When the world’s largest vaccine manufacturer, India’s Serum Institute (SII), was forced to ban the export of vaccines in order to cope with surging domestic demand caused by the rampant pandemic, the UN-led vaccine supply COVAX initiative faced the risk of failing to meet its global supply objectives. This has put developing countries in an uncertain situation in terms of their national vaccination strategies since many are fully dependent on COVAX.
Halt in vaccine supplies
To meet this goal, COVAX has been cooperating with a number of vaccine producers with SII being the largest. Under the agreements signed with SII, the manufacturer initially committed to produce 100 million doses of vaccines with that amount subsequently doubling to 200 million.
By the beginning of April, COVAX had provided 38 million doses of vaccine to over 100 economies including 61 lower-income ones. Almost half of these were produced by SII, with AstraZeneca and Pfizer-BioNTech producing the remainder. In addition, another 46 million doses of the SII-produced vaccine were shipped directly to other countries.
However, in March, India imposed a ban on vaccine exports as the country battled a rampant surge in COVID-19 cases. In early May, daily cases exceeded 400,000. In this context SII CEO, Adar Poonawalla said that India was a priority as his company “has never exported vaccines at the cost of the people of India” although he voiced a hope “to start delivering to COVAX and other countries by the end of this year”.
COVAX deliveries affected
As India’s SII was expected to supply 110 million vaccines by May, COVAX announced the effects of the delays. By mid-May, the facility had managed to supply 65 million doses out of the planned 170 million.
Commenting on the situation, Henrietta Fore, the executive director of UNICEF, a partner to COVAX, said that India’s ban on vaccine exports “has meant that 140 million doses intended for distribution to low- and middle-income countries through the end of May cannot be accessed by COVAX”. Moreover, “another 50 million doses are likely to be missed in June,” she said.
At the same time, Fore noted that the export ban was not the only reason for vaccine shortages and delays.
“This, added to vaccine nationalism, limited production capacity, and lack of funding, is why the roll-out of COVID vaccines is so behind schedule,” she said.
Impact on developing countries
Africa is the least vaccinated continent globally with less than 2% of all distributed doses having been administered there as of April. The plan was to have 30-35% of the continent’s population vaccinated by the end of this year, a goal that no longer looks attainable. Kenya, for instance, received 1 million doses of the Astra Zeneca vaccine from COVAX for its 50 million population. The second batch of 3 million was expected to arrive in June but this is now rather unlikely to happen. Ethiopia planned to vaccinate 23 million of its 115 million population by the end of the year but so far has received only 2.2 million shots from COVAX which had committed to deliver 9 million in total.
Many developing Asian countries have also been relying on COVAX. Indonesia started to immunize people in January and planned to vaccinate 181.5 million of its 270 million population by the end of 2021. So far, only 6.4 million doses have come through the COVAX facility, a little more than half of that which was promised. Bangladesh, with a population of over 160 million and home to about 1 million Rohingya refugees, only received the first consignment of vaccine from COVAX on 1 June which contained over 100,000 doses of the Pfizer vaccine. Despite the fact that the country had signed a direct agreement with SII in 2020 for 30 million doses, it only received 7 million from January to February and another 3 million as a donation from India.
Latin American countries are facing a similar situation. Although COVAX committed to deliver 22 million doses there by the end of May, by the end of April Latin America had only received 18.5% of the doses promised.
What of the solutions
UNICEF and other charities have called on high-income countries to donate their surplus vaccines and abstain from the vaccination of less vulnerable children until the elderly and people at risk in poor states are vaccinated.
UNICEF referred to an analysis showing that “G7 nations and ‘Team Europe’ group of European Union Member States could donate around 153 million vaccine doses if they shared just 20% of their available supply over June, July and August”. This, UNICEF said, would not impede these countries in vaccinating their own populations.
The call from UNICEF has not gone unnoticed. Norway and New Zealand have given the vaccines they were eligible for back to COVAX. Some other European countries have also announced their readiness to donate AstraZeneca shots and the US has announced it will donate 80 million doses, the highest number so far.
In a joint statement issued on 27 May, COVAX said: “If the world’s leaders rally together, the original COVAX objectives – delivery of 2 billion doses of vaccines worldwide in 2021, and 1.8 billion doses to 92 lower-income economies by early 2022 are still well within reach”.
Meanwhile, some projections show that production has been increasing rapidly, and thus, by the end of the year, the world will have sufficient doses to vaccinate everyone. According to a document issued last March, “vaccine manufacturers and suppliers of vaccine components are scaling up for COVID-19 vaccine production from zero to billions of doses, with an announced cumulative supply target of up to 14 billion doses by the end of 2021”. To achieve this, most vaccine manufacturers have increased their capacities since before the pandemic, global vaccine production stood at about 5 billion annually.
As of 3 June, 172 million COVID-19 cases have been recorded globally and almost 3.7 million people have died.
