COVID-19 Vaccines for all. Where are we at?

Today the Guardian reports that Chris Baryomunsi, the State Minister for Housing in Uganda blames ‘the western world’ for the lack of COVID-19 vaccine availability in his and other African countries as they have just experienced their worst week of the COVID-19 pandemic to date. “…the western world has focused on its population” he is quoted as saying, “The impression is that people there don’t care about Africans”.

The truth is worse. Rich countries have bought up so much of the global vaccine supply that some could vaccinate their whole populations several times over. At the top of the greedy list are the UK and Canada, both with contracts for vaccine supply capable of fully vaccinating more than three times their whole populations. 32 countries have signed up for enough vaccine to fully vaccinate more than double their populations. At the other end of the spectrum 85 countries, including Dr. Baryomunsi’s, have contracted for enough vaccine to cover only about 5% of their populations.

This is an outrage from a global health equity perspective. Recent scenes in India and those currently playing out across Africa and countries such as Indonesia are hard to witness from afar, far less I’m sure, experience up close. They produce a conjunction of concentration of people who are dying and very unwell from the COVID-19 virus, and health system with the least capacity to respond. It is also pig headed and short sighted on the part of rich countries. Leaving majorities of populations in poor countries unvaccinated maintains a virus reservoir from which mutations will continue to emerge.  So far, the resulting new strains have been ever more deadly, whether measured in terms of transmissibility or their ability to evade the vaccines that are currently our main tool for reclaiming some degree of pre-virus normality.

There are initiatives aimed at improving the situation with the Global COVAX facility promising to deliver 2 billion doses of the vaccine to 190 countries by the end of the year, this includes the 1 billion doses pledged at the G7 meeting in June. The combined population of low- and middle-income countries is estimated at 6.5 billion requiring 13 billion doses. Not all these countries will be wholly dependent on COVAX. China for example, a middle- income country, is the world’s largest vaccine producer and had produced about 35% of the world’s vaccine supply up to March. Nevertheless, 2 billion doses fall far short of what will be required and while there are other initiatives, like the African Union and World Bank’s African Vaccine Acquisition Task Team (AVATT) initiative, it is likely that even current ambitions barely yet delivered can do much to close that gap.

All of this focuses on the supply side of the global vaccine equation, and no doubt there will be a need to ensure that demand matches available supply as that does eventually ramp up. Vaccine hesitancy is not a uniquely first-world problem: across African countries the proportion reluctant to be vaccinated against COVID-19 has been estimated to vary from 6% in Ethiopia to 41% in the Democratic Republic of Congo for example. Nevertheless, an overall majority of 79% of Africans would take a COVID-19 vaccine if available. In aggregate that would probably be sufficient to prevent the kinds of reservoirs of virus that are such a threat to global health, but as in other contexts like the US, pockets of hesitancy will create pockets of virus transmission that remain dangerous sources of mutated new strains.

So, there is much for the global health community to tackle, no room for complacency and an urgency about marshalling not only the trillions of dollars required to scale up the ambition of existing programs but also the production capacity and demand supporting measures that will enable that level of investment to achieve the impact needed.

Professor Barbara McPake is the Director, Nossal Institute for Global Health University of Melbourne.