• The G7 pledged to dramatically increase vaccine donations to developing countries.
  • But serious challenges remain in terms of distributing the doses necessary to protect everyone.

“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 “approachherd 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.

Image: World Economic Forum

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.

For more context, here are links to further reading from the World Economic Forum's Strategic Intelligence platform:

  • Without “sweeping reform” of COVAX’s distribution criteria, this analysis argues, there’s no assurance that pledged doses will make it to countries suffering disproportionately. (Peterson Institute for International Economics)
  • It’s brilliant news that wealthy countries plan to donate vaccines to developing countries, according to this piece, but it also points to a weighty question: what is the “right price” to pay for surplus vaccines? (Center for Global Development)
  • In Afghanistan it’s children who are paying the harshest price for vaccine inequality, according to this report, as confirmed cases hit a record high and schools remain closed even as wealthier nations celebrate a return to normal life. (The Diplomat)
  • In some ways the ability of vaccines to end pandemics might also be weak in wealthy countries. This profile of a vaccine anthropologist ponders what an abundance of vaccines is really worth if not enough people are willing to take them. (New Yorker)
  • As the G7 was meeting in the UK, the first COVID-19 vaccinations arrived in Bor – a town in South Sudan where people see more deaths from conflict than the virus, according to this analysis, and both mistrust in government and vaccine skepticism run high. (LSE)
  • Reports have surfaced of cases spiking in countries using China’s Sinopharm COVID-19 vaccine, but this piece argues that it should continue to underpin the global response to the pandemic as long as vaccine demand outstrips supply. (The Conversation)
  • The curious case of Tamil Nadu – in India, vaccine shortages and a lack of robust healthcare infrastructure is one reason for uneven coverage, according to this report, but another can be a high degree of vaccine hesitancy. (Observer Research Foundation)

On the Strategic Intelligence platform, you can find feeds of expert analysis related to COVID-19, Global Governance and hundreds of additional topics. You’ll need to register to view.

Image: World Economic Forum