The difficulty of vaccinating the world against COVID-19 is enormous
Uneven vaccine distribution raises concern about new variants while fuelling economic problems and unrest
As G7 ministers prepare to meet this week in Cornwall, U.K., there are renewed calls to increase global vaccine manufacturing, as well as rising concerns over a "two-track pandemic" favouring wealthier nations as vaccinations in poorer countries lag.
The World Health Organization (WHO) has long said that the pandemic ends when everyone is vaccinated against COVID-19, and it initially hoped to have 20 per cent of the global population inoculated by the end of 2021. That is looking less and less achievable, since 88 per cent of the world has not yet had a single dose, and delivering the vaccine to many populations in need is being hampered by politics and nationalism.
"I'd be worried about the 39 or 40 countries that have vaccinated only one per cent of their population," said Rohinton Medhora, president of the Centre for International Governance Innovation, citing concerns over newer variants that could arise.
"These might not be countries that are on the tips of tongues of Canadians and Americans every day. But as I've said before, this is where the bad things will emanate from."
Achal Prabhala, who studies access to medicines with AccessIBSA in Bangalore, India, notes a point towards the end of May when the pandemic's course changed. COVID-19 deaths were initially higher in wealthier countries, perhaps because they tend to have older populations. But as vaccines became available and were scooped up by richer nations, death rates dropped below those in lower-income countries for the first time. The poorest countries with the weakest infrastructure are now seeing the most deaths and illness.
Prior to that point, the world "was experiencing the same problem," Prabhala said.
"When poor countries are left to themselves for a disease that primarily affects them, it will mean that they will be worse off and have less resources to deal with that," Prabhala added.
Medhora says international cooperation is crucial to ending the pandemic, pointing to the 20-year campaign to end smallpox — which required the U.S. and then-U.S.S.R. to work together — as an example of success.
"We will need about 10 to 12 billion doses this year if we want to inoculate every adult around the world. The optimistic forecasts for production of all the vaccines that we know kind of add up to 10 billion," Medhora said. "But that still is [by] the end of the year."
Additionally, some wealthier countries are monopolizing the vaccine supply.
"It is highly unlikely that just because we produce 10 billion, everyone who needs them will get them," Medhora said.
"The estimate that I've seen is that if you want to achieve what might be global herd immunity, we're looking at 2023 to 2024 for the world as a whole," he added.
Manufacturing issues
COVID-19 Vaccines Global Access (COVAX) — a global initiative to distribute doses that's backed by the WHO, along with other health groups and national governments — was meant to fill the gap for countries unable to produce vaccines or negotiate contracts themselves. It had pledged to deliver 237 million doses to 142 countries by the end of May this year, but was only able to ship 80 million. (Canada, which does not manufacture vaccines, has supported COVAX but also drawn from it, the only G7 nation to do so.)
COVAX and the WHO are now calling on countries to donate their excess doses to help make up the shortfall.
The U.S. announced it will be offering millions of doses, and pharmaceutical company Pfizer says it will donate two billion over the next year. But the gap between vaccine "have" and "have not" countries remains a problem.
WATCH | COVAX chair asks Canada and other countries to donate surplus doses:
Bangladesh, for example, with a population of 163 million, only received its first shipment of 100,000 Pfizer vaccines on May 31.
Part of the reason for the shortfall in vaccine deliveries to some nations, both directly and through COVAX, is that it is a complicated business to make and distribute them, says Prabhala.
One of the issues is that vaccines are protected by intellectual property laws, and only facilities licensed by the pharmaceutical companies that own the patents are permitted to make them.
"So somebody has to literally give you the permission to make a vaccine," Prabhala explained, noting that manufacturers also need access to raw materials and infrastructure.
"And none of this can happen unless the technology is shared."
Some countries are calling for a waiver to be signed by member nations of the World Trade Organization (WTO), due to the unique circumstances of the pandemic, allowing other manufacturers to make and distribute the vaccine without licences from the pharmaceutical companies that own the patents.
U.S. President Joe Biden has supported the idea. However, a majority of WTO countries, including Canada and Germany, have not. All WTO countries must vote in favour of the waiver for it to pass.
