Tackling vaccine inequality: ‘There aren’t enough vaccines in the world’

As the emergence of the Omicron variant has caused a scramble for booster shots in richer nations, scientists and international organisations say tackling vaccine inequality is the only way to fight the global threat of Covid-19.

As cases continue to soar, some 120 countries have already started implementing booster programmes, the WHO's Strategic Advisory Group of Experts on Immunisation (SAGE) said Wednesday, even as WHO chief Tedros Adhanom Ghebreyesus warned that "no country can boost its way out of the pandemic”.

As Omicron gathers pace, boosters have been found to provide higher levels of protection against the variant. But administering third and even fourth doses is also exacerbating vaccine inequalities around the world.

In the six weeks leading up to Christmas, the European Union, the United Kingdom and the United States collectively received 513 million doses of Covid-19 vaccines while African countries have collectively received just 500 million all year, according to a study released this week by the People’s Vaccine Alliance, an alliance of health and humanitarian organisations.

Some 30 million people have already received a third dose of the vaccine in Britain while 19 million people have received a third shot in France. Israel announced this week that it would be offering a fourth shot to those 60 and over.

“What is important is that we make sure that everywhere around the world gets a jab,” Lawrence Young, virologist from Warwick medical school in the UK, told FRANCE 24 on Wednesday. “Omricon is a wake-up call that tells us what we’ve been hearing throughout the pandemic; that none of us are safe until all of us are safe.”

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‘There aren’t enough vaccines in the world’

Vaccine inequality means that wealthy countries have been able to respond to the threat of the virus by securing enough doses to vaccinate their entire populations several times over, while poorer countries have not. The least well-provisioned countries, which are largely in central and southern Africa but also include countries such as Afghanistan, have been able to secure first doses for barely 60 percent of their population.

Max Lawson, co-chair of the People’s Vaccine Alliance, told FRANCE 24 that the threat of Omicron has stretched vaccine supplies to the limit, worsening access for poorer countries.

“As we go into 2022, we're faced with an even bigger supply crunch – there aren't enough vaccines in the world. In this situation of scarcity, it's the most powerful with the biggest bank balances that fight their way to the front of the queue and developing countries are, once again, left behind.”

Vaccine hoarding has also meant that many pledges from richer countries to share vaccines have not been honoured. By October 2021, one study found that of the 1.8 billion vaccine doses promised by rich countries, only 14 percent (261 million doses) had been delivered.

This has since increased, with the US donating 350 million doses by the end of the year – but it still falls short of the 1.2 billion total it has promised.

“It's the single most inefficient way of vaccinating the world,” Lawson said. “Your rich countries hoard as many vaccines as they can, and then when they've got a few spare, they send them overseas.”

‘Unacceptable supply delays’

The October 2021 study also found that four major vaccine producers (AstraZeneca/Oxford, Moderna, Johnson & Johnson and Pfizer/BioNTech) have also delivered less than half of the doses they promised to the Covid-19 Vaccines Global Access programme, COVAX.

Consequently, poorer countries have faced “unacceptable supply delays” throughout 2021, said a spokesperson for the Global Vaccine Alliance (GAVI), which co-leads COVAX alongside the WHO and the Coalition for Epidemic Preparedness.

And this has not been the only problem. Some donated vaccines have failed to meet the basic criteria for use, “in particular ensuring donations have at least 10 weeks’ shelf life and come with ancillaries such as syringes, diluent and freight costs included”, explained the GAVI spokesperson, who did not want to be identified.

Doses that fail to meet these criteria are likely to go unused. Nigeria incinerated more than 1 million doses on Wednesday that, by the time they had been donated, were already "about to expire", said Faisal Shuaib of the National Primary Health Care Development Agency, a parastatal organisation linked to Nigeria’s health ministry.

Less than three percent of the adult population are vaccinated in Nigeria, and the government felt under pressure to accept the doses despite the difficulty in deploying them at such short notice.

"When these vaccines were offered to us we knew that they had a short shelf-life, but we were living in an environment where the supply of Covid-19 vaccines was very scarce," Shuaib said, adding: "They were not available due to vaccine nationalism."

‘No reason to think this will stop’

Alain Alsalhani, a vaccine and special projects pharmacist from Doctors Without Borders (Médecins sans frontières), told FRANCE 24 that COVAX’s reliance on donations, which have been meagre and irregular, means the programme has been a “total failure” for low-income countries.

Wealthier nations have naturally strived to protect their own populations as much as possible – especially at the start of the pandemic.

Crucially, high-income countries also had – and largely still have – control over the allocation of vaccines such as Pfizer and Moderna, meaning they can “easily prioritise their populations”, Alsalhani said.

“The only solution to this problem is to have a more evenly distributed production of vaccines,” he added.

Lawson believes that the main obstacle to ending vaccine inequality is “the monopoly” of Pfizer and Moderna, which essentially control all vaccine supplies through their ability to “decide how many vaccines are produced, who produces them, where they're produced, how much they're sold for and who they sell to”.

India and South Africa have advocated at the World Trade Organisation for the companies to be forced to waive the patents for the vaccines, which would mean that laboratories around the world would be able to reverse engineer them. Recently Moderna said it would not enforce its patent, effectively allowing laboratories to manufacture its vaccine, but even reverse engineering can take up to two years.

Both Lawson and Alsalhani believe that if governments pressured companies to share their technical know-how the process would be much faster – especially as Human Rights Watch reported on December 15 that there are 100 companies in Africa, Asia and South America capable of producing the mRNA vaccines.

As the virus continues to circulate, it continues to mutate. The worst-case scenario would be the emergence of a vaccine-resistant strain.

“We clearly are far from vaccinating enough of the world population to stop the circulation of the virus. And if that's the case, it means that you potentially will have new variants,” Alsalhani said. New variants could mean more boosters, or even new vaccines – in richer nations, at least.

“There’s no reason to think that this will stop,” he added.

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