Worldwide vaccination is a long way off

Breakfast with Bwana

By Anil Madan

It was inevitable that a chorus of pleas for more equitable distribution of vaccines would lead to a crescendo of exhortations that the US must take the lead in ensuring that this happens. Strangely, even though Russia (Sputnik) and China (Sinovac) have developed their own vaccines, there are no great numbers of outstretched arms looking to those nations to be the world’s saviour. The most notable recent plea is from Darren Walker, president of the Ford Foundation who, in a Washington Post op-ed piece declared that the solution is for the US to “dip into its vast reserves and vaccinate the world — mobilizing the resources of the US military and other agencies to manufacture, ship and distribute doses around the world.” It is not clear if the “vast reserves” refers to vaccines already ordered and purchased by the US, but in context, he seems to be referring to the ability of the US to manufacture enough vaccines to inoculate the world in short order.

“Even if the US military could become a major manufacturer as the president of the Ford Foundation suggests, this is not necessarily going to solve the world’s problems. Finding a way to make the Oxford Astrazeneca vaccine safe is much more likely to put India’s vast production resources into the pipeline. In the meantime, most of the world will simply have to wait until supply catches up to demand…”

Respectfully, this is a pipe dream. Manufacturing vaccines is not simply a matter of deploying soldiers to perform a task. It is a highly technology and control intensive proposition with the need for specialized equipment and sophisticated process controls. In addition, a vaccine production facility requires vast quantities of raw materials and supplies, not readily available around the world. Even with necessary equipment, raw materials and trained personnel in place, things can go wrong. In fact, recently Johnson & Johnson had to discard millions of doses of its vaccine due to a manufacturing error by a contractor.

It is a well-known fact that rich western countries such as the UK, Canada, and the US have pre-ordered millions of doses of the Pfizer, Moderna, Astrazeneca, and Johnson & Johnson vaccines. Whereas this situation has in one respect led to the laments about lack of equity, there is little that is surprising here. The simple fact is that the vaccines mentioned were produced with American, British, Canadian and European support, financing, and risk-taking when it came time to place orders. Those countries, in order to protect their citizens, hedged their bets by spending billions of dollars well before any of the vaccines were proven or approved. It would be extremely risky for any politician to be seen as failing to put his or her countrymen’s health concerns as a priority over exporting vaccines to other countries. We have seen how vaccine nationalization is playing out in the EU countries which fell short in placing early orders for vaccines and have now reacted by trying to impose export controls on vaccines.

Regardless of how many vaccines have been ordered by any country or group of countries, the practical reality is that the world’s vaccine producers cannot produce more than 2 or 3 billion doses per year. Even if Johnson and Johnson could produce one billion doses a year, that means 2 billion people could be fully vaccinated in one year, i.e. 1 billion doses of J&J and 2 billion doses of a two-shot Moderna or Pfizer vaccine. Given that the world’s population is approximately 7.7 billion, there is no chance of getting everyone vaccinated much before 2023 or 2024. Indeed, 2025 or 2026 may be a more realistic projection.

For a while, it appeared that the US would have a significant surplus of vaccines that it could share with the world. And President Biden did promise that he would indeed share with the world after domestic needs were fulfilled. Unfortunately, recent developments suggest that things are not that simple. 

Preliminary reports suggested that the US, had pre-ordered 300 million doses of each of the Pfizer and Moderna vaccines, 100 million of the Johnson & Johnson single shot vaccine which was then augmented to 200 million doses, 300 million doses of the Astrazeneca vaccine, 100 million doses from Novovax, and 100 million from Sanofi.

The latter three are not yet approved in the US. The Astrazeneca vaccine is unlikely to get emergency use authorization given the reports of blood clotting incidents and restrictions in Germany and other EU countries on administration of the Astrazeneca vaccine. It is unlikely, therefore, that until these problems are resolved, the US, could safely and credibly export such vaccines to other countries while not having approved their use within the US. And, of course, since the Serum Institute of India was on tap to manufacture billions of doses of the Oxford Astrazeneca vaccine, until the issue of blood clotting is cleared up, its production cannot be counted upon to meet the world’s needs.

Recent studies have suggested that the Pfizer vaccine is effective in children under the age of 16. At the same time, cases among those aged 12-17 have been surging in the US. This means, the focus will shift to inoculating those in that age group. 

There is also the concern that variants of the virus may require that vaccines be tweaked and that booster shots be given even to those who have received both shots of the Moderna or Pfizer vaccines. Both of those companies stand to profit immensely if booster doses are required in the US and, indeed, from making the Covid vaccine an annual ritual. Even if existing surpluses of vaccines could be made available for distribution to other countries, domestic needs in the US, Britain, Canada, Australia, Japan, and the EU will constrain availability elsewhere in the world. The available surplus from the US may be only 170 million doses (300 million Pfizer shots, 300 million Moderna shots and 200 million J&J shots = 500 million fully vaccinated). Even if these are all J&J doses so that 170 million people could be vaccinated effectively, this is a drop in the ocean when it comes to worldwide demand.

And, of course, one has to deal with the problem of how equity is determined. It has been suggested, quite rightly, that frontline healthcare workers around the world be first in line. One can expect, however, that as happened in the US, the politicians and those in power will put themselves first in line.

As of now, the Pfizer and Moderna vaccines are manufactured in the US, and in Europe. Given the ultra-cold storage temperatures required for these vaccines, export to warmer climes in Africa and Asia presents logistical and technical challenges that make distribution of vaccines immensely difficult.

Sadly, even if the US military could become a major manufacturer as the president of the Ford Foundation suggests, this is not necessarily going to solve the world’s problems. Finding a way to make the Oxford-Astrazeneca vaccine safe is much more likely to put India’s vast production resources into the pipeline.

In the meantime, most of the world will simply have to wait until supply catches up to demand.


* Published in print edition on 9 April 2021

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