How countries are adapting to AstraZeneca vaccine shortages

In February, Ghana became the first country to receive a shipment of COVID-19 vaccines from COVAX — these were AstraZeneca doses, which are manufactured in India under the name Covishield and produced by the Serum Institute of India. In mid-May, it again began administering vaccines, meaning recipients are now eligible for their second shot.

But getting one is complicated.

When Pam, a resident of Accra, who requested to be referred only by her first name, went to a hospital to attempt to get her second shot, she was told there were no more vaccines left. Now, nearly four months since she received her first dose — way past the 12-week maximum gap recommended by the World Health Organization — she’s still unsure when she may get her second.

Pam is not alone. There are millions like her in other countries who don’t know when they’re getting their second dose of AstraZeneca. The vaccine was seen as a lifeline in many low- and middle-income countries which couldn’t get other COVID-19 vaccines due to lack of funding or limited supplies, as most doses had been purchased in advance by higher-income countries.

But in April, in the middle of a deadly second wave of COVID-19 in India, the Serum Institute had to prioritize domestic supplies. That left a huge supply deficit in low- and middle-income countries relying on the vaccine, and with COVAX, which announced in May a shortfall of 190 million doses by the end of June. Aurélia Nguyen, managing director of COVAX, wrote in a blogpost that COVAX deliveries “will continue to be very lean through July and August.”

“[S]hort term supply constraints are very much in play due to redirection of India supply and continued challenges manufacturers face in ramping up production at historic speed and scale,” a spokesperson from Gavi, the Vaccine Alliance said. WHO issued guidance in May to help countries partnered with COVAX to prepare for delays, and country offices of UNICEF and WHO are providing them support, the spokesperson added.

Dose donations are meant to fill the gap. During a press briefing, Matshidiso Moeti, WHO’S Africa regional director, said 300,000 doses of AstraZeneca vaccine donated by France through COVAX are arriving in Kenya and Somalia today. 

High-income countries have pledged to donate 500 million doses to date for 2021 and 2022, and COVAX is working with donors to get these pledged donations delivered to countries with acute needs. More deliveries are expected “in the coming days,” said the Gavi spokesperson.

Dealing with shortages

In Nepal, about 1.4 million people over the age of 65 have been waiting for a second dose of AstraZeneca. Many of them are past the 12-week window for a second dose — which the government officially extended to 16 weeks in May — and there’s still no concrete information on when new supplies will arrive.

Nepal’s Health Ministry Spokesperson Dr. Krishna Paudel told Devex the government is trying different diplomatic channels and engaging with vaccine manufacturers to secure the needed doses. The government, he said, has not yet decided on whether to administer a different vaccine for a second shot.

Nepal is not just waiting for doses from COVAX, but also directly from India. The government said it has paid for two million doses of AstraZeneca but has only received half of the doses.

Meanwhile, others aged 60 to 65 who received Sinopharm last month are already receiving their second doses.

“While we have been getting a lot of assistance which includes masks, sanitizers, cylinders, ventilators, and whatnot, we have been unable to get hold of the promised doses,” said Sandesh Raman Parajuli, a doctor in western Nepal. Parajuli is fully vaccinated.

In neighboring Sri Lanka, the government started offering Pfizer vaccines to people aged 55 and older on Wednesday in the absence of supplies of AstraZeneca vaccines. But this was canceled Thursday after officials announced that a new supply of AstraZeneca vaccines will arrive in mid-July.

Sri Lanka received 264,000 doses of AstraZeneca in March, but before that received a gift of 500,000 doses from India. As in other countries, however, supply disruptions have stalled additional doses. A shortage of 600,000 doses has left people waiting for their second dose for 16 weeks, according to Gathsaurie Neelika Malavige, a professor in microbiology and director at the Centre for Dengue Research at the University of Sri Jayewardenepura in Sri Lanka.

Mixing and matching

In Africa, where majority of countries received AstraZeneca doses from COVAX, Dr. John Nkengasong, director of the Africa Centres for Disease Control and Prevention, suggested in a recent briefing that those who received AstraZeneca as a first dose could get the Johnson & Johnson COVID-19 vaccine as a second dose.

Africa’s first shipments of the J&J vaccine are expected to arrive this week, said Strive Masiyiwa, special envoy of the African Union during the same briefing.

A number of high-income countries have adopted policies allowing for the mixing and matching of different COVID-19 vaccines — even German Chancellor Angela Merkel received two different COVID-19 vaccine shots.

A WHO guidance note in May acknowledged that studies are underway to assess whether other COVID-19 vaccines can be used as a second dose, but advised countries to wait for more data. Instead, the guidance said countries facing a limited supply of AstraZeneca's vaccine could delay second doses for as long as 12 weeks or “as soon as possible thereafter.” 

An eye on Chinese vaccines

Not all countries are planning to use whatever vaccines they are able to get hold of.

In Somalia, the government decided to allocate a portion of the 300,000 doses of AstraZeneca it received via COVAX in March for second doses. Over 70% of the doses have been administered to date, according to Ahmed Khalif, Somalia country director at Action Against Hunger, with more than 83,000 individuals receiving both doses of the vaccine.

Somalia is using up its supply to administer second doses before the vaccines expire, but discussions are ongoing with COVAX partners for an additional 300,000 doses, which they expect to arrive this month, he told Devex in an email.

There are currently no plans to consider using a different vaccine for a second shot, he said. Somalia has an existing supply of 150,000 doses of Sinopharm vaccines — only 3,000 of which were used as of July 6, and those could be an option if the country’s current supply fails to meet second dose needs, he added.

In Afghanistan, there are no plans to give a different vaccine for those awaiting a second dose of AstraZeneca, Athena Rayburn told Devex, director of advocacy, communications, campaigns, and media at Save the Children Afghanistan.

But she said the initial AstraZeneca doses received had been used up in early June and the next shipment isn’t expected until at least August. Less than 1% of the population was fully vaccinated, and another 1% of the population received a first dose of the vaccine “when supplies were exhausted.”

Afghanistan also received 700,000 donated doses of Sinopharm vaccine last month, which are also being administered, but they are not an alternative for those waiting for the second dose of AstraZeneca.

“At present, the only vaccine left in Afghanistan is the Sinopharm donated by China,” Rayburn said.