Deep dive: Is COVID-19 vaccine equity a pipe dream?

Devex offices are closed this week for a summer break. Instead of our regular Newswire, we are bringing you deep dives into some of this year’s key development topics. Today, we ask: Is COVID-19 vaccine equity a pipe dream?

It’s been a rough year for the COVAX Facility — and also for the countries that leaned on it heavily for COVID-19 vaccines. Not only has COVAX struggled to deliver on its promised doses, experts have also questioned its structure and purpose. COVAX has operated on a charity model, instead of equipping lower-income countries with the knowledge and infrastructure to produce their own vaccines, raising questions on whether it’s the right model to ensure equitable vaccine distribution.

Only weeks after the facility’s first COVID-19 vaccine shipments at the end of February, the facility’s supply chain fell apart as its major supplier, the Serum Institute of India, had to prioritize domestic supply and may only restart COVAX deliveries by the end of 2021. Countries had to find ways to augment the shortages.

The situation is slowly starting to turn — millions of doses have finally begun to flow again to many low- and middle-income countries, as high-income countries that have now vaccinated substantial portions of their populations start to donate excess doses via COVAX or bilaterally.

In its most recent supply forecast, COVAX expects as many as 1.5 billion doses shipped by the end of the year. This equates to about 23% of these countries’ populations.

But new challenges are emerging. Breakthrough COVID-19 infections among fully vaccinated individuals have created debates over vaccine booster shots, which could affect supply. Dr. Soumya Swaminathan, WHO’s chief scientist, said in a recent press briefing that if all high-income countries decide to give booster shots to members of their population above 50 years old, close to 1 billion more doses will be needed.

WHO called for a moratorium on booster shots for all countries until at least the end of September. High-income countries are also vaccinating younger, healthier portions of their populations. This discussion is taking place as some vulnerable groups, such as pregnant women, are still waiting for their turn to get vaccinated.

There are concerns surrounding the logistics of distributing multiple types of vaccines in one country, and their equitable allocation.

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Equity needs a plan

In April, the Democratic Republic of Congo returned 1.3 million doses to COVAX, because it couldn’t roll them out before they expired. In May, South Sudan also returned 72,000 doses for the same reason.

Health experts argued these challenges occurred because while the purchase of vaccines is often the focus, plans for their delivery can be underfunded and an afterthought. Some doses delivered in Africa had short shelf lives, leading to the destruction of about 450,000 expired doses. This time around, there are hopes countries are better prepared to roll out doses quickly and that none of the doses are wasted.

Pleas for an intellectual property waiver

In May, the U.S. backed a waiver of intellectual property protections for COVID-19 vaccines. But little has changed since. Other high-income countries have stood firm on their positions. Germany, for instance, may donate doses, but won’t budge on IP.

+ Debates over vaccine equity have often involved terms such as patents, patent pooling, and compulsory licenses. Confused? Here’s a rundown on the terminology.

Locally produced — for whom?

The inequity in vaccine access highlights the need to build local capacity for vaccine manufacturing. Some efforts to do that are underway. South Africa’s Aspen Pharmacare is producing doses of Johnson & Johnson’s COVID-19 vaccine for the African Union. But the manufacturing plant is sending 10 million doses to Europe and a recent investigation from The New York Times found the contract “required South Africa to waive its right to impose export restrictions on vaccine doses.”

Pfizer and BioNTech also signed an agreement for The Biovac Institute in South Africa to manufacture their messenger RNA-based COVID-19 vaccine. This follows WHO’s announcement of establishing the first technology transfer hub for mRNA COVID-19 vaccines in the country.

But the deals are also “fill and finish,” meaning the manufacturing plants receive the actual vaccine substance from elsewhere and then fill the vials. Some argue the pharmaceutical companies should provide the technology transfer for these manufacturers to produce the entire vaccine.

Experts also said wide-scale increase in COVID-19 vaccine production across the African continent could take plenty of time and investments. Financial sustainability of these manufacturing is a concern, and a deterrent for some investors, and there is a need to focus on dependable market demand.

Out of reach

The elusive goal of herd immunity has been at the forefront of public discussion since the onset of the pandemic — if a high enough percentage of a population is vaccinated, life might return to pre-pandemic days. But when governments obsess over this goal, it comes at the expense of global equity in access to vaccines, one vaccine expert said.