On September 14, WHO Director-General Dr. Tedros Ghebreyesus highlighted vaccine inequity globally, particularly in Africa, when he revealed that of the nearly 6 billion doses administered globally, only 2% of those have been in Africa; about 80% have been administered in high- and upper-middle income countries. Less than 3.5% of people in Africa have been fully vaccinated so far compared with 54% of the total population in the U.S.
“This doesn’t only hurt the people of Africa, it hurts all of us. The longer vaccine inequity persists, the more the virus will keep circulating and changing, the longer the social and economic disruption will continue, and the higher the chances that more variants will emerge that render vaccines less effective,” the WHO Chief said.
Vaccine inequity between high- and low-income countries is striking. More than 75% of all vaccines have been administered in just 10 countries. According to United Nations Development Programme (UNDP), 60.1% of the people in the high-income countries have been vaccinated with at least one dose as on September 15, while in the low-income countries, it is just 3%.
The WHO has set an ambitious target of vaccinating at least 10% of the population of every country by September, at least 40% by the end of the year and 70% globally by the middle of next year. But according to the WHO, eight in 10 African countries are likely to miss vaccinating at least 10% of the population by the end of this month.
“Forty-two of Africa’s 54 nations — nearly 80% — are set to miss the target if the current pace of vaccine deliveries and vaccinations hold,” according to Africa’s WHO regional office. Just nine African countries, including South Africa, have already reached the global target set for September and three more countries are set to meet the target before the end of this month. In contrast, almost 90% of high-income countries have already reached the September target of at least 10% vaccination, and more than 70% have already reached the year-end target of 40%.
Promises unkept
In June, the G7 nations promised to share 870 million doses to COVAX but released just 100 million. Just about 4% of all vaccines produced worldwide have been channelled through COVAX.
According to GAVI, as on September 15, COVAX has so far shipped over 272 million vaccines to 141 countries. Though high-income countries had promised to donate more than 1 billion doses, less than 15% of those doses have materialised, says the WHO. Instead of increasing supplies to make up for the shortfall, vaccine supply to COVAX is only going to witness a further reduction.
On September 9, Dr. Matshidiso Moeti, WHO’s Africa director said that for a variety of reasons including the demand for booster doses in the high-income countries, vaccine supply to Africa through COVAX will be 25% (about 150 million doses) less by the end of the year. As a result, Africa will face a shortage of almost 470 million doses in the global year-end target of fully vaccinating 40% of its population. COVAX will be supplying only about 470 million doses by the end of the year, sufficient to vaccinate just 17% of the population.
In August, Africa received almost 21 million vaccine doses through COVAX. Another 95 million doses are expected during September. WHO expects more vaccine supplies through COVAX and additional supplies from the African Union, which is directly purchasing vaccines from manufacturers. African Union member States had come together to pool their purchasing power.
Reneging on deal
In end-March, the African Union placed an order to purchase 220 million doses of Johnson & Johnson’s single dose vaccine, with the potential to order an additional 180 million doses. In addition, South Africa entered into a bilateral deal with J&J to procure 31 million vaccine doses; the fill and finish activities of the vaccine are in South Africa.
If initially J&J did not guarantee any supply to either South Africa or the African continent, just 9 million doses were set aside for South Africa after a protest. Yet, shockingly, while only a small quantity of the 9 million was supplied to South Africa, J&J exported doses to Europe instead. After a renewed protest and global outrage, J&J backed down, and began supplying vaccines to South Africa and the African Union.
The same pattern is now playing out in India. About 40 million doses of the vaccine that will be produced each month by Biological E, a Hyderabad-based company, are likely to be exported to Europe and the U.S. “The decision on where they will be exported, and at what price, is under the purview of J&J completely,” Mahima Datla, the Managing Director of Biological E confirmed to Nature magazine.
“We demand that any J&J vaccine doses made in India be supplied on priority to the Indian government, the African Union, and the COVAX Facility. Developing countries with large unvaccinated populations are witnessing a frightening rise in infections and deaths from COVID-19. J&J must prioritise them,” Indian Civil Society Organisations said in a letter to the Indian government and J&J.
Exports banned
Strive Masiyiwa, African Union’s special envoy recently said: “We are not asking for donations. We want to buy vaccines and that means we want access to purchase.” He wanted countries that have imposed restrictions on vaccine exports to lift them. “That would give us vaccines immediately,” he said.
Serum Institute had stopped supplying to COVAX since end-February, and Adar Poonawalla in a statement on May 18 said: “We continue to scale up manufacturing and prioritise India. We also hope to start delivering to COVAX and other countries by the end of this year.”
Though low vaccination coverage seen in many African countries is primarily due to lack of vaccine supply, vaccine hesitancy too has a role to play. “While many African countries have sped up COVID-19 vaccinations as vaccine shipments ramped up in August, [as on September 2] 26 countries have used less than half of their COVID-19 vaccines,” the WHO says.
Wasted doses
Besides additional doses required for booster, the high-income countries have also wasted millions of doses. Even while many countries in Africa and elsewhere are yet to vaccinate even the healthcare workers, over 15 million doses have been thrown away in the U.S. since March 2021. The US had already binned more than 1,82,000 vaccine doses by the end of March.
Over 0.8 million doses were wasted in the U.K. In August alone, nearly 0.1 million doses were binned as younger people were advised not to take the AstraZeneca vaccine. This was following reports of rare blood clotting events related to the AstraZeneca vaccine.
The reason why the U.S. wasted over 15 million doses was because the priority was to vaccinate people when they show up without prioritising efforts to reduce wastage. Even the new advisory from CDC urges doctors “not miss any opportunities to vaccinate every eligible person who presents at a vaccination site, even if it means puncturing a multidose vial to administer vaccine without having enough people available to receive each dose.”
As per a 2019 paper from the WHO, there is 15-20% wastage in the case of 10-dose vials. But the amount wasted can be reduced through targeted action. A few States in India reported huge vaccine waste initially but quickly turned the table in April — they not only had zero wastage but also extracted additional doses from the given supply.
