In late December, Guinea, a West African nation, injected 25 of its senior officials with doses of the Russian Sputnik V COVID-19 vaccine. Not shaken by security concerns, national leaders went to state TV to celebrate.
“We are the guinea pigs,” said one.
Almost a month later, there has still not been a single dose of a licensed western vaccine administered on the continent of Africa – even though some 60 million doses have been given worldwide.
This drastic disparity represents a result long feared by public health experts. It also highlights the colossal challenge ahead for the global coalition, known as COVAX, struggling to secure doses of vaccine for the world’s poorest nations.
“The price of not solving the problem of international distribution of the vaccine will be measured in lives,” said Thomas Bollyky, director of the Council on Foreign Relations’ global health program.
Even before the arrival of vaccines, the spread of the coronavirus revealed the advantages that rich nations enjoy in securing essential resources such as hospital ventilators and personal protective equipment for medical workers.
The same dynamic occurred in the global race to accumulate doses of vaccines.
A small group of rich countries – comprising just 16% of the world’s population – have blocked 60% of the global vaccine supply, according to the Global Health Institute at Duke University.
Canada has already pre-ordered enough potential doses to vaccinate its entire population almost six times, and the United States has enough purchase options to vaccinate all Americans almost five times, according to the institute.
The accumulation of vaccine doses left the rest of the world confused.
Australia, Canada and Japan account for 1% of the world’s coronavirus cases, said Bollyky, but they have accumulated more doses than all of Latin America and the Caribbean, which has about 20% of cases. The death rate from coronavirus in Africa rose to 2.5% this week, officials said, surpassing the US rate of 1.7%.
“What happened here is that nations have decided to be more concerned with the reactions of their populations at home than with what needs to be done to control this pandemic,” said Bollyky, author of the book “Plagues and the Paradox of Progress. “
This “vaccine nationalism” has serious consequences, according to public health experts like Dr. Larry Brilliant.
Brilliant, a leading epidemiologist who helped eradicate smallpox, said the accumulation of vaccines by rich countries could trigger a tragic boomerang effect.
“Being at the front of the line doesn’t help as much as ensuring that everyone crosses the line,” said Brilliant, founder and CEO of Pandefense Advisory, a group of experts working to combat the Covid-19 pandemic.
“Until everyone in the world is safe, nobody is safe,” added Brilliant. “This is a pandemic. If a country is not vaccinated, the disease will spread back and forth. And we will all be constantly surrounded by him. “
COVAX was formed precisely for this reason.
The coalition’s initial goal, which includes global health groups like the World Health Organization and more than 190 nations, is to buy 2 billion doses by the end of 2021 to inoculate 20% of the population in the roughly 100 poorest countries.
“It is the biggest logistical challenge on a scale that we have not seen before in global public health,” said Gian Gandhi, COVAX coordinator for UNICEF, who is leading the group’s efforts to purchase and deliver vaccines.
The total cost is expected to reach $ 17 billion, Gandhi said, but the coalition has only $ 2 billion in hand and has not yet received a single dose of the coronavirus vaccine, despite having agreements in place to secure 1.97 million. of doses.
COVAX, however, made further strides this week.
The coalition announced on Friday that it had signed an advance purchase agreement with Pfizer for up to 40 million doses of its vaccine. COVAX also said it would exercise the option of receiving its first 100 million doses of the AstraZeneca vaccine.
And earlier in the week, newly elected President Joe Biden announced that the United States would reestablish ties with WHO and join the COVAX coalition, in a reversal of the Trump administration’s policy.
But the coalition is still several billion dollars without the money it needs to achieve its ambitious goal.
“He doesn’t have the funding and the resources he needs,” said Brilliant.
The COVAX initiative was born in part from a history lesson – an attempt by the global community to prevent rich countries from monopolizing vaccines in bilateral agreements, as they did with swine flu vaccines in 2009.
The concept resembles a financing pool, where members pay a central fund in exchange for enough vaccines to immunize 20% of its population.
For wealthy countries that can trade their own supplies, it is insurance in case a vaccine candidate they pre-ordered is not approved by regulators. But for the world’s poorest countries, COVAX is a lifeline – the only viable way to receive doses of vaccine.
The distribution of COVAX will be carried out from the largest humanitarian deposit in the world, a donation to UNICEF from the Danish government. The space spans three soccer fields, stacked above a medium-sized building, with products ranging from syringes to therapeutic foods, soccer balls to water-drilling equipment.
A box of supplies can travel from the Copenhagen hub to anywhere in the world in 72 hours. The vaccines – once guaranteed – will be sent directly by the manufacturers.
With the world’s rich countries accumulating vaccines, COVAX has resorted to requests for donations of viable doses from rich countries – the sooner the better.
“If there are vaccines that are not used and are being saved for a rainy day, they should be donated, because more can be produced,” said Gandhi, head of market modeling and supplier financing at UNICEF.
Both Canada and the European Union said they were willing to donate surplus vaccines, but nothing has been consolidated. According to UNICEF, COVAX has not received donated vaccines.
Meanwhile, some nations that are struggling to gain access to vaccines are doing what Guinea has done, resorting to less regulated vaccines from China and Russia.
State-supported doses already have buyers in more than a dozen different middle-income countries, including Argentina, Mexico, Turkey, Brazil and Egypt.
“The challenge we have with COVAX is that it is currently a charitable company,” said Bollyky. “At the end of the day, charity will appear to many politicians and national leaders as a second-rate issue.”
“Until we recognize that the success of this initiative is in our interest…. we will not see the types of investment and types of behavior of national leaders that we need to see in order to make progress, ”added Bollyky.
One of these arguments is purely economic. According to RAND, global GDP would fall by nearly $ 300 billion each year if only high-income countries could be vaccinated, with losses of $ 30 billion specifically for the United States. But if high-income countries paid for vaccine supplies, they would receive $ 4.8 back for every $ 1 spent, estimated the nonprofit policy research organization.
There are also many secondary consequences if developing nations are left unprotected. If COVAX cannot vaccinate frontline health workers in developing nations, it could disrupt long-standing vaccination programs, said Gandhi, leading to a resurgence of diseases like measles and polio, which the world is close to eradicating. .
But the biggest consequence of an uneven global vaccination is a protracted pandemic. Failure to vaccinate in Mali or Mozambique could mean a resurgence of the virus in America, putting at risk a large number of people who do not want or cannot get the vaccine, such as children and immunocompromised people.
“No child and no individual is safe,” said Gandhi, “until everyone is safe.”