WATCH | Joe Biden backs waiving vaccine patents:
"And so the kinds of things I'm working on right now are to say, this is great that we started the conversation, but please, let's finish it because it's a long, long way from being done," Prabhala said.
"I would argue that the vaccines that we now have on the market were not developed only by the pharmaceutical companies," Medhora added. "They were heavily subsidized by taxpayers in many countries, including ours. Therefore, some of that intellectual property does belong in the public domain."
Pharmaceutical companies argue that opening up the patents won't speed up vaccinations, due to a lack of global manufacturing capacity and raw materials for vaccines.
India, a global leader in vaccine manufacturing, was responsible for fulfilling COVID-19 vaccine contracts for COVAX before the country was engulfed in its deadly second wave. It cancelled its export contracts to focus on manufacturing for its own population.
Countries waiting for doses from COVAX, particularly those in Africa, have fallen behind other countries that have been able to negotiate contracts directly with vaccine manufacturers.
"One of the problems is that any country that woke up late to understand that it needs a large supply of vaccines is now at the back of the queue," Prabhala said.
In response, on Tuesday the Mastercard Foundation announced a donation of $ 1.3 billion in partnership with the African Union Centre for Disease Control to help bring more doses to the continent. That money will help vaccinate 50 million people, and boost local vaccine manufacturing.
Global inequalities
The inequality of vaccine distribution is more than a health issue. It's causing economic problems and fuelling unrest.
In Venezuela, where just 11 per cent of the population has received one shot, people are protesting and demanding the government secure more vaccines. Venezuela has not received any doses from COVAX yet, has refused AstraZeneca due to health concerns, and the U.S. will not allow any of the vaccines it is donating to other nations to be used there.
Dr. Julio Castro, an infectious diseases specialist in Caracas, says the country is hoping to receive 11 million mRNA doses from COVAX between July and December.
Meanwhile, Venezuelan president Nicolas Maduro announced the arrival of vaccines from China and Russia last month, as well as the beginning of a national vaccination campaign, but a weak health care system and infrastructure could hamper the rollout. There are also concerns about the worsening humanitarian crisis in the country involving a mass exodus of people, including doctors, along with growing malnutrition and calls for aid.
Dr. Castro says he is seeing a growing black market in vaccines, with people selling doses for hundreds of dollars online and administering them in people's homes. "This is irregular, unethical, and this is dangerous for people."
Nigeria, in contrast, has relied on COVAX and the African Union for its doses. So far, less than one per cent of its population is vaccinated.
"Nigeria has some vaccines," said Edwin Ikhuoria, Africa Executive Director at the ONE Campaign, an organization working to eradicate preventable disease. "But we are yet to distribute about 50 per cent of them, simply because the government of Nigeria decided that we don't know when the next batch will come."
Ikhouria says COVID-19 is having a major economic impact on Nigeria, with exports drastically reduced. Unemployment has risen to 33 per cent and urgent action is needed.
"I don't get any help from anybody, I don't get help from any government, I am on my own," said Nafisat Iliyasu Adamu, 30, who lost her job at a bank in November 2020. She has since been living in a guesthouse in Abuja.
"It's very scary. How can a young woman like me survive without a job?" she said, noting that high unemployment has also resulted in an increase in crime and violence. She says people need to get vaccinated to bring the economy back.
Ikhuoria says that the best-case scenario sees the pandemic ending in 2022, if countries come together and help those struggling. If governments continue to take a nationalistic approach, "we might go on like this for the next four or five years."
While countries like the U.S. and Canada are thinking about easing pandemic health measures, Ikhuoria says officials have to remain mindful of what is happening in other parts of the world so no one is left behind.
"As long as this virus remains in those places, it [will] continue to mutate. It will come back to your own population in the long run, and every effort you've made before will be wasted."
He also makes an economic argument for helping other countries with their rollouts.
"Once the virus is rampaging in other places of the Earth, everything that Canada needs from those places or is supposed to be selling to those places will not be there," he said. "The sooner we deal with the pandemic everywhere, the sooner the world returns to normalcy."
Ikhuoria says he hopes the sentiment that began the pandemic can help end it: We are all in this together.
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With files from Adrienne Arsenault