Growing vaccine nationalism in major producers such as India are hitting the world’s most disadvantaged nations the hardest, leaving them waiting for millions of doses promised through a WHO-backed inoculation initiative.
The plans to keep more vaccine supply for domestic use are exacerbating what the WHO’s head this week called a “grotesque” supply chasm between rich and poor nations, dealing another blow to the prospect of global solidarity in fighting the COVID-19 pandemic.
The world’s biggest vaccine manufacturer, India’s Serum Institute, is a key supplier to COVAX, a program through which 2 billion vaccine doses are supposed to be distributed to middle and low-income countries, many of which have no ability to sign procurement contracts on their own.
Illustration: Yusha
These plans are now threatened by India’s decision to pare back shipments so that more supply can be kept for domestic use as a new wave of infections emerges and the government expands inoculation to all aged 45 and above.
Serum’s emergency license granted in early January does not allow it to fulfill export orders without a nod from New Delhi.
Developing nations from Kenya to Brazil — where deaths have surged past 310,000 — have been left waiting for doses after only a fraction of those promised have been received, according to data from Gavi, the Vaccine Alliance, one of the WHO’s COVAX partners.
The shortfalls are mainly of AstraZeneca’s vaccine, which Serum makes, not other vaccines ordered by COVAX, such as the Pfizer-BioNTech vaccine, Gavi data showed.
Most of COVAX’s initial allocations of the Pfizer-BioNTech shot have been received by countries, the data showed, although many developing nations cannot handle their mRNA vaccine given the deep freeze logistical requirements.
India’s pivot mirrors the EU’s consideration of controversial restrictions in response to criticism of its chaotic, slow immunization campaign.
Both places have exported more shots than they have administered at home, and are coming under domestic pressure as infections surge again — although the EU has pledged that its new rules would not affect COVAX shipments.
Hope for vaccine equality and solidarity is imploding, said Fiona Russell, principal research fellow at the University of Melbourne and group leader for Asia-Pacific health at the Murdoch Children’s Research Institute.
“We’ve seen that already because it’s being sucked up by Europe, and now India and the US, so the supply to the rest of the world doesn’t go anywhere. It’s a huge issue,” Russell said.
VACCINE DIPLOMACY
In the past few months, India has attempted to burnish its global image through vaccine diplomacy, challenging China for political influence across the developing world.
Indian Minister of External Affairs Subrahmanyam Jaishankar touted friendship and solidarity through “Made in India” vaccines that were arriving in countries from Bolivia and South Sudan to the Solomon Islands.
However, after the country shipped or donated more than 60 million doses of COVID-19 vaccine, India’s exports have slowed to a trickle.
Growing criticism of the speed of its own immunization campaign and a fivefold increase in new virus infections over the past month spurred the change, said government officials familiar with the matter who asked not to be identified as the decision has not been publicly announced.
“Both these things are linked,” said Shahid Jameel, director of the Trivedi School of Biosciences at India’s Ashoka University. “At a time that a surge is happening in India, there is pressure on the government.”
Gavi on Thursday said that increased demand for COVID-19 vaccines from India was behind delays in authorizing further export licenses from its main supplier, Serum.
“COVAX is in talks with the government of India with a view to ensuring deliveries as quickly as possible,” a Gavi representative said.
The Indian Ministry of Health and Family Welfare declined to comment through a spokesperson.
THE US AND MEXICO
A domestic-focused stance is evident in the world’s most powerful economies and there are signs that vaccine diplomacy is being used to achieve government aims. The US has ordered almost enough shots to inoculate every American adult twice, and it is still adding to its coffers.
While there is no restriction against exporting shots made in the US, companies are required to fulfill their contractual obligations first, officials from US President Joe Biden’s administration have said.
Earlier this month, the US said that it plans to send 4 million doses of the AstraZeneca vaccine to Mexico and Canada, potentially its first exports.
The deal, which would send 2.5 million doses to Mexico, was floated at the same time that the Mexican government agreed to crack down on the flow of migrants north through the country and to the US, where a humanitarian crisis continues to brew on the border.
“Every government is accountable to its own citizens,” said Jaspreet Pannu, a resident physician and a global health and biosecurity researcher at Stanford University’s Department of Medicine. “It’s very difficult for national governments to keep the global good as their main priority. It’s very tempting for national governments to break off on their own because of the ways the incentives align.”
NOT ENOUGH
Since Ghana became the first country to take delivery of 600,000 COVAX-supplied shots last month, the program has distributed more than 32 million doses to 60 countries, but officials said that supply limitations are holding it back.
“The problem we have, quite frankly, is we cannot get enough vaccine,” Bruce Aylward, a senior WHO official, told a news conference on Monday last week, specifically identifying Serum and AstraZeneca as the holdups.
“Right now the manufacturers are unable to keep up with our orders,” Aylward said.
COVAX’s troubles have left developing countries, some of which were relying entirely on the initiative to access immunizations, at a loss and scrambling to secure orders on their own.
Pakistan was in line for 45 million doses through COVAX. The first shipment, due this month, has now been indefinitely delayed, Pakistani Minister for Planning, Development, Reforms and Special Initiatives Asad Umar said on Thursday.
Vietnam, which had been promised 1.37 million doses on Thursday, would now get 811,200 in three weeks time, local UN International Children’s Emergency Fund representative Rana Flowers said.
These shortfalls come despite supply being relatively abundant globally. Production from 13 vaccine makers could rise to 12 billion doses by the end of the year, a study from Duke University’s Global Health Innovation Center found.
That would be enough to inoculate 70 percent of the world if distributed equally — an aim that the WHO is struggling to achieve.
“There is such an urgent need for more balanced access to vaccines,” said Andrea Taylor, who leads COVID-19 research at Duke’s Global Health Institute.
“We can’t allow a significant portion of the world to wait six months or a year or more to get vaccinated,” Taylor said. “It just gives the virus more opportunities to evolve in ways that could greatly prolong the pandemic for everyone.”
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