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The hoarding of vaccines by richer countries could ultimately prove costly for the international community, says Dr Gavin Yamey of Duke University in Durham. (Image: Foxeel/Shutterstock)

Vaccine nationalism poses threat to global health

By Jeremy Booth, Dental Tribune International
March 25, 2021

LEIPZIG, Germany: Many understood the news of the first SARS-CoV-2 vaccines in late 2020 to represent a panacea in the global fight against the pandemic. In reality, a short list of rich countries had already purchased the lion’s share of doses that the makers of these vaccines will be able to produce in 2021—often before clinical trials were even concluded. Many countries are dependent on COVAX, the COVID-19 vaccines global access initiative that aims to distribute doses to healthcare workers and at-risk populations in the developing world. Scientists have pointed out that a lack of equitable distribution could harm global public health.

Inoculation against SARS-CoV-2 is well under way in developed nations, and early results appear promising. Researchers in Israel conducted a study, which is yet to be peer reviewed, on the advanced roll-out of the Pfizer-BioNTech vaccine in the country, and found that infections and hospitalisations had decreased in the population.

Israel began its vaccination campaign on 20 December 2020, and the researchers analysed Ministry of Health (MOH) data from March 2020 to February 2021 in order to assess its initial impact. By comparing MOH data from early February with that from 21 days prior, the researchers observed that the number of new cases of SARS-CoV-2 infection dropped by 49%, hospitalisations related to COVID-19 dropped by 36% and the number of patients critically ill with COVID-19 decreased by 29%.

Israel signed a private purchase agreement with Pfizer for the supply of its vaccine in January, and around 80% of residents in the country over the age of 60 had been vaccinated by 6 February. At that time, in around 130 other, poorer, countries governments had not administered a single jab.

Vaccinating healthcare workers and at-risk groups against COVID-19

According to Dr Gavin Yamey, director of the Center for Policy Impact in Global Health at the Duke Global Health Institute at Duke University in Durham in the US, the hoarding of vaccines by richer countries could lead to the development of new variants of the virus in areas where doses are scant.

In an article published on 24 February in Nature, Yamey argues that vaccinating the general population in rich countries, before healthcare workers and at-risk groups in poorer countries, will prolong the pandemic. “When SARS-CoV-2 transmission is wildly uncontrolled, the virus has more scope to evolve into dangerous variants. A COVID-19 outbreak anywhere could become an outbreak everywhere,” Yamey explains. He says that developed nations should be sharing their vaccine supply and negotiating with vaccine manufacturers in order to increase supplies, adding: “Many public health workers strived to avoid the disparities we are seeing now.”

“When SARS-CoV-2 transmission is wildly uncontrolled, the virus has more scope to evolve into dangerous variants”
– Dr Gavin Yamey, Duke University

Around 190 countries have joined COVAX, but many of them have opted to purchase their own vaccine doses directly from pharmaceutical companies and not through the COVAX scheme. According to Yamey, by negotiating directly with vaccine manufacturers, richer countries are pushing COVAX—and poorer nations who are relying on the initiative—to the back of the queue. He says that doing so could prove costly.

Jointly led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations and the World Health Organization, COVAX is the first initiative of its kind. Member countries can collectively purchase SARS-CoV-2 vaccines through COVAX and fund vaccine development and manufacturing through the COVAX pool. Countries can be donors, self-financing participants, recipients—or a mixture of the above—and a certain amount of the collective resource pool is earmarked for poorer countries. According to Yamey, sharing vaccines with the COVAX pool “will help beyond dimming the chance of an outbreak from an imported variant that hoarded vaccines might have reduced efficacy against”.

Vaccine nationalism—an ugly side of the pandemic

The escalating row between the EU and the UK over the Oxford-AstraZeneca jab shows that vaccine shipments may complicate trade and other bilateral relations. Post-Brexit tensions between the fledgling trade partners are currently extremely high owing to the dispute.

COVAX is expected to secure around 2 billion doses for its pool this year—which represents less than one-third of the 5.8 billion doses that rich countries have secured through private deals with drug makers for shipment in 2021. In addition to an emerging trend of inequitable global distribution, the distribution of COVAX-supplied vaccine doses in recipient countries is also raising the ire of healthcare workers.

“Global equitable access to a vaccine, particularly protecting healthcare workers and those most at risk, is the only way to mitigate the public health and economic impact of the pandemic” – COVAX

Reuters reported on 20 March that thousands of United Nations staff in Kenya had been offered COVAX-supplied vaccines by the Kenyan government despite the country not having inoculated its healthcare work force. Macharia Kamau, principal secretary in the Ministry of Foreign Affairs and International Trade in the Kenyan government, defended the plan, pointing out that Nairobi is the default diplomatic capital of the United Nations in the southern hemisphere. “We need to protect everyone resident in Kenya. It just made sense not to reach out only to Kenyans but also to the international community here,” Reuters quoted Kamau as saying.

“Kenyans must be given priority,” Dr Chibanzi Mwachonda, acting secretary general of the Kenya Medical Practitioners, Pharmacists and Dentists Union, told the news organisation. One diplomat who was offered a vaccination by the Kenyan government asked the question: “Why does the Kenyan government prioritise expats—who have money and can get the vaccines through their own channels—over its own population, especially the poor?”

So far, Kenya has received one shipment of around 1 million COVAX-supplied vaccine doses, and 100,000 doses have been donated to the country by the Indian government.

Nations and political blocs were already vying for advantages in the global supply of SARS-CoV-2 vaccines well before the first efficacy studies were completed, but Yamey suggests that rich nations donate one dose to the COVAX pool for every nine doses that they administer. “This falls far short of ‘equitable’, but it is within what is possible,” he maintains.

On its website, COVAX states: “Global equitable access to a vaccine, particularly protecting healthcare workers and those most at risk, is the only way to mitigate the public health and economic impact of the pandemic.”

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