It’s likely many low and middle-income countries will have to wait until as late as 2024 to be able to vaccinate the majority of their population against COVID-19, after wealthy nations rushed to stockpile available doses through bilateral deals.
High-income countries have so far reserved 12.5 billion doses of vaccines currently in development, according to data compiled by Duke University, leaving poorer nations scrambling to get their hands on doses.
Researchers estimate many of these countries will not achieve nationwide herd immunity until at least 2023 or 2024, sowing doubt that a vaccine will be effective in combatting the pandemic.
“The picture is actually really bleak right now,” Andrea Taylor, the assistant director at the Duke Global Health Innovation Centre, told SBS News. “It looks very dire for all low-income countries, and most lower-middle-income countries as well. These countries just do not have enough vaccine to cover their populations.”
Most countries in sub-Saharan Africa, Pakistan, Ukraine, and Mongolia are among at least 67 nations that have so far been unable to secure any doses of the vaccine, beyond those to be made available through the COVAX initiative, jointly led by the World Health Organization (WHO).
Five of these countries – Kenya, Myanmar, Nigeria, Pakistan, and Ukraine – have reported more than two million COVID-19 cases between them.
Meanwhile, using World Bank country income classifications, high-income countries currently hold 4.2 billion confirmed vaccine doses, upper-middle-income countries hold 1.2 billion, and lower-middle-income countries hold 495 million, with no evidence of any direct deals made by low-income countries.
WHO director-general Tedros Adhanom on Monday described the possibility of poor countries missing out on the vaccine as a “catastrophic moral failure” with the promise of equitable access “at serious risk”.
So far, more than 39 million doses of the vaccine have been administered in at least 49 high-income countries, he said, compared to just 25 single doses in one low-income country.
“Not 25 million, not 25 thousand, 25,” he said. “I need to be blunt: the world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.”
How the COVAX initiative works
COVAX aims to provide up to two billion doses by the end of 2021 to cover vulnerable populations in low and middle-income nations, such as frontline workers and the elderly, and is likely the only lifeline for countries unable to make advanced purchases of vaccines.
Established during the early stages of the pandemic, the initiative relies on the support of wealthy countries to fund advance market purchases of vaccines, which will then be distributed fairly throughout the globe.
The coalition is also supporting the research, development and manufacturing of a wide range of vaccine candidates. All participating countries, regardless of wealth, will have fair and equal access to vaccines once they are developed.
Australia has so far donated $80 million to the COVAX Advance Market Commitment as part of a collaborative effort to provide doses to developing countries. In September, another $123.2 million was committed to access purchasing offers through the scheme once vaccines are available.
“Access to vaccines will play a critical role in the economic recovery of our region from this pandemic,” Foreign Minister Marise Payne said at the time. “Now more than ever, we must come together as a global community to ensure that our response leaves no one behind.”
COVAX is ready to start deliveries from February, Dr Tedros said, but he accused some high-income countries of “attempting to jump to the front of the queue”.
“Even as they speak the language of equitable access, some countries and companies continue to prioritise bilateral deals, going around COVAX, driving up prices,” he said.
“Forty-four bilateral deals were signed last year, and at least 12 have already been signed this year … This could delay COVAX deliveries and create exactly the scenario COVAX was designed to avoid, with hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption.”
He urged nations that had independently entered into bilateral deals with vaccine manufacturers to share their own doses with COVAX, especially once their own vulnerable populations had been vaccinated.
But Dr Taylor says she’s “beginning to worry we’ve passed that point” of being able to avoid disaster.
Without further commitments from wealthy countries, Duke University researchers estimate the COVAX stocks will only be enough to vaccinate 20 per cent of the population of lower-income countries.
“To get to herd immunity we think we need about 60 to 70 per cent of population coverage,” Dr Taylor said. “What we’re looking at is a situation in which low-income countries just are not going to have the vaccines that they need in the next year or so, while rich countries do.”
Timelines for when the majority of the world will be able to receive a vaccine are calculated using current and estimated future manufacturing capacity. This means, as it stands, there is a finite number of vaccine doses that can be produced in a year without further development of manufacturing facilities.
“We’ve never seen advanced purchases like this,” Dr Taylor said. “What we were seeing was millions and millions of doses being committed before any of the vaccine candidates were even on the market or had any data about their efficacy.”
What it means for Australia
For wealthy countries like Australia – which is expected to launch its vaccination program in mid-February – this shortfall in the global vaccination program means the strength of a vaccine in stopping the spread of the virus will be weakened.
If the pandemic is able to continue spreading in low-income countries, the virus has a greater chance of mutating and evolving into strains not covered by the first generation vaccines.
Continuing outbreaks in low-income nations will also wreak havoc on the world’s economy, Dr Taylor warned, estimating $120 billion in lost GDP for high-income countries this year if low-income countries are unable to access a vaccine.
“The impact it will have on the global economy is staggering, and we really, really can’t afford that,” she said, adding: “The longer we allow the virus to spread … the higher chance we are giving it to mutate into something that we can’t protect ourselves against.”
The unprecedented early purchasing of vaccines before they went to trial has revealed fundamental flaws with the global vaccine roll-out strategy, according to Oxfam Australia’s chief executive Lyn Morgain.
She told SBS News that even if a decision was made to ensure the vaccine technology was shared globally, there would still be “very significant” challenges in distributing it.
“We need to support the mechanisms and organisations on the ground in countries,” she said.
“What Oxfam is asking for is a much stronger contribution from governments, not just nationally but globally too, to back firstly having the technology and secondly ensuring that we’re funding the distribution approaches that we need.”
Oxfam International estimated in December there were at least 67 countries that will struggle to access the vaccine this year. “What these countries have in common is they’re all poor countries,” Ms Morgain said.
The Australian Government has so far pledged half a billion dollars in foreign aid to support neighbouring countries in the Pacific and East Asia vaccinate to their populations over the next three years. This will include sharing vaccines obtained through a range of advance purchase agreements.
Australia, with a population of 25 million, has so far purchased 114.8 million vaccine doses from three sources – Oxford/AstraZeneca, Novavax, and Pfizer/BioNTech – in addition to vaccines made available from COVAX, according to the Department of Health.
“Everything about this is unprecedented,” Dr Taylor said. “Because of the sheer scale of this effort, and the volume of vaccine needed, and the need to cover every population in every country across the globe, more or less at the same rate, in order to control the pandemic, these are all new, new experiences for the global community.”
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