Covid-19 vaccines: Until the whole world is protected, is anyone safe?
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As the world struggles to find a way to live with Covid-19, one truth is becoming clearer - until the whole planet is protected from the virus the world cannot return to what it once considered normal.
Unfortunately, while the developed world has now for the most part reached heightened levels of vaccination among its various populations, the same can not be said for developing countries. Ireland has long since breached the 90% mark for adult vaccinations, something we haven’t been shy in patting ourselves on the back for.
Meanwhile, the average level of vaccine penetration in the developing world hovers around the 2% mark. In a world of international travel, the virus simply cannot be contained with a vaccination mismatch of that magnitude.
So surely it is in richer countries’ interest to aid those who have less in the interest of the common good? That’s where Covax was due to come in.
The Covid-19 Vaccines Global Access project (Covax), which was begun in April of 2020 - long before any vaccine for the virus was even available - was initially a joint venture of the World Health Organisation, the European Commission, and the Government of France. To date more than two thirds of the planet’s countries have engaged with the initiative, which has a goal of 2 billion vaccine doses being made available for lower-income nations.
Ireland’s history with Covax is not particularly auspicious. While we as a nation first committed to the project, together with our 26 fellow EU states, back in September of 2020, it took a further 12 months before Ireland’s first commitment to a donation was made official.
On September 15, Minister for Health Stephen Donnelly and Minister for Foreign Affairs Simon Coveney announced that Ireland would be donating 1 million surplus vaccine doses to those in need abroad via Covax before the end of 2021, potentially rising to up to 2 million by the end of next year (a further 335,000 vaccine doses have already been supplied to Uganda via direct donation).
Meanwhile, €7 million in funding has been committed by Ireland to Covax, which has received €10.4 billion in such donations, to date, from developed countries across the planet.
The first vaccine dose pledges via Covax were made back in April of this year. It’s not clear why Ireland took a further five months to make such a pledge of its own, which was made after a summer of frenzied uptake saw more than 90% of the population aged 12 and greater elect to get the jab.
However, pledging vaccines is one thing - actually delivering them is another.
A recent report, titled ‘Dose of Reality’, by the The People’s Vaccine alliance, a coalition of groups including charities Oxfam and ActionAid and Amnesty International, stated that as at end October just 14%, or one in seven, of the 1.8 billion doses pledged by richer countries had made their way to their destinations.
Criticism was heaped upon the UK at the time for its apparent laggard status, having delivered 9.6 million doses at the time, against a commitment of 100 million. The UK had made its initial pledge in late July. Ireland followed suit a month and a half later.
How Covax actually works in practice is complicated. The initiative is directed by vaccine alliance Gavi, the coalition for epidemic preparedness innovations (CEPI), and the WHO.
“We set rules, individual countries can’t be picked, but regions can be, and then doses are distributed via a fair allocation system, though there are a few legal steps which have to happen for doses to be delivered,” a Gavi spokesperson told the .
“So the vaccines go to the countries most in need, which could be any one of 92 lower-income countries.” That list of poorer nations corresponds broadly with the countries and territories ranked lowest on the World Bank’s wealth list.
“Half of the economies in question are in Africa, and the rest in Asia, Oceania, Latin America, and Eastern Europe. Covax allocates those doses based on need and existing rates of coverage,” the spokesperson says.
Physical donations, which comprise all of the by-now familiar vaccine brands (at 71.7 million doses AstraZeneca is by a distance the most donated vaccine, Pfizer at 7.9 million is the least) do not generally leave the country doing the donating. Having been initially earmarked for Ireland for example, they are rerouted from the manufacturing site to their new Covax destination once all legal boxes are ticked (assuming said country agrees to the donation - they are entitled to refuse if it’s not the type of jab they’re looking for).
Gavi describes Covax as “the most effective model the world has for bringing an end to the acute phase of the pandemic”. It cannot do it alone however, it adds, stressing the problem of “vaccine nationalism”, in particular the slow delivery of pledged doses.
The developed world’s renewed focus on vaccine boosters, with Ireland being no exception, is the latest example of same. ‘How can countries with phenomenally high vaccination rates justify their use of even more doses while the developed world is being ravaged by the virus?’ is the question being asked.
“What is crucial is clarity from manufacturers and donors on how many doses Covax can expect, when and from where. Too often this information comes late,” Gavi says.
“What we need from donors is not necessarily more donations, but better-quality ones. This means large volumes up front, with plenty of notice and long shelf lives.” There is an additional problem however - Covax may have received €10 billion in donations with which to purchase vaccines, but that doesn’t mean the manufacturers like Pfizer and Moderna are prioritising that humanitarian effort.
And if they’re not doing so, it’s because developed countries like Ireland aren’t telling them to do so.
“Ultimately, Covax needs access to the doses it has procured itself,” the spokesperson says. “We urgently need countries to instruct manufacturers to allow Covax to take their place in the queue and for manufacturers to waste no time in prioritising Covax, and facilitating release and delivery of doses.”
So how many of the 1 million dose commitment has Ireland delivered to date? The Department of Health has danced around this figure a little since the Minister’s September commitment.
The short answer is none, but there appears to be light at the end of that particular tunnel (Ireland hasn’t earmarked a specific region for its own donations).
“Ireland has recently finalised all of the legal documentation necessary to facilitate this significant donation,” a Department spokesperson said.
