Covid – An Absence of Global Strategy

We are essentially a year into the Coronavirus crisis and whilst therapeutics and of course vaccines bring hope to the millions living in various states of lockdown, this phase is highlighting global divisions like never before.

The world is on the edge of a “catastrophic moral failure” in the distribution of Covid-19 vaccines the head of the World Health Organization noted earlier in the month with just 25 doses administered across all poor countries compared with 39m in wealthier ones. One example received lots of attention in that Israel has provided vaccines for Palestinians living in east Jerusalem, but no citizen or medic has received jabs among the nearly 5 million Palestinians in the occupied West Bank and Gaza.

Media outlets have begun updating global charts hour by hour which show the per capita numbers across the world who have been vaccinated. The UK is ahead of the pack as far as large, developed countries with an ambitious target of some 13 million of the most vulnerable people predicted to be vaccinated by mid-February. Small wealthy countries like the Gulf States and Israel are way ahead of the rest of the world.

The ability of states to roll out mass vaccination programmes is dependent on a multitude of factors; having a functional and effective health system with easy access to patient’s data is a crucial starting point. Secondly having a population who are willing to take the vaccine is key with the rates ranging hugely across Europe. Among all countries surveyed by Imperial College, people in the UK showed the highest willingness with around 2 in 3 (65%) agreeing that they’d be willing to have a vaccine in 2021, followed by Denmark and Australia. In contrast the French population had the smallest share of willing respondents, with only a third saying they would take a vaccine next year (35%) or a quarter at the time of the survey (25%)

Beyond a suitable health infrastructure and a willing population is of course access to the vaccines themselves. Already we are seeing different countries ‘bet’ on different vaccines according to their cost, the ease of logistical rollout and other geopolitical factors that could impact supply. The UK is lucky that the Oxford/AstraZeneca – which is cheap and easy to store – is made in three factories, two of which are in the UK. The new shiny MRNA vaccines such as the Pfizer-BioNTech and Moderna ones require complex and costly refrigeration and are so fragile that medics deploying them speak of people having to ‘come to the vaccine’ rather than the other way round.

As countries increasingly close their borders to protect against Covid variants that could lessen the impacts of the vaccine and the path back to some sense of normality, more tensions are emerging around global supply chains. The EU has warned it will tighten exports of Covid vaccines produced in the bloc, amid a row with AstraZeneca over a cut in planned supplies. Last week, AstraZeneca told the EU it was falling behind on its supply target because of production problems.

Meanwhile, poor countries with less developed health systems, sceptical populations and that are lacking either the money to buy or the factories to produce the vaccine are the ones who have found themselves set adrift in this global effort.

There are 190 countries and territories participating in COVAX, which is co-led by the World Health Organization, Gavi, the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovation. The facility said it was able to secure the doses through additional supply agreements with AstraZeneca and Johnson & Johnson. COVAX said it’s planning for initial deliveries to begin in the first quarter of 2021 if the drugs are approved. There should be enough doses delivered in the first half of next year to protect health and social care workers in the participating economies, the alliance said. COVAX plans to deliver at least 1.3 billion doses to 92 countries, which are all low- and lower-middle-income, participating in the facility by some point in 2021.

The election of President Biden and his instant re-joining of the WHO is important, as is his promise to significantly up the US rate of vaccinations. US-leadership can hopefully address the rise in vaccine nationalism and help set up a system for the future which will allow better managed travel between countries. There remain significant concerns as to people who’ve been vaccinated being protected but still able to transmit the virus, meaning that the likelihood of ‘vaccine passports’ is not yet realistic. A (virtual) global summit to set out a global strategy towards vaccinations is urgently needed to set out a roadmap towards a fair and effective rollout.

James Denselow