Sep 4th 2021
FOR MUCH of this year, the global distribution of co vaccines has been enormously inequitable. The rollout has been a two-speed affair, with richer countries in the fast lane. Today, in low-income countries, less than 2% of adults are fully vaccinated, compared with 50% in high-income ones. A new analysis from Airfinity, a life-sciences data firm, spells out the startling implications: if rich countries do not redistribute surplus vaccine this year, between 1m and 2.8m lives could be lost as a result.
The data show that G7 countries could redistribute 500m doses by the end of September, and up to 1.2bn doses by the end of the year. Moreover, Bruce Aylward, a senior adviser at the World Health Organisation, says this surplus is actually an underestimate because it takes into account only supplies to the G7, and not the whole world.
The analysis was done by looking at the output of vaccine factories on a daily and weekly basis and the number of doses procured by G7 countries. The supply is vastly larger than countries will be able to use. The analysis generously assumes that children over the age of 12 will mostly be vaccinated, and everyone is offered a booster shot after six months. Rasmus Bech Hansen, the boss of Airfinity, says that even with these unlikely assumptions the number of surplus doses is “extraordinary”.
He says that countries have been stockpiling because of past uncertainties over supply. As vaccine production ramped up at the start of the year, supplies were small and unreliable. All that has changed. Today more than 1bn doses a month are reliably produced, and this will continue to increase every month this year. In November 2021, the world will make 1.5bn doses of co vaccine. This is more than all the vaccines made in the first four months of this year.
If this rate of production continues there will be a glut of vaccines by the middle of next year. This year the world will make about 12bn doses, and it has the capacity to make the same amount again by June 2022. To fully vaccinate 80% of the population above the age of 12, only 11.3bn doses are needed.
With output now reliable, Mr Bech Hansen thinks the world has reached a “tipping point” in production, and that high-income countries can be confident about supply. Dr Aylward says the goal is to achieve 10% coverage in all countries by the end of September, and at least 40% by the end of 2021. Vaccinating 10% will cover health-care workers and the elderly; vaccinating 40% will cover most at-risk groups, including people with comorbidities, and reduce death rates enormously. Reaching this target will require only between 2bn and 2.5bn doses this year.
Yet Covax, the biggest buyer of vaccines and supplier of them to poorer countries, has struggled to get hold of doses it has bought and has shipped only 230m this year. It faces a variety of difficulties. A critical one has been that its most important suppliers, in India, have been prevented from exporting by their government. Seth Berkley, head of the vaccine-finance group Gavi says Covax invested more than $1bn in Indian vaccine production, and helped with the technology transfer. But, he says, “there is no answer out of India on what they are going to do.”
Although India has now vaccinated 47% of its population aged 12 and over with a first dose, it has so far failed to say when exports will resume. This lack of clarity now means that Covax is currently struggling to project precisely how much it can distribute this year.
Donations, to the tune of 100m doses, have acted as a stopgap while Covax waits for the arrival of the doses it has contracted to buy. Discussions are under way about a summit that the Biden administration intends to convene to discuss global vaccine distribution. One source says it will take place on September 20th. This is expected to tackle the immediate vaccine-supply gap in poorer countries.
Yet, although vaccine donations are urgently needed, Dr Aylward argues that Covax ought to be getting its orders directly from the firms themselves, rather than as donations from third parties. He urges a more rational approach: that countries swap early-delivery contracts with Covax. Australia has been doing exactly this with Britain, Poland, and Singapore. Australia needs vaccines now but is not yet scheduled to receive deliveries. It has, therefore, swapped its contracts with countries that can get delivery more immediately but do not need vaccines now. Other countries urgently need to make similar arrangements.
In the months to come, it seems likely that America will want to try to play a leading role in sorting out the global vaccine supply. The country’s early vaccine nationalism allowed China to project itself as a benevolent global leader by sending an abundance of vaccines overseas. A geopolitical win for America would be especially useful after the debacle in Afghanistan.
On September 2nd America said it would invest $3bn in the vaccine supply chain to position itself as a leading global supplier of vaccines. The money will be spent on American suppliers that make the ingredients for vaccine production, as well as on sites that fill and finish vaccines. This is probably as much for economic as political reasons. As the start of next year approaches, the supply of vaccines will grow so large that, if they are plentiful enough, more popular vaccines will have the opportunity to push the less popular ones out of the market.
It is fairly clear that the mRNA vaccines are widely seen as the most effective and desirable around the world, whereas Chinese vaccines are seen as an inferior product that works less well. By supporting American mRNA manufacturing, the government can also help these vaccines win in the competitive market to come.
Yet vaccine geopolitics aside, the moral case for vaccines to flow quickly to lower-income countries could not be clearer or more urgent. The two-speed world means that as cases of Delta surge everywhere, the burden of death is falling heavily on the poorest.