“The Covax donation process follows several complex steps and coordination across multiple stakeholders,” they said. “The priority focus given by the Department to the swift completion of all necessary steps in the framework process will ensure that donated vaccine doses from Ireland will begin to reach those most in need in the coming weeks.”
To be fair, the length of time it takes to finalise the donation itself is not of Ireland’s making (an average from pledge to delivery, all things going to plan, is about six weeks, Gavi says). A more valid criticism would probably be the length of time it took for us as a nation to pledge doses to Covax in the first place.
So is it a case of charity beginning at home?
For Michael McCarthy Flynn, head of policy and advocacy with Oxfam Ireland, less well-off countries having to wait longer for vaccination “smacks of vaccine apartheid”.
“I’m not sure the Irish population would be too happy having to wait for leftovers from the US,” he says. For him, the international coalition for vaccine donation is something of a red herring.
“I think it’s been obvious for quite a while that we can’t donate our way out of this pandemic. It is only increased manufacture of vaccines that will make the difference,” he says.
Part of the issue here is the proposed temporary waiver of intellectual property rights for the manufacture of the vaccines.
Were this to happen, the means to manufacture doses cheaply en masse and on site would become available in developing nations, removing the supply chain roadblocks currently clogging the global rollout of the lifesaving vaccines.
At present the European Union and the UK remain holdouts against such a waiver, while the US indicated in May that it would back a temporary removal of IP rights. The pharmaceutical industries, as you might expect, are vehemently opposed to any such move.
Ireland’s largest pharmaceutical lobby, the Irish Pharmaceutical Healthcare Association described the American decision re a potential waiver as “short-sighted and ineffectual” at the time, suggesting it “puts at risk the hard-won progress in fighting Covid-19”. The lobby’s argument is basically that the way forward is via industrial intellectual property creating ever newer medicines, vaccines, and technology.
“While donations of vaccines are very important, the pandemic and the amount and need for vaccines will only be dealt with when we have generic production,” says Michael McCarthy Flynn.
“Vaccine companies aren’t in favour of that, but they weren’t in favour of antivirals when it came to AIDS either,” he says. “At the moment generic vaccinations can only happen with the go-ahead of the companies.”
The World Trade Organisation will be seeking the temporary TRIPS (Trade-Related aspects of Intellectual Property rights) waiver at its next summit meeting at the end of November, when Ireland will have the opportunity to lay its own cards on the table.
“We have been holding out against it. My suspicion is that we’re being heavily lobbied by pharma,” says Mr McCarthy Flynn. “The argument we will make as a country is that we have to work with the pharmaceutical industry, but we’ve been 18 months doing that.
He argues that waiving the IP is just half the battle, the rest is both sourcing areas to manufacture doses in poorer countries, and upskilling the workforce there so production on a grand scale becomes possible.
“There are any number of empty factories around the world, in places like Bangladesh, Senegal. They’re ready to produce vaccines in a short number of months. They’re being prevented from doing so, and Ireland is in support of that policy.” Donating vaccines without a plan on how to produce more of them is like “putting a band-aid on a machete wound”, he says.
Which leads us to the elephant in the room - given it would appear to be in no-one’s interest to prolong the pandemic any longer than necessary, why isn’t the global focus now on the have-nots?
“The pharmaceutical industry has been making an enormous amount of money from the manufacture of vaccines,” says Mr McCarthy Flynn.
“There isn’t much money to be made from low income countries. Most of the money that will be spent in the near term will be on booster campaigns in western countries,” he says. “Then you’re looking at 2023 for full vaccination, and that’s too late.”
“It’s not in our own interest to keep large populations still unvaccinated. It’s just creating space for new variants to emerge.”
A spokesperson for the Irish Pharmaceutical Healthcare Association told the Irish Examiner the TRIPS waiver discussion was "a diversion".
"Vaccine manufacturing is complex, requiring skills, technology, sites and know-how that are not readily available. Vaccine manufacturers must meet the highest regulatory standards to ensure safety. The proposal, led by India and South Africa, to temporarily suspend the Trips Agreement for Covid-19 vaccines and treatments would not boost production. Production capacity expansion is enabled by identifying and securing expert manufacturing partners. That is happening. Our industry has voluntarily formed some 330 partnerships with expert manufacturers globally, including in regions of the world that are struggling to vaccinate their populations. Manufacturers are investing in their own existing sites, too, to scale production. The result is that, by end of this year, 12 billion Covid-19 vaccine doses will have been produced. By next June, it will be 24 billion doses," he said.
"The Trips waiver debate is a diversion: the real question is how can much more of the world’s population be vaccinated faster? Two ways: surge production through on-site investments and voluntary, collaborative links between vaccines innovators and expert manufacturing partners, and share more surplus vaccine doses in developed countries with poorer ones. Although the EU and the US are boosting their dose-sharing commitments, that needs to happen faster and at greater volumes. Key to vaccinating poorer countries’ populations faster is improving their capacity to absorb and distribute vaccines. Often, that capacity is very limited. Vaccine hesitancy can be a barrier, too. All of us need to do what we can to improve country readiness."
He said that waiving intellectual property rights would make "no difference" to vaccine production and would set "a dangerous precedent".
"It could hamper the scientific community’s response to variants of concern, too. We need to protect scientists’ ability to turn cutting-edge research into transformative vaccines and treatments."