Countries may stall COVID-19 vaccinations due to Indian export limits

Restrictions on exporting COVID-19 vaccines in India have left countries wondering what to do with doses they’ve already received through the global COVAX initiative.

“The uncertainty around vaccine timing changed the plans and slowed down the vaccine rollout,” said Antoinette Ba-Nguz, regional immunization coordinator for eastern and southern Africa at UNICEF, during a webinar Tuesday. UNICEF is leading the logistics on the distribution of the vaccines for the facility.

Worldwide, nearly 40 million doses have been released for shipment through the COVAX Facility, which is aimed at equitable access to COVID-19 vaccines. Doses of the vaccine developed by AstraZeneca and the University of Oxford accounted for the majority of that figure, and many of those were produced by the Serum Institute of India. But because of the rising number of COVID-19 cases in India, the government put a temporary hold on the export of the vaccine to meet domestic demand.

“There is not enough for the COVAX Facility at this point,” Ba-Nguz said.

Questions around the timing of future shipments leave countries with the dilemma of whether to administer all the doses already in their possession now, in the hope that more batches will arrive in time for people to receive their second shots. The second dose of the vaccine should be administered between four and 12 weeks after the first.

Alternatively, each country could vaccinate a smaller group of people than originally planned to ensure enough supplies for the second doses, Ba-Nguz said.

“It's more of the vaccination strategy they are discussing, given the uncertainty on when the second shipment will be,” she said.

SII is contracted to provide COVAX with vaccines for the 64 lower-income countries participating in the facility. As of last week, it had provided 28 million doses to the facility; it was expected to supply 40 million more doses this month and up to 50 million in April.

The next shipments of doses were supposed to reach many countries in April but now aren’t set to arrive until May, at the earliest, because of supply constraints. While these restrictions create uncertainties around timing, SII does still plan to provide these doses to the facility, Ba-Nguz said.

Initial doses from the COVAX Facility are intended to target the highest-risk populations, such as health workers, people with underlying health conditions, and older adults.

Africa is heavily dependent on vaccines from COVAX. In the region, 28 countries have already received 16 million doses from the facility, according to the World Health Organization. Of these doses, countries have only administered about 1.8 million, according to a chart that Ba-Nguz presented.

The low number of administered doses is “very concerning,” Ba-Nguz said.