A year ago, when the Covid-19 pandemic was still in its relative infancy, the head of the World Health Organization stressed that a global approach would be the only way out of the crisis.
"The
way forward is solidarity: solidarity at the national level, and
solidarity at the global level," WHO Director General Tedros Adhanom
Ghebreyesus told a media briefing in April 2020.
Fast-forward
12 months and the devastating scenes in India, where hospitals have
been overwhelmed by a surge of Covid-19 cases and thousands are dying
for lack of oxygen, suggest the warnings went unheeded.
India is not the only global Covid-19 hotspot. Turkey
entered its first national lockdown Thursday, an unwelcome step
prompted by infection rates which are now the highest in Europe.
Iran
reported its highest daily Covid-19 death toll so far on Monday, with
many towns and cities forced into partial lockdown to curb the spread of
the virus. Iranian President Hassan Rouhani has said the country is
suffering a fourth wave of infections.
The
picture across much of South America is also gloomy. Brazil, with more
than 14.5 million confirmed coronavirus cases and nearly 400,000 deaths,
according to Johns Hopkins University data, continues to have the
highest daily rate of Covid-19 deaths per million in the world.
Some
countries have offered help as hotspots emerge, for example flying in
oxygen concentrators, ventilators and other medical supplies to India in
recent days. But the coordinated global response urged by Tedros a year
ago -- and repeatedly since, by WHO and other global heath bodies --
remains elusive.
And
while some Western countries are eying a return to more normal life in
the coming weeks, the worldwide picture remains dire. The number of
global Covid-19 cases has risen for the ninth consecutive week and the
number of deaths is up for the sixth week straight, WHO said last
Monday.
"To
put it in perspective, there were almost as many cases globally last
week as in the first five months of the pandemic," Tedros said.
COVAX,
the global vaccine-sharing initiative that provides discounted or free
doses for lower-income countries, is still the best chance most have of
procuring the vaccine doses that might bring the pandemic under control.
But
it is heavily reliant on India's capacity, through its Serum Institute
of India (SII), to produce doses of the AstraZeneca vaccine which are
the cornerstone of the COVAX initiative.
While
India promised to supply 200 million COVAX doses, with options for up
to 900 million more, to be distributed to 92 low- and middle-income
countries, its own rapidly worsening situation has prompted New Delhi to
shift focus from the initiative to prioritizing its own citizens.
At
the same time, Western countries have been criticized for vaccine
stockpiling. Some, including the United States, Canada and United
Kingdom, have ordered far more vaccine doses than they need.
UK
Health Secretary Matt Hancock said Wednesday that the UK -- which is
now vaccinating healthy
people in their 40s, having already offered at
least one dose to all its older and more vulnerable residents -- had no
spare vaccines to send to India. The UK government has said it will
share surplus doses at a later stage.
The
SII "are making and producing more doses of vaccine than any other
single organization. And obviously that means that they can provide
vaccine to people in India at cost," Hancock said. "India can produce
its own vaccine, based on British technology, that is... the biggest
contribution that we can make which effectively comes from British
science."
In the United States, everyone age 16 and older
is now eligible for a Covid-19 vaccine and 30% of the population is
fully vaccinated, according to data Friday from the US Centers for
Disease Control and Prevention. Earlier in the week, the White House
said it would donate up to 60 million doses of the
AstraZeneca vaccine
-- of which it has a stockpile but has not yet authorized -- in the
coming months following a federal safety review.
Well
over half of Israel's total population has received at least one dose
of the coronavirus vaccine, and the country is easing restrictions.
As
of early April, just 0.2% of the over 700 million vaccine doses
administered globally were given in low-income countries, while
high-income and upper middle-income nations accounted for more than 87%
of the doses, according to Tedros.
In
low-income countries, only one in more than 500 people has received a
Covid-19 vaccine, compared with almost one in four people in high-income
countries -- a contrast Tedros described as a "shocking imbalance."
Patients
sit in a monitoring area after they were inoculated with the
Pfizer/BioNTech vaccine against Covid-19 at a mass vaccination center on
April 15, 2021 in Berlin, Germany.
"Some
[of the 92 lower-income countries] haven't received any vaccines, none
have received enough and now some countries are not receiving their
second-round allocations on time," Tedros told a global donor event on April 15.
"We've
shown that COVAX works. But to realize its full potential, we need all
countries to step up with the political and financial commitments needed
to fully fund COVAX and end the pandemic."
While
many wealthier nations have pledged funds, they have been less ready to
give up their Covid-19 shots. France last week became the first country to donate AstraZeneca doses from its domestic supply to COVAX.
"The
problem is the people with the power are predominantly national
governments," said Michael Head, senior research fellow in global health
at the University of Southampton, in England. "The WHO offers guidance,
but it doesn't have much power. And it's the WHO that works on things
like equity to ensure that the world is as protected as it can be.
"Obviously
national governments are there to act in their own citizens' interests,
and when it comes to a pandemic the world is quite selfish, all
countries are quite selfish -- they to a certain extent quite reasonably
look after their own people first."
An
initiative led by WHO, the Vaccine Alliance -- known as Gavi -- and the
Coalition for Epidemic Preparedness Innovation, COVAX was heralded last
year as the "only truly global solution" to the pandemic by ensuring equitable global access to Covid-19 vaccines.
Its initial aim was to have 2 billion doses
of vaccines available by the end of 2021, which should be enough to
protect high risk and vulnerable people, as well as frontline health
care workers in participating countries, according to Gavi.
ut
in the face of vaccine hoarding by rich countries and disruption of
supplies, COVAX has struggled to keep up with its delivery schedule.
