Rich Countries Hog Vaccines. Is There a Solution?

(Bloomberg) -- Almost a year into the rollout of Covid-19 vaccines, health officials are still struggling to close a yawning gap. While 64% of people in wealthy countries had received at least one dose by Nov. 23, just 7.5% had in low-income nations, according to the United Nations. Concerns that the rich would also monopolize new Covid treatments sparked an effort to prevent that from happening. For vaccines, there was no sign of a solution any time soon, despite proposals to suspend intellectual-property protections for makers of the shots and an effort in Africa to reverse-engineer one of the most successful formulations and produce it in factories there.

1. Why have poor countries lagged so far behind?

Affluent countries locked up the lion’s share of initial doses by signing contracts with vaccine companies as inoculations were being developed. But the concentration of vaccine manufacturing in a handful of countries has also played a role. Before Covid emerged, the rich world relied mostly on the U.S. and the European Union for vaccine imports while India was the main exporter to developing countries. In the pandemic, all three prioritized their own markets. China, whose industry previously focused on domestic production, has become a major supplier of Covid vaccines to developing nations, using them as a tool of diplomacy. But its exports couldn’t fill the gap, and its shots haven’t proved as effective as several others. Covax, a program set up to try to distribute shots fairly around the world, has struggled to secure doses and missed its delivery targets.

2. Is it just that there aren’t enough vaccines to go around?

No. It’s also that wealthy countries are stockpiling them. This is partly a response to anticipated demand. Prompted by the rise of the delta strain of the coronavirus and evidence that vaccine effectiveness may decline relatively quickly, a number of rich countries are offering vaccinated residents a booster dose; shots were also authorized for younger children. The Group of Seven nations promised to provide 1.8 billion shots to developing nations in 2021 and 2022, but billions more are needed and actual donations have trickled out. The analytics firm Airfinity projected that doses stockpiled by rich countries would roughly equal doses they will donate through April 2022, reaching about 1 billion each by then.

3. What’s at stake?

While the incidence of Covid cases and deaths has been higher in wealthier states, deaths have been increasing fastest in the regional groups with the lowest vaccination rates. When the virus flourishes in a population, the risk increases that additional variants will develop; they will inevitably make their way elsewhere and may not be neutralized by existing shots. In late November, fears emerged that a new variant dubbed omicron, which was first identified in southern Africa, could to some extent evade vaccine-induced protection and spur additional Covid surges.

4. What are the worries about access to Covid treatments?

Positive results for the first antiviral pills to treat Covid by Merck & Co. and Pfizer Inc. sparked worries that poorer regions would be denied supplies of those as well; as pills, these drugs are easier to administer than Gilead Science’s remdesivir, an antiviral delivered by infusion. In an effort to ensure fair access to the pills, the United Nations-backed Medicines Patent Pool secured an agreement with Merck in October and with Pfizer in November facilitating licenses for generic-drug makers to produce the drugs for low- and middle-income nations. Still, it could take months for countries to get medicines through these agreements, putting them behind rich states in line.

5. What are the proposals for expanding vaccine