While people in rich countries get Covid-19 boosters, those in poor countries get vaccine scraps

Oct 29, 2021 | 18 comments

Women wait to receive the Covishield vaccine at a health center in Siliguri, West Bengal. India blocked vaccine exports in March to battle a devastating second wave of infections.

The giant steel vats used to make most of the world’s vaccines are not easy to come by. They’re highly specialized pieces of equipment; there are only so many of them to go around, and it’s expensive and time-consuming to make more. So when vaccine developers were figuring out how to produce billions of Covid-19 vaccine shots as quickly as possible, they decided to use an alternative: disposable bioreactor bags. At first, it was a win-win. The bags are quicker and cheaper to make than the tanks, and using them can shave precious hours off manufacturing times because they don’t have to be cleaned and sterilized after each use.

But before long, even this innovation became an obstacle in the quest to end the Covid pandemic. First, larger vaccine makers bought up many more bags than they could use, leaving smaller vaccine makers with no recourse and potential manufacturing sites underutilized. Then as the vaccination campaign wore on, supplies began drying up altogether. Only a few companies make the bags, and they have little incentive to ramp up their manufacturing efforts because there’s no telling how long the uptick in demand will last.

“It’s become a huge problem,” Prashant Yadav, a senior fellow at the Center for Global Development, told me in June. “And it’s something that only an actual government can resolve.”

Pharmaceutical companies generally know how to coordinate their global supply chains. They also know how to work together to secure the resources they need to make their products. But when the situation requires changes to national and global policy, world leaders need to step in.

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So far, they have not. For all its successes, the race to vaccinate the world against Covid has unfolded like a symphony without a conductor. The corralling of manufacturing sites has been haphazard. The channeling of equipment and ingredients has been messy and at times wasteful. And the flow of vaccines has been recklessly uneven: More than 80 percent of the four billion vaccine doses that had been distributed as of early August went to high- and upper-middle-income countries.

Several South American countries, including Ecuador, are world leaders in vaccinations despite their relative poverty.

While the United States has bought enough shots to vaccinate its entire population three times over, most low-income nations still don’t have enough to give even first doses to their frontline health workers or older citizens. The People’s Vaccine Alliance estimated in June that at the current pace, it would take 57 years for low-income countries to vaccinate their entire populations. High-income countries will do so within the next six months (hesitancy notwithstanding).

This month, the global vaccine-sharing initiative known as Covax cut its projections by nearly 30 percent, saying it would have available only 1.4 billion doses by the end of this year. (The initiative has delivered just 271 million doses so far.) Later, President Biden reassured Americans that the United States had enough shots on hand to offer boosters to all its residents. The World Health Organization has been pleading with wealthy nations to hold off on boosters — and to forgo some of their planned vaccine purchases — until the rest of the world has a chance to secure more first doses. But if Mr. Biden felt any moral qualms about the United States’ booster ambitions, it didn’t show. “We’re proud to have donated nearly 140 million vaccines,” he said, to “over 90 countries, more than all other countries combined.”

Boosters for the wealthy and scraps for everyone else will neither get us out of this pandemic nor prepare us for the next one. But nearly a year since the first shots were administered, world leaders have yet to put forth a bolder or more comprehensive plan. “Nobody is saying unequivocally, ‘Here is what we need, and here is how we are going to get it,’” said Zain Rizvi, a health law expert at the consumer advocacy nonprofit Public Citizen. “We were promised a war effort, and instead we got a pillow fight.”

Mr. Biden attended a virtual global Covid-19 summit Wednesday. Among other things, he is calledon world leaders to invest in vaccine making and vaccination and to increase vaccine donations — with the goal of inoculating some 70 percent of the global population by this time next year. Those are welcome steps, but the World Bank, the International Monetary Fund and the W.H.O. set a similar goal months back, and the global vaccine gap has only widened since then. For these latest pronouncements to make a dent in the problem, the summit must be followed, quickly, by concerted action.

While the world dithers, the virus is evolving. Given enough time and enough unvaccinated people, it could mutate its way past our best defenses, potentially sending the world — vaccinated and unvaccinated alike — back to square one. The best hope for preventing that from happening is to make many more vaccines — at least three times as many as the world has so far — and then deploy them as quickly and equitably as possible across the globe.
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Credit: The New York Times

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