To understand how unequally covid-19 vaccines are being rolled out around the world, look to Guinea. The World Health Organization says the West African state has administered just 25 doses. By comparison, more than 7 million have been given .
The reality is that while the 聽and the many middle-income countries have only just begun roll-outs. Most low-income ones will take months to get started.
For Kate Elder at the non-profit M茅decins Sans Fronti猫res, the day聽UK resident Margaret Keenan became the first person in the world to be vaccinated in December was the day countries failed to deliver on earlier promises of vaccine equity. 鈥淒elivering equity means vaccines are available in low-income countries at the same time as high-income countries,鈥� she says.
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India, Mexico, Indonesia, Argentina and other lower-middle to upper-middle-income countries have begun immunisation programmes by buying a supply of vaccines. Some middle-income countries have 鈥渂een supported with the Chinese or Russian vaccines鈥�, says Elizabeth Mason at the UN-appointed Independent Accountability Panel.
However, most low-income countries cannot afford to buy vaccines. 鈥淭he state of play is devastating because there is no state of play,鈥� says Elder. Those countries are waiting on Covax, a scheme backed by the World Health Organization (WHO) that aims to vaccinate 20 per cent of participating countries鈥� populations in the long run. The initiative that the first deliveries will come by the end of February, and claimed it is on track to hit its goal of 2 billion doses by the end of the year.
Observers are split on how realistic that is. 鈥淲e expect delays to Covax. We think the commitments will be very difficult to meet,鈥� says Agathe Demarais at the Economist Intelligence Unit, a UK-based research group. Of the 2 billion doses Pfizer recently said it would make for the world this year, have been agreed for Covax. Despite having raised more than $2 billion, Covax is 鈥渙bviously not very attractive to pharmaceutical corporations鈥�, says Elder. Mason is more optimistic, and says the initiative is 鈥渕oving at a good speed鈥�.
It isn鈥檛 the only effort. An African Union-led initiative agreements for 270 million vaccine doses from a variety of manufacturers. However, Richard Mihigo at the WHO told a press conference on 28 January: 鈥淲e knew very well some of these doses may not become available soon.鈥�
Mihigo said many African countries will need different types of vaccines to succesfully vaccinate beyond capital cities. Capitals will have storage that can keep Pfizer/BioNTech鈥檚 vaccine at -70C, for example, while more remote areas may need vaccines that don鈥檛 need to be stored at such temperatures, such as Oxford/AstraZeneca鈥檚, although that still requires two doses. The single-dose vaccine from US firm Johnson & Johnson, which clinical trial results are expected on imminently, will be 鈥渧ery interesting鈥� for logistical reasons in Africa, Mihigo said.
Overall, due to difficulties with vaccine supply, challenges in some countries around transporting and storing vaccines, and a lack of healthcare workers, mass immunisation of populations in some low-income countries may not happen until 2024, 鈥渋f at all鈥�, according to by Demarais on 27 January. The same milestone is expected in mid-2022 for high-income countries.
The first and most obvious consequence of slow and patchy immunisation in low-income countries is more cases and deaths that could be avoided, says Mason. The second is the economic ramifications. 鈥淚t will delay the global economic recovery. We鈥檒l have a situation where richer countries are vaccinated but the poorer are not, so they will have to resort to local lockdowns,鈥� says Demarais. The International Chamber of Commerce estimates such a failure would .
The third problem is that 鈥渘o one is safe until everyone is safe鈥�, a point made by WHO director general聽 and some world leaders. Having the virus circulating in populations for longer increases the risk of mutations leading to variants that are more transmissible, such as the so-called Brazil, South Africa and UK variants. That may render vaccines less effective in future, which would be an issue for vaccinated populations in affluent countries as well as poorer ones.
鈥淚t鈥檚 the nature of viruses to mutate. We hope vaccines keep ahead of the mutations 鈥� and that means making sure the lower and middle-income countries are vaccinated as well,鈥� says Mason. As she points out, even with many flights grounded, there is still 鈥渁 huge movement of people across the globe鈥�.
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