Efforts to vaccinate the poorest countries against Covid-19 have dwindled to a trickle, leaving many with weakened defenses against the coronavirus, just as the weight of the pandemic is shifting from developed to developing countries.
An initiative backed by the World Health Organization and wealthy countries to provide free vaccines to 92 low- and middle-income countries recently cut the number of shots it plans to send by the end of May. That initiative, dubbed Covax, will deliver 145 million doses instead of around 240 million, as India, the main supplier, has largely stopped exporting shots as it fights an increase in cases at home.
That widens the already huge vaccination gap between rich and poor countries. Although more than 200 million doses have been administered in the US, Covax has delivered less than 41 million of its planned two billion doses so far by the end of 2021.
Slow uptake of Covid-19 vaccines in developing countries could pose problems for the rest of the world. Epidemiologists believe that if much of the developing world is not vaccinated, a large reservoir of the coronavirus can circulate, allowing it to mutate and potentially transfer to developed countries.
Most of the Covax injections planned for the first half of the year would be manufactured by the world’s largest vaccine manufacturer, the Serum Institute of India, which is partnering with AstraZeneca PLC to create the vaccine the company has developed with the University from Oxford. The SII says its production is also limited by US restrictions on exports of key vaccine raw materials, an attempt by Washington to speed up production at home.
The lack of clarity has made planning more difficult.
Officials from the Africa Centers for Disease Control and Prevention and the WHO recently suggested that governments could consider prioritizing a first injection for as many people as possible, even if it means delaying the second dose and despite a lack of clear data on how the efficacy could be. drop without a booster.
“We are in a difficult situation as a continent,” said John Nkengasong, the CDC’s head for Africa, last week. “We cannot predict when the second doses will come and that is not good for our vaccination program.” Dr. Nkengasong added that even without a booster, one dose of the AstraZeneca vaccine should protect against severe Covid-19.
Other countries, meanwhile, are struggling to administer the few vaccines they have received.
People are waiting in line to get an injection of the AstraZeneca vaccine at the Mulago referral hospital in Kampala.
Photo:
badru katumba / Agence France-Presse / Getty Images
One reason for the low demand for vaccines in some countries, health officials say, is the decision by some European countries to limit the use of the AstraZeneca vaccine to younger people because of reports of a rare but serious blood clotting disorder. Health authorities in the US also paused the introduction of a Johnson & Johnson vaccine last week while investigating similar reports. Covax and the African Union have submitted large orders for the J&J recording for the second half of the year.
“There is a lot of misinformation and this negative reporting, especially in Europe and America, is the main reason our vaccinations have been slow to get underway,” said Diana Atwine, permanent secretary of Uganda’s Ministry of Health. “Enthusiasm is low because people are hearing bad things about the vaccine.” Uganda, a country of 45 million inhabitants, administered just over 200,000 of the 964,000 doses it received in March.
A lack of investment in vaccination logistics, including messages to the public, is also slowing the rollout.
As highly communicable variants of coronavirus fly around the world, scientists are rushing to understand why these new versions of the virus are spreading faster and what this could mean for vaccination efforts. New research says the key may be the spike protein, which gives the coronavirus its unmistakable shape. Illustration: Nick Collingwood / WSJ
US-based charity CARE estimates that for every $ 1 spent on vaccine doses, governments should invest an additional $ 5 to get them into people’s arms, including health worker salaries, education campaigns, and cold chain logistics.
But the Covax division, intended to help countries prepare for vaccine rollouts, has only received about $ 600 million in contributions, leaving a $ 7.3 billion gap for this year, and the World Bank has only received $ 2 billion of a $ 12 billion funding package pledged to help countries. buy and distribute vaccines and strengthen their health systems.
About $ 9 billion has been donated to Covax to purchase vaccines, although large purchases by wealthy countries mean most doses won’t be available until later in the year.
In Uganda, authorities place ads calling for vaccinations, but the posters and billboards that have been the mainstays of previous vaccination campaigns, including for measles and polio, are missing. Outside the capital Kampala, elderly people often lack the transport necessary to reach the vaccination sites. High illiteracy also means that some people have trouble reading the consent form they have to sign, health officials said.
Medical staff attend the opening ceremony of Angola’s central vaccine warehouse in Luanda, the capital, following the arrival of the first shots as part of the Covax initiative.
Photo:
ampe rogerio / EPA / Shutterstock
“If we have access to more money, we can speed up the process,” said Vera Daves, Angola’s finance minister, who has used less than half of his Covax doses.
WHO and other agencies are adjusting their guidelines in light of supply shortages. In a report posted to a network for international immunization professionals last month, WHO suggested countries dependent on Covax could focus on getting as many people as possible a first dose, even at the risk of delaying it for a second by more than the recommended 12 weeks. .
That “would significantly increase the number of deaths avoided,” the report said. But the WHO also says that the levels of antibodies activated by the vaccine drop by about a third 90 days after the first dose. There is only limited data on what happens next with the vaccine’s efficacy, it says.
Tulio de Oliveira, a geneticist at the Nelson Mandela School of Medicine in South Africa, said the risk of the injection becoming less effective without a timely booster, is especially high in countries fighting against variants that can contain antibodies from previous infections or vaccinations. like the ones first discovered in South Africa and Brazil and quickly spread to nearby countries.
But, he added, “If the choice is between no vaccine and one vaccine… then you don’t have much to lose on an individual level. What you can lose is confidence in vaccines. “
Covid-19 in the developing world
Covax’s current supply plans foresee a resumption of deliveries from India in June, but the SII has said this depends on the decline in Indian cases. Last week, Covax delivered less than a million doses. The WHO said on Monday it was still in talks with the Indian government and had no clear indication of when deliveries would resume and how many doses would be released.
Some countries are already looking elsewhere. Indonesia, which has recorded more Covid-19 cases and deaths than any other country in East Asia, has asked Beijing to secure 100 million additional doses of Chinese vaccines on top of the 125 million it has already ordered.
Earlier this month, Indonesian Health Minister Budi Gunadi Sadikin said the government had discussed the issue of vaccine supply directly with Gavi, one of the groups behind Covax, and AstraZeneca, which has also postponed the orders. The Chinese “have proven to be the most consistent in delivering on their promises,” said Mr Sadikin.
A medical officer administers the Chinese Sinovac vaccine to a teacher in South Sulawesi, Indonesia.
Photo:
Moch Farabi Wardana / Pacific Press / Zuma Press
Write to Gabriele Steinhauser at [email protected], Nicholas Bariyo at [email protected] and Jon Emont at [email protected]
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