missteps with regard to Covid,” Representative Raja Krishnamoorthi, Democrat of Illinois, told The Times. Krishnamoorthi is one of 116 Democrats who have called for allocating $34 billion to increase vaccine manufacturing capacity in coming legislation.

But the world may reach its supply targets soon enough without additional US intervention. After a painfully sluggish start, vaccine manufacturers are now producing 1.5 billion doses every month, according to the International Federation of Pharmaceutical Manufacturers and Associations. By January, the organization estimates, there will be sufficient vaccines produced for every adult on every continent.

“Global inequities in vaccine access have been a crisis for all of 2021, but we are seeing a sightline to a time in early 2022 to where that vaccine global shortage will evaporate,” Ruth R. Faden, a Johns Hopkins professor and founder of the Berman Institute for Bioethics, told Wired. “So it’s a matter of getting through the next few months.”

Will enough doses really be enough?

Even once enough doses are produced to meet global demand, there’s no guarantee they will go where they’re needed. After all, the world produces more than enough food to feed the global population, but hundreds of millions of people still go hungry every year because of unequal access.

So far, the global vaccine rollout has been plagued by its own staggering inequities: Of the 5.76 billion doses given around the world, 80 percent have been administered in high- and upper-middle-income countries, while just 0.4 percent have been administered in low-income countries.

“In most high-income countries, at least half the populations are fully vaccinated,” Dr. Krishna Udayakumar, the founding director of Duke’s Global Health Innovation Center, told The New Yorker recently. “In most low-income countries, they’re really looking at only two shots per 100 people. You’ve got something like a fiftyfold difference in terms of access.”

Covax, the United Nations-backed program to vaccinate the world, was billed as a preventive solution to this kind of disparity, promising to deliver two billion doses by the end of 2021. But Covax is failing to meet even that fairly modest goal: The program has delivered just about 271 million doses, a little more than a third of its target for this point in the year, and its forecast for the rest of 2021 was slashed by roughly a quarter last week.

Vaccine hoarding has hobbled the program since its inception, as The Times’s Benjamin Mueller and Daniel E. Slotnik report. Rich nations competed in a vaccine-buying race, paying premiums to secure their own shots — and often far more of them than they needed — directly from vaccine makers. At the same time, rich nations slow-walked financial donations that Covax needed to sign its own deals. And now, several of those countries are considering or have already started administering booster shots, which threatens to cut even further into Covax’s supply.

Even with boosters, though, the United States, Britain, European nations and others could satisfy their own needs and still have an estimated 1.2 billion excess doses by the end of the year. The United States, for its part, has either donated or pledged about 600 million doses to other countries, which the Biden administration is quick to point out exceeds any other country’s commitment. But only 115 million of those doses have actually been donated, or about 1 percent of the 11 billion doses the world needs.

“We’re patting ourselves on the back for doing the bare minimum and doing more than any other country, but that’s not a great mark,” Matthew Rose, the head of US policy at the Health Global Access Project, told The Washington Post. “If everyone’s failing, then we’re all failing together. We’re just the head of the people failing.”

Covax has also suffered from administrative and logistical problems. In Chad, for example, the program delivered 100,000 doses of the Pfizer-BioNTech vaccine in June, but five weeks later only 6,000 of them had been administered. Like many countries, Chad cannot move Pfizer doses outside major cities because of demanding storage requirements.

“The vaccine pileup illustrates one of the most serious but largely unrecognized problems facing the immunization program as it tries to recover from months of missteps and disappointments: difficulty getting doses from airport tarmacs into people’s arms,” Mueller and Rebecca Robbins reported for The Times last month.

It hasn’t helped that bureaucratic barriers imposed by Covax’s leadership have held up the disbursement of $220 million for countries to buy freezers. Nor has it helped that the Biden administration is funding its donation of doses by diverting hundreds of millions of dollars promised for vaccination drives in poorer nations. That has left countries with even fewer resources to transport doses to clinics, train people to administer shots and persuade people to get them.

What to watch for

To vaccinate the global population quickly, Biden and other leaders of rich countries will have to take these four key steps, argues Seth Berkley, the chief executive of the nonprofit organization that leads Covax:

Honor promises to donate doses now: Of the 600 million doses pledged to Covax so far, only 100 million have been delivered. More is needed, he says, and soon.

Enforce transparency: Covax has agreements with vaccine manufacturers for more than four billion doses, but it has often faced delays in getting them — potentially because manufacturers are giving preferential treatment to countries that have signed their own deals.

Make global vaccine access the first priority: Countries with pending orders for doses that they do not need should allow Covax to take their place in line.

Provide financial and technical support: Strengthening national health systems in lower-income countries to get shots into arms will not only help end the pandemic sooner but also leave in place systems that can be used to guard against future global health threats.

As the global supply of vaccines swells to meet demand over the coming months, Udayakumar, the Duke doctor, believes the fourth step may prove the toughest. “We’re nowhere near having the capacity in most low- and middle-income countries to be able to ramp up vaccinations at scale,” he said. “That’s not an excuse to keep supply away, but it should be a sign that we need to do more in terms of building capacity, so that every country is ready to ramp up vaccination as the supply is available.”

The New York Times

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