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As The Virus Mutates, The World Is In A Race To Vaccinate Against COVID-19

It could be years before everyone who needs a COVID-19 vaccine gets one.

To date, more than 100 million doses of COVID-19 vaccines have been administered, spanning 67 countries across the world.

In Canada, a total of about 1.07 million doses have been administered as of Sunday night. Despite multiple delays, Prime Minister Justin Trudeau reiterated last week that every Canadian seeking inoculation would be vaccinated by September.

In the U.K., more than 10 million people have already received their first dose and the government aims to offer a vaccine to all adults “by the end of autumn.”

Here’s a look at how the global vaccination program is progressing — and why it matters just as much how other countries are faring as your own.

Where are we currently at?

According to figures published by the University of Oxford’s Our World in Data and by the U.S. Centers for Disease Control and Prevention, a total of 104.9 million vaccine doses have been administered in the world. This means more people are now vaccinated against COVID-19 than have been infected by the virus.

Israel is the undisputed world leader in its vaccination program by Tuesday, one in three Israelis had received at least one dose of the Pfizer/BioNtech or Moderna vaccines. From this week onwards, anyone over the age of 16 can book an appointment to receive their jab in the country.

People wait in a queue to receive a dose of the Pfizer-BioNtech vaccine in Jerusalem.
People wait in a queue to receive a dose of the Pfizer-BioNtech vaccine in Jerusalem.

The U.K. and U.S. follow. In the U.S., an average of 1.3 million doses have been administered per day in the last week as part of U.S. President Joe Biden’s “100 million shots in 100 days” pledge.

China and Russia had approved their own vaccines long before the U.K.’s Medicines and Healthcare Products Regulatory Agency (MHRA) gave approval for the Pfizer/BioNTech vaccine in early December 2020. Russia was the first country in the world to approve a COVID-19 vaccine back in August. Since then, both countries have administered millions of doses to its citizens, although information on their progress is limited.

Many East Asian countries where infections are largely under control have not prioritized vaccinating their citizens. Taiwan, for example, which on Wednesday recorded its ninth COVID-related death since the start of the pandemic, does not plan to vaccinate its population until March at the very earliest. New Zealand, which is considered another coronavirus success story, only approved the Pfizer/BioNTech vaccine last Wednesday and plans to begin vaccinating frontline workers in April.

In those countries with limited outbreaks, regulators have chosen to observe the safety and efficacy of vaccines as they are rolled out in more COVID-affected countries such as the U.K. and U.S. — although there has not been any cause for concern. South Korea also chose to take its time and negotiate a reasonable price for its vaccines, as its COVID situation meant it could afford to wait.

And although the global vaccination program is just weeks old, Our World In Data’s head of data, Edouard Mathieu, points to the “very, very stark” differences already evident between countries and continents. “We know that Israel and the U.K. are doing really well, as well as Denmark, Malta and Ireland. Within the EU, there are countries that doing really poorly and slowly such as Bulgaria, Belgium and the Netherlands,” he tells HuffPost U.K.

“There are also the big countries that have already started [vaccinating] but not quickly, such as India, Indonesia, Mexico and Brazil. But the biggest difference is the fact that there are also a lot of countries in the world that haven’t seen a single dose — for example in sub-Saharan Africa, where right now there have been no vaccinations at all.”

How important is COVAX?

Some 190 countries, including Canada, have signed up to the global vaccine sharing scheme known as COVAX, which stands for COVID-19 Vaccines Global Access Facility.

Launched in April 2020 and led by the WHO and the Global Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations, the scheme aims to ensure vaccines are distributed fairly around the world.

For low- and middle-income countries who cannot afford to make direct deals with pharmaceutical companies, COVAX could be their lifeline. The scheme hopes to deliver more than two billion doses by the end of 2021, of which 1.8 billion will be given to the 92 lower-income countries, covering about 20 per cent of their populations.

But COVAX has struggled to raise the funds it needs to complete this mammoth mission and faces a $35 billion funding shortfall. It has also struggled to convince its wealthier signatories to use the scheme for their own domestic vaccine procurement. As a result, countries such as the U.S. and U.K. have sought out bilateral deals with vaccine manufacturers to secure doses instead.

