The G7's vaccine pledge is a 'big help', but what about distribution and delivery?

“A big help, but we need more.”

That was the director-general of the WHO’s reaction to a pledge made last weekend by some of the wealthiest nations on Earth to ramp up donations of COVID-19 vaccines to poorer regions.

Yet, successfully sending even the additional 870 million doses promised by the G7 will be no easy task – as the distance between good intentions and delivery can be dauntingly vast.

An estimated 11 billion doses will be needed to vaccinate 70% of the global population and “approach” herd immunity – assuming that most vaccines require two doses. So far, however, only slightly more than one in five people worldwide are estimated to have had at least a single dose.

The experience to date of the COVAX vaccine initiative, which will distribute doses pledged by the G7 to developing countries, has illustrated the challenges involved. Even as the resourceful endeavour has used camel riders in Kenya to spread awareness and delivered doses via drones in Ghana, the initial COVAX effort has in many ways disappointed.

In Afghanistan, for example, about 18% of the doses allocated for the country by COVAX have reportedly been received, while the figure is 22% for Cameroon, and 20% for the Dominican Republic. El Salvador, meanwhile, has received all of its allocated doses.

A dearth of vaccine manufacturing capacity has been blamed for shortfalls. When COVAX’s supplier, the Serum Institute of India, was impacted by a devastating outbreak in that country and a subsequent vaccine export ban, there were no other options.

The prevailing approach among wealthy countries also made early hiccups inevitable. Rather than promptly committing funds to COVAX, many opted to first secure doses for domestic use. The US, for example, spent billions of dollars to lock up vaccines while refusing to take part in COVAX, before a change in administration led to a fresh commitment to the effort.

Making complex pharmaceutical products that require a high degree of safety and quality is not a simple process. Building up the sort of infrastructure needed to churn out COVID-19 vaccines as needed globally may therefore take several years.

The existing COVID-19 manufacturing landscape has been described as “remarkably opaque.” Estimates for production this year range from about 9.5 billion doses to 12 billion, and UNICEF has estimated that capacity will top 43 billion doses next year.

Once a vaccine is made, however, demanding logistics and storage requirements can make it difficult to deliver (issues can arise during production, too, as was the case with the 15 million possibly-contaminated doses of Johnson & Johnson’s COVID-19 vaccine that had to be thrown out in March when flaws at a US plant were revealed).

The cold storage requirements of some vaccines developed at a relatively early stage have forced developing countries with warm climates to consider other alternatives.

In addition to vaccines made specifically for distribution to disadvantaged regions, countries able to buy more than they’ve needed aim to donate their surplus. However, the issue can be politically sensitive, and the risk that surplus doses will expire before they can be used adds even more pressure to vaccine supply chains.

Another sensitive issue is patent protection. Public health researchers, humanitarian organizations and some countries have advocated waiving patent protection for vaccines to boost supply. Others are not so keen; Gavi, the Vaccine Alliance – the primary organization behind COVAX – has argued that there’s no evidence to suggest patent protection is hindering the production of vaccines.

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