In recent weeks, both Democrats and public health experts in Congress have called on the Biden government’s to increase its global vaccination campaign. Although the President has promised to send or finance more than half a million doses overseas, that amount is still less than the required number. Senators Elizabeth Warren and Elizabeth Warren argue that the lack of vaccines is both a security risk and a humanitarian crisis. The domestic Biden administration seems to be close to recommending booster doses to Americans six months after they have received their initial doses. This has been met with consternation by the World Health Organization as its director spoke out against “vaccine nationalalism”
Krishna Udayakumar is a doctor and founder of Duke’s Global Health Innovation Center. He advised the government that the United States must increase its vaccination efforts in developing countries. Udayakumar mentioned that the center is a recipient of grant agreements from Pfizer. The nonprofit also receives funding through AstraZeneca, but not for the COVID-19 vaccines. For the sake of Editing and length, we talked about what the Biden government should do differently and why booster syringes are not the biggest barrier for fairer access. We also discussed the best way to ensure that vaccine doses don’t go wasted.
One feeling is that we aren’t increasing our delivery capacity quickly enough, and the other feeling is that we don’t donate enough of our shots to the rest the world. Do these two issues exist independently or as part of the same issue?
I would consider the whole picture as three buckets. The first is how much supply can be offered in the US and around the world. The second is the distribution idea. How can vaccines reach where they are needed most and get there fairly? How can we ensure that vaccines are distributed and delivered in a way that increases vaccination rates?
We have not had to place a global supply restriction on the first bucket. This is because, despite having administered approximately 5.3 billion doses and administered just over 5 billion doses so far, it was done with a great deal of injustice. At least half of all high-income countries have vaccinated their population. They only get two shots for every 100 people in low-income countries. Accessibility is 50 times less in low-income countries. Even though there was a shortage, the allocation system was so inequitable that we created administrators and vaccine owners.
Good news is that the supply is increasing very rapidly. We expect there to be about a billion cans per monthly of production capacity for the next two or three months. So we are close to moving from being major constraints to non-major ones. That means that we have even more to worry about the second and the third buckets.
Are the private sector responsible for the rapid increase in supply, or are governments such as the United States pooling their efforts, or are NGOs and international health organizations to blame? Why is this happening and what are the implications for global health?
It was over. It was all over a year ago that we had investment from governments, including the US, through Operation Warp Speed. This allowed governments to take risks and invest in new manufacturing capacities. There were also big foundations, such as the Gates Foundation, that invested more than a billion dollars to help the overall response. We also saw private sector investment. There has been much investment and vaccines can take six to 12 months to fully ramp up. That is why we see it ramping up with such a long delay.
It was also difficult because we had previously developed a highly consolidated, just-in-time model of vaccine manufacturing. That model collapsed during a global pandemic. Now we know we need a more distributed and resilient production model so we don’t run out of vaccine supplies such as filters, reactor bags, and other small things that could prevent production.
The second caveat was that these were global supply chain that broke down. This was partly because of logistical challenges as well as because governments, including the US used export restrictions in an attempt to increase their own production while materials are leaking to other countries.
It has been criticised that the government did not spend money originally allocated to increase production. Is it possible to see why?
While I am not able to see how the government used these money, I think there should still be some distinction between increasing global manufacturing capability as a whole and investing into and increasing production capacities based on low and medium income countries. Both are necessary, but they’re not the same. A manufacturer might be able increase US capacity. However, this will not solve long-term production issues in low- and mid-income countries. It will require continued investment and transfer of intellectual and technological property, knowledge, and capacity building. This could take several months or even years. All of this should be done now, and much faster than we are currently.
We now come to bucket #2, the allocation. What are your biggest concerns regarding global allocation and how the United States is doing in this regard?
If we look at the allocation, I believe that only a few countries, mostly countries with high or middle incomes, have used the vast majority vaccines thus far. This highlights the problems facing COVAX, a multilateral platform set up early in the pandemic for justice and to help address the global situation. It was able to fight from many perspectives. The first was funding. It made enough commitments only recently to purchase vaccines on large scale. AstraZeneca was the main supplier of vaccines, while Novavax had issues with manufacturing. The Serum Institute of India was the manufacturer with whom they worked closely. India cut its exports in order to have more domestic supply for the second wave. It prevented much of COVAX’s early supply. Your inability to take action is a constant struggle. It is clear that of the five billion COVAX doses, only approximately two hundred and fifteen thousand have been administered. It doesn’t really matter at this point.
What can rich countries do to ensure equitable distribution if supply capacity improves in the coming months?
There are many things I believe. One is that there needs to be more cans split faster. If you take a look at Europe and the G-7, we project that they will be able share at least one billion cans by the end this year. Even if they have all their domestic needs met, boosters included. The US currently has just over 100 and ten millions cans. This is more than any other nation combined. But that’s still a very low standard. This is only 1% of the global need. We are far from being able to meet both the urgency and the magnitude of the need. Because supply is concentrated in a few countries only, it’s important that those countries do more than simply share their donations.
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