There has also been criticism that COVAX has been “on the back foot” and too slow to secure vaccine deals and deliver doses to countries. Clemens Martin Auer, a WHO board member, said the scheme “has to do a better job.” In a statement, he added: “The glass of delivering [vaccines] is not even half full.”

Also, even if COVAX meets its own target of two billion doses by the end of the year, that would only cover 20 per cent of each country’s population — not nearly enough to end the pandemic.

What about wealthier countries?

Canada has pledged $440 million to COVAX. The U.K. has provided $948 million to COVAX, while the EU has pledged nearly $1.3 billion to the scheme. Following Biden’s inauguration, the U.S. also pledged $5.1 billion to COVAX.

Ghana is expected to receive 2.5 million doses of the vaccine by the end of March through the COVAX scheme.
Ghana is expected to receive 2.5 million doses of the vaccine by the end of March through the COVAX scheme.

But despite this, some wealthy countries have been under pressure to secure doses for all its citizens and are directly negotiating their own deals with pharmaceutical companies.

According to Duke University’s vaccine tracker, these high-income countries — comprising just 16 per cent of the world’s population — have purchased 60 per cent of the global vaccine supply.

The U.K. government has suggested it could share vaccines with other countries — but only after its entire adult population has been vaccinated. Similarly, Canada — which has reserved more vaccine doses per capita than any other country — has also pledged to donate jabs “if we have more vaccines than necessary.”

Why does it matter?

Vaccine nationalism is counterproductive. When a small number of wealthy countries rush to buy the world’s vaccine supply, they undermine the COVAX scheme by stockpiling vaccines and taking doses off the market. Doing so will prolong the pandemic.

The director-general of WHO, Tedros Adhanom Ghebreyesus, was harsh in his criticism for those countries during a speech last month. “Even as they speak the language of equitable access, some countries continue to prioritise bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue,” he said. “This is wrong.”

A report by the Economist Intelligence Unit predicts vulnerable groups in rich countries with access to proven vaccines, including the U.K. and the U.S., will have all been vaccinated by mid-March. But in most low-income countries, meaningful vaccination coverage that could return life to normality may not be possible until 2023, if ever.

If poorer countries are forced to wait for doses as wealthy nations scramble to buy up the available ones, the virus will have more time to circulate and could mutate faster, potentially into new strains that existing vaccines will not be effective against. “That works against everyone’s best interests,” warned COVAX chief Seth Berkley on Wednesday.

Unless vaccines are shared more fairly, experts have warned it could take years before the pandemic is brought under control.

Mathieu says he personally strongly rejects the “I care about my country first” attitude. “There’s also a matter of when a human is a human,” he explains.

“In terms of more tangible arguments about why people should care about what’s happening elsewhere, there’s the fact that too many people focus on making sure herd immunity will happen in their country. For that to happen, that would mean closing all the borders around the country and not allowing anyone else to come in.

“If we just vaccinate everyone in Europe and leave Africa non-vaccinated, it’ll mean we can’t allow anyone whatsoever to come and go from one continent to the other. We’re also giving a huge opportunity for the virus to create more and more strains in Africa that we won’t be immunised against.”

He adds: ”[Vaccine nationalism] is something that feels intuitive to people but actually doesn’t make any sense scientifically. I think too few people realize this and instead see it as a national problem.”

So when can we expect the world to be vaccinated?

On Wednesday, COVAX released its first vaccine distribution forecast, outlining how many doses of the Pfizer/BioNTech and AstraZeneca/Oxford vaccines it planned to deliver.

More than 330 million doses would be used to cover, on average, 3.3 per cent of total populations of 145 countries participating in the initial round of distribution. The first doses would be delivered “hopefully by the end of February, beginning of March.”

According to Bloomberg’s COVID-19 vaccine tracker, it will take 11 months to vaccinate 75 per cent of the population of the U.S. with a two-dose vaccine. That 75 per cent is the percentage that some scientists, including the U.K.’s Scientific Advisory Groups for Emergencies (Sage) group, have suggested could be the level where a country could reach so-called “herd immunity.”

Mathieu warns against this figure, saying “people should be super careful” about basing their forecasts on this. “It’s a number that lots of people are throwing around based on how some communicable diseases work, but it’s now emerging that it could be very different for COVID. We don’t really know what’s going to happen at 75 per cent, so we don’t want people to think that there’s an actual threshold where something is going to massively change.”

