Where are vaccines going?

Policy Monitor, March 18th 2021

By Luke Lythgoe, GCPPP staff

“Everyone, everywhere… should have access as quickly as possible, starting with those at highest risk of serious disease or death.” That is the vision of the World Health Organization: a truly global, highly choreographed rollout of life-saving Covid-19 vaccinations. WHO has recommended “an initial proportional allocation of doses to countries until all countries reach enough quantities to cover 20% of their population” — i.e. those most vulnerable to serious illness and death.

National vaccination rates, however, show a very different picture. Israel has now administered 110 doses per every 100 of its citizens. A handful of other wealthy countries look to be catching up. Meanwhile many low-income countries have not received a single dose.

Why such uneven distribution? Many wealthy democracies have been accused of “vaccine hoarding” to ensure their populations receive shots as swiftly as possible. Production remains limited and principally located in rich nations, who face political pressures to vaccinate their citizens first, especially when they have used taxpayers’ money to support vaccine research and manufacturing. With drug companies resisting pleas to waive their vaccine patents during the crisis preferring instead to sell at low or no profit margins, this is unlikely to change radically. As a result, many poorer countries are taking advantage of the so-called “vaccine diplomacy” pursued by Russia, China and others. Diplomatic competition, however, may not prove such a bad thing. This article first catalogues the “hoarders”; then looks at how the collective COVAX programme is going; and finally catalogues the current state of vaccine diplomacy.

Our-citizens-firsters

The US has refused to export vaccines even to close allies including Canada, Mexico and the EU. President Joe Biden has rehearsed the WHO line that Americans would not be safe “until the world is safe”. He nevertheless insisted: “We’re going to start off making sure Americans are taken care of first, but we’re then going to try to help the rest of the world.”

British prime minister Boris Johnson has also come under fire for telling the G7 his country would eventually send “surplus” vaccines to poorer countries. Critics have urged him not to make other nations wait.

The UK, where doses of the AstraZeneca vaccine and part of the Pfizer vaccine are manufactured, has also been accused by the EU of blocking vaccine exports — which the UK government denies.

In reality the UK has no need to do this. Savvy deals with suppliers have created the same effect by different means, say legal experts, giving the UK an effective monopoly over vaccines produced on its shores. These contracts then force companies to make good any shortfall in supply from factories elsewhere. As a result, by far the most vaccines exported from EU sites are going to the UK: almost one-third of EU exports during February. The UK is also importing vaccines from India. Meanwhile, for deliveries to EU countries even from EU-based factories AstraZeneca only has an obligation to make “best reasonable efforts” at honouring vaccine orders, and so has fallen far short thanks to pressures from other contracts and supply glitches.

The squeeze on vaccine supply in the EU risks member states implementing their own export restrictions. However, so far only one case of this has occurred, with Italy blocking the shipment of 250,000 doses to Australia.

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Israel has emerged the champion of vaccine supply deals. Despite having no vaccine production of its own, Israel moved quickly to do a mutually beneficial deal with Pfizer. Its government was willing to pay over the odds and promise access to its citizens’ health data in return for early, secure supplies, thus creating an ongoing clinical trial. Israel also made a strong pitch that its modern, digitally connected public health system was capable of rolling out Pfizer’s product rapidly to its 9 million citizens. Prime Minister Benjamin Netanyahu’s personal relationship with Pfizer CEO Albert Bourla no doubt also helped.

Global order

Unfolding in parallel to wealthy nations’ scramble for jabs is COVAX, a programme dedicated to the WHO’s original equitable vision of a global vaccine rollout, itself funded by those wealthy nations but supplied by factories elsewhere.

COVAX buys up vaccines using funding from donor countries, with the US, Germany and UK currently contributing the most money. Ninety-two low and middle income countries (LMICs) are eligible for heavily subsidised vaccines through the programme at less than $2 per dose, while other states can still participate but must pay an estimated $11 per dose. So far Canada is the only G7 country to have taken this option.

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The first wave of COVAX deliveries began in February and will run up until May. Ultimately, the programme aims to deliver 2 billion doses by the end of 2021.

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However, COVAX’s initial target will buy up enough doses to vaccinate only 20% of members’ citizens. Furthermore, the timeline for that modest target could be stretched by a lack of global supply due to wealthier nations’ procurement strategies: according to a study in The Lancet countries representing just 16% of the global population have secured at least 70% of the doses available in 2021 for five leading vaccines. Many countries are therefore looking elsewhere for vaccine access.

Vaccine diplomacy

Having in August 2020 won the worldwide race to approve a vaccine, Russia reports that it has since received requests for 2.4 billion doses of its Gamaleya “Sputnik V” vaccine from over 50 nations. There are so far agreements to send 392 million doses abroad, with talks ongoing for another 350 million.

However, there is a difference between doses promised and doses delivered. Mexico signed a deal for 24 million Russian doses and was hoping to receive 400,000 in February but got only 200,000. Delays and shortfalls have also been reported by Argentina, Hungary and others.

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China has now begun to eclipse Russia in vaccine diplomacy. China’s Sinovac and Sinopharm jabs, which use the older method of exposing the body to inactive virus particles rather than the DNA or mRNA techniques used by other Covid vaccines, are now being deployed in around 50 countries. This is despite concerns over efficacy and lack of transparency.

Adopting the Chinese vaccines benefits low and middle-income countries for several reasons: those doses are not being hoarded by Western countries; delivery has so far proved more reliable than Russia’s; and unlike many vaccines these can be stored in a standard refrigerator. Meanwhile, China benefits from countless PR pics of handover ceremonies between world leaders and Chinese officials.

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Vaccines provision is proving particularly embarrassing in the EU, where Hungary and Slovakia have welcomed Russian vaccines and Italy is in talks to manufacture Sputnik V itself. EU applicant Serbia will become the first European country to manufacture a Chinese vaccine. As their own rollout falters, EU officials are reportedly even considering using Russia’s jabs to plug the gap.

India is meanwhile undertaking its own vaccine diplomacy. Alongside its contribution as a major manufacturing site for the COVAX programme, India has now exported over 8 million doses as grants to LMICs and almost 34 million through commercial deals.

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Israel has also flirted with the idea of advancing diplomatic interests with its surplus vaccines. Netanyahu’s initiative was temporarily halted by a legal backlash, but not before a shipment had made its way to Honduras.

More politics, more vaccines?

Other countries are already moving to counter vaccine power politics. A plan announced on March 12th by the so-called “Quad” nations — the US, Japan, India and Australia — will jointly fund, manufacture and distribute 1 billion vaccines in South-East Asia.

This move to balance Chinese influence is only in its early stages. But it shows that policies on global distribution of vaccines have further to evolve. As wealthy our-citizens-firsters immunise the bulk of their own citizens, might a contagion of geopolitical rivalry finally deliver the doses low-income countries so desperately need?