The global launch of coronavirus vaccines has never been easy. But it quickly turned into frustration at home and nationalist acrimony abroad, as countries around the world deal with a whirlwind of logistical and political challenges.
All 50 U.S. states are reporting shortages, as America’s fragmented health and administrative systems struggle to distribute even the limited vaccine stocks that have been produced.
Europe has plunged into its own ugly supply struggle. And there are few signs that the world’s poorest countries will have access soon, perhaps not until 2023.
Some in Africa, South America and Asia have turned to China and Russia, which are using vaccine diplomacy to increase their influence in these parts of the world, say some experts.
In the United States, “the launch is slow and strange and very frustrating for our population,” said Dr. Tom Kenyon, a former director of the CDC Global Health Center.
Washington should be in a better position to immunize its citizens, having ordered 1.2 billion doses while working hand in hand with pharmaceutical giants. Still, the United States is behind Israel, the United Arab Emirates, the United Kingdom and Bahrain in per capita shots.
Its problems are largely twofold: manufacturing and distribution.
As in Europe, the American supply has been strangled as pharmaceutical companies struggle to keep up with the clamorous demand, sometimes promising too much before having to reduce orders.
“They probably did not do a very good job of communicating correctly, managing expectations and being transparent,” said Maria Elena Bottazzi, associate dean at the National School of Tropical Medicine, part of the Baylor College of Medicine in Houston.
But what worries the U.S. especially, according to experts, is that its health care system is not centralized and President Donald Trump’s government has failed to build an appropriate national vaccine deployment plan to fill the gap.
Having inherited what some experts describe as one of the best pandemic preparedness plans in the world, Trump fired his top biosafety adviser, allowed his global health facility to be dissolved and minimized the coronavirus during the crucial first weeks of the outbreak last year. .
The result today is chaotic confusion when it comes to vaccines, so that criticism goes where states, counties and hospitals were left on their own.
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“We have a very divided approach,” said Kenyon, who is now the health director for Project HOPE, an international global and humanitarian health organization. “In fact, we have been competing with each other to get the vaccine. This is not ideal in any sense.”
These concerns must be seen in context, however. Under Trump’s supervision, vaccines arrived faster and were more effective than many expected. And encouraging data keeps coming.
But at the moment, it does little to calm authorities, experts and citizens exasperated by the distribution of the vaccine, which is only exacerbated by new variants and the hesitation of some to get vaccinated.
This week, President Joe Biden announced measures to revamp the federal deployment strategy. Time will tell if that will change things.
“When it comes to coordination during a public health emergency, you see where our system has collapsed,” said Justin Ortiz, an associate professor at the University of Maryland School of Medicine, referring to the Trump administration’s records. “The idea that the previous federal government can dismiss this and trust each state to create its own systems is an abandonment of duty.”
In Europe, the situation is also worrying.
A swamp of bureaucratic infighting seems to have prevented the establishment of the European Union, which has been glacially slow and dysfunctional. Doctors in Madrid and Paris had to stop vaccinations because stocks were almost dry.
In the midst of all this, the EU and AstraZeneca are at odds after the British-Swedish pharmaceutical giant said it would have to reduce deliveries because of a manufacturing problem. The EU has insisted that the pharmaceutical company keep its word.
In a drastic measure, the EU is now trying to block exports of any vaccine from companies that did not comply with Europe’s request first. EU officials have also suggested that vaccines destined for the UK be redirected to make up for the deficit on the continent.
A dispute over logistics now risks metastasis in a complete diplomatic crisis.
“We reject the logic of first come, first served,” EU Health Commissioner Stella Kyriakides told a news conference on Wednesday. “This may work in a butcher shop, but not in contracts and not in our advance purchase agreements.”
Even in the UK, there are concerns about its seemingly successful launch, notably its decision to allow up to 12 weeks between the first and second doses.
The decision was made while the country was facing the most deadly outbreak in Covid-19. Vehemently defended by government expert advisors, the delay is much greater than that recommended by pharmacists, dividing the scientific community.
But nowhere does the picture look worse than in the developing world.
Despite all the drama in the West, delays will be measured in weeks and months. But Africa, parts of South Africa and Central Asia are unlikely to have broad vaccine coverage until 2023, according to an article published this week by the Economist Intelligence Unit, a London research group.
In addition to trying to put his own house in order, Biden joined a program led by the World Health Organization called COVAX, which raised $ 2 billion to buy vaccines for poor countries.
Seeing the United States engage in an altruistic effort shunned by Trump was welcomed by public health experts. But in reality, what COVAX needs is not just more money and kind words, but available doses and the ability to distribute them.
“American funds are welcome, but COVAX’s problems go beyond money,” said Mukesh Kapila, who was an advisor to the former director-general of WHO.