Even if a country such as the U.K. were to reach herd immunity, it would almost certainly be a matter of time before it was reinfected unless it completely closed its borders — an unlikely prospect considering how more than 10,000 people are still thought to be entering the country each day.

For Mathieu, who spends each day tracking the global vaccination program, he is reluctant to offer a firm prediction. “If the question is when we can expect to get 14 billion doses to vaccinate the world, then frankly I wouldn’t be able to say. My feeling is that if the world decides to make it the most important problem in the world — which it should be — then we can hope the world would be vaccinated sometime in 2022 or 2023.”

A more realistic goal is to vaccinate the world’s vulnerable groups, elderly people and health-care workers. Poorer countries will struggle to access enough shots to vaccinate its entire population, so they may use other strategies. “The focus on herd immunity might be a biased view because we live in rich countries where we can afford to vaccinate 75 per cent of people, but for a lot of countries that won’t be the goal,” he says.

“So if we reframe the question to when everyone in the world over 65 years old will be vaccinated, then maybe we can really hope for that to be achieved by 2022.”

He emphasises that the date is mostly guesswork on his part. “But we’re already one month into 2021 and some countries haven’t seen a single dose, so I have a hard time seeing how the entire world’s vulnerable people could get a vaccine by the end of the year. That just seems to be too optimistic.”

According to Duke University’s tracker, current models predict it will take well into 2023 or 2024 for everyone who needs a vaccine to receive one.

What are the obstacles that lie ahead?

In COVAX’s interim forecast, it warned the plan was “non-binding and may be subject to change” and that allocation and distribution would be dependent on many factors — including the WHO’s emergency use approval and the readiness of countries to receive and administer shots.

The main challenges for the global vaccination program are production, distribution and storage. Facilities belonging to Pfizer and Moderna are located in the U.S. and in the EU, so transporting the doses to other countries could be a major challenge. The Pfizer/BioNTech vaccine needs to be stored at -70 C, which is a challenge fo many countries in Asia and Africa.

“Most of the pharmaceutical companies were fairly optimistic at the beginning, but now that they’re getting orders from basically every country in the world it’s becoming much harder,” Mathieu says. One solution to this problem would be to manufacture vaccines locally — the Oxford/AstraZeneca vaccine, for example, is being manufactured by the Serum Institute of India.

The stockpiling of vaccines by richer countries must also change. “Some countries have ordered enough to vaccinate their populations three or four times over — that obviously doesn’t make much sense and it’s going to be a huge problem for a large chunk of the world’s population.”

In terms of administering the doses itself, Mathieu does not believe that countries will run into too many challenges in that respect. “There was a lot of discussion about that in late December and early January, when people were making fun of some EU countries (including France) for going super slowly. But things have picked up and are going pretty fast now. Once we get the doses, it’ll be fine.”

Could pharmaceutical companies do more?

The head of the WHO has accused drugmakers of prioritizing profits above protecting the elderly and health-care workers in poorer countries.

“Just 25 doses have been given in one lowest-income country ― not 25 million, not 25,000 ― just 25,” Ghebreyesus said in January. “I need to be blunt: The world is on the brink of a catastrophic moral failure,” he continued.

“It’s right that all governments want to prioritize vaccinating their own health workers and older people first, but it’s not right that younger, healthier adults in rich countries are vaccinated before health workers and older people in poorer countries.”

There have also been calls for vaccine manufacturers to freely share their formulas so other companies can produce the vaccine. In April 2020, Oxford University promised to donate the rights of its vaccine to any drugmaker. Only a few weeks later, it reversed its decision after signing an exclusive deal with AstraZeneca.

The campaign group People’s Vaccine Alliance has called on pharmaceutical companies and research institutions to share their intellectual property, so that generic forms of the vaccine can be made and distributed across the world.

Some are listening. Last week, the French pharmaceutical company Sanofi signed a deal with Pfizer/BioNTech to bottle their vaccines, after an unsuccessful effort to develop its own jab. “We asked ourselves how we could make ourselves useful in the present, to participate to the collective effort to end this crisis as soon as possible,” said Sanofi’s head, Paul Hudson.

With files from HuffPost Canada, The Canadian Press and Reuters

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