COVAX delivered its very first batch of Covid-19 vaccine doses to Ghana
on February 24. As of now, it has shipped 49.5 million doses of
coronavirus vaccines to 121 countries -- far behind the original plan of
distributing 100 million doses by the end of March.
"Our
initial goal was to reach 20% of populations, with a specific focus on
the 92 lowest-income countries and territories eligible for support from
the Gavi COVAX Advance Market Commitment," a Gavi spokesperson said.
"We
have now secured deals for significantly beyond that amount, though the
tight supply context on global markets means that the first half of the
year has seen delays in getting doses to countries. With the correct
funding in place, we believe it will be possible to finance and secure
1.8 billion doses to those 92 lower-income economies (AMC92) in 2021."
The
struggle of COVAX is a telling example of the obstacles to a
coordinated global response, as individual countries prioritize their
own interests.
COVAX
works by buying a portfolio of coronavirus vaccines in bulk at a lower
price from pharmaceutical companies and allocating them to participating
countries. Higher-income countries can
buy the vaccines at cheaper
prices negotiated by COVAX -- and perhaps as a backup to their own
bilateral deals -- while lower-income nations who would otherwise be
unable to afford these vaccines can get the doses at a discounted price
or for free.
A
shipment of Covid-19 vaccines from the COVAX initiative arrives at the
Kotoka International Airport in Accra, Ghana, on February 24, 2021.
From
the beginning, however, COVAX has struggled to secure vaccines from
manufacturers, as wealthy nations rushed to snap up global vaccine
supply via their own bilateral deals with
pharmaceutical companies.
According to data compiled by Duke University, high income countries currently hold 4.7 billion doses of Covid-19 vaccines, while COVAX has purchased just 1.1 billion.
In
addition, only WHO-approved vaccines can be distributed by COVAX, which
has limited its portfolio. So far, only vaccines from Pfizer-BioNTech,
Moderna, AstraZeneca and Johnson & Johnson have been green-lit for
emergency use by WHO.
While
boasting a high efficacy rate of around 95%, both the Pfizer-BioNTech
and Moderna vaccines require freezer storage -- and many low income
countries simply don't have that cold storage capacity.
Therefore,
before the Johnson & Johnson vaccine was approved by WHO in March,
COVAX relied
heavily on the AstraZeneca vaccine, which can be kept at
normal refrigerator temperatures. In early March, it said the target was
to deliver 237 million doses of AstraZeneca's shots to 142 countries by
the end of May -- a goal it is unlikely to achieve given the delay in
supplies from India.
"If
many of the AstraZeneca vaccines are made in India, and India has got
thousands of deaths everyday and is completely overwhelmed, then you can
see another reason why COVAX is challenged," said Dale Fisher, a
professor of infectious disease at the National University of Singapore.
Vaccine equity
Gavi
told CNN it expects all Indian vaccine production will be committed to
protecting its own citizens "for the next month at least." But it
insisted such issues had been anticipated, and that as a result, it was
in talks with manufacturers of other vaccine candidates on supply
schedules.
Next on the WHO's approval list
are two China-made vaccines. The vaccine made by Chinese state-owned
pharmaceutical giant Sinopharm is expected to be approved by the end of
April, while the go-ahead for the other, made by private company
Sinovac, is expected by early May.
Like the AstraZeneca and Johnson & Johnson shots, both Chinese vaccines require only normal refrigerator conditions, and thus can be more easily transported in developing countries.
China has committed 10 million doses of its vaccines to COVAX, but that number pales in comparison with the more than 100 million doses it has sent overseas via bilateral deals with individual countries -- including donations to poor nations.
While
a welcome gesture, these donation deals, often influenced by politics,
don't necessarily lead to vaccines reaching the countries in greatest
need.
Thomas Bollyky,
director of the Global Health Program
at the Council on Foreign Relations, said that of the 65 countries
China has pledged donations to, all but two are participants in the Belt
and Road Initiative, Beijing's multibillion dollar global
infrastructure and trade program.
"While
I'm glad China is donating, those donations aren't being distributed in
the way with the first priority of preventing unnecessary deaths or
ending this pandemic as soon as possible," Bollyky said. "They seem to
be distributed in the manner that is guided by China's strategic
interest."
Another
concern is a lack of transparency surrounding the two Chinese vaccines,
Bollyky said. Neither Sinopharm nor Sinovac has released the full data
from late-stage clinical trials.
Lifting patents
As demand outstrips supply, there have been calls for big pharmaceutical companies to lift the patents on their vaccines to allow them to be produced more widely.
Bollyky said to scale up global manufacturing of vaccines, however, what is really needed is the technology transfer.
"It's
not just a matter of intellectual property. It's also the transfer of
know-how," he said. "I don't think there's clear evidence that a waiver
of an intellectual property is going to be the best way for that
technology transfer to occur."
Waiving
patents will not work in the same way for vaccines as it has for drugs,
Bollyky said. For HIV drugs, for example, manufacturers were more or
less able to reverse engineer them without much help from the original
developer.
"It's
very different for vaccines, where it's really a biological process as
much as a product. It's hard to scale up manufacturing in this process
for the original company, let alone another manufacturer trying to
figure this out without assistance," he said. "It requires a lot of
knowledge that's not part of the IP.
"
The
deal between AstraZeneca and the Serum Institute of India is a
successful example of such technology transfer, Bollyky said, where the
licensing of IP happened voluntarily. "The question is what can we do to
facilitate more deals like the one between AstraZeneca and the Serum
Institute of India to have this transfer," he said.
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