The global rollout of coronavirus vaccines was never going to be easy. But it soon subsided in frustration at home and nationalistic bitterness abroad as countries around the world face a maelstrom of logistical and political challenges.
All 50 states in the US are reporting shortages as the fragmented US administrative and health care systems struggle to distribute even the limited stocks of vaccine that have been produced.
Europe has descended into its own ugly battle for supplies. And there is little evidence that the world’s poorest countries will gain entry anytime soon, perhaps as late as 2023.
Some in Africa, South America and Asia have turned to China and Russia, who are using vaccine diplomacy to increase their influence in those parts of the world, some experts say.
In the US, “the rollout is slow and troublesome and very frustrating for our population,” said Dr. Tom Kenyon, a former director of the CDC’s Center for Global Health.
Washington should be in the best position to immunize its citizens, as it has ordered 1.2 billion doses while working hand-in-hand with pharmaceutical giants. Still, the US lags behind Israel, the United Arab Emirates, the United Kingdom and Bahrain in terms of shots per capita.
The problems are broadly twofold: production and distribution.
As in Europe, US supply has been throttled as drug manufacturers struggle to keep up with dire demand, sometimes too promising, before having to scale back orders.
“They probably haven’t communicated well, managed expectations, and are transparent,” said Maria Elena Bottazzi, associate dean at the National School of Tropical Medicine, part of Baylor College of Medicine in Houston.
But what most worries the US, according to experts, is that its healthcare system is not centralized and that President Donald Trump’s administration has failed to put in place a proper national vaccine rollout plan to fill the void.
After inheriting what some experts describe as one of the best pandemic preparedness plans, Trump went on to fire his top biosafety adviser, dissolve his global health division, and downplay the coronavirus during the pivotal first weeks of last year’s outbreak. . .
Today’s result is a chaotic battle when it comes to vaccines, so this criticism goes where states, counties and hospitals have left it on their own.
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“We have a very divided approach,” said Kenyon, who is now chief health officer at Project HOPE, an international global health and humanitarian organization. “We actually have states competing to get the vaccine. That’s not optimal in any way.”
However, these concerns must be seen in context. Under Trump’s supervision, vaccines arrived faster and were more effective than many expected. And the encouraging data keeps coming in.
But right now, that calms officials, experts and citizens who are upset about the distribution of vaccines, which is only exacerbated by new variants and the reluctance of some to get vaccinated.
This week, President Joe Biden announced measures to overhaul the federal rollout strategy. Time will tell if this will change things.
“When it comes to coordination during a public health emergency, you see where our system has fallen apart,” said Justin Ortiz, an associate professor at the University of Maryland School of Medicine, referring to the track record of the Trump administration. “The idea that the previous federal government can wash their hands on this and trust each state to create its own systems is a dereliction of duty.”
The situation in Europe is equally fraught.
A swamp of bureaucratic infighting seems to have hindered the rollout of the European Union, which has been glacially slow and dysfunctional. Doctors in Madrid and Paris have had to interrupt the vaccinations because supplies were almost dry.
In the midst of all this, the EU and AstraZeneca are at odds after the Anglo-Swedish pharmaceutical giant said it would have to scale back deliveries due to a manufacturing problem. The EU has insisted that the drug company keep its word.
In a drastic step, the EU is now trying to block the export of vaccines from companies that have not first fulfilled the European order. EU officials have also suggested that vaccines are diverted to the UK to fill the continent’s shortage.
An argument over logistics is now threatening to turn into a full-blown diplomatic crisis.
“We reject the logic of first-come, first-served,” EU Health Commissioner Stella Kyriakides said at a news conference on Wednesday. “That might work in a butcher shop, but not in contracts and not in our advanced purchase agreements.”
Even in the UK, there are concerns about its own seemingly successful rollout, namely the decision to leave 12 weeks between the first and second dose.
The decision was made while the country was in the teeth of the world’s deadliest Covid-19 outbreak. Firmly defended by the government’s expert advisers, the delay is much longer than the drug manufacturers recommend, dividing the scientific community.
But nowhere does the picture look worse than in the developing world.
For all the drama in the West, delays are measured in weeks and months. But Africa, parts of South Africa and Central Asia will most likely not see wide vaccination coverage until 2023, according to a paper this week from the Economist Intelligence Unit, a research group in London.
In addition to trying to get his own home in order, Biden has joined a World Health Organization-led program called COVAX, which has raised $ 2 billion to buy vaccines for poor countries.
Seeing the US engage in an altruistic effort shunned by Trump was welcomed by public health experts. But what COVAX really needs is not only more money and kind words, but also doses in hand and the ability to distribute them.
“The US funds are welcome, but COVAX’s problems go beyond money,” said Mukesh Kapila, who was an adviser to WHO’s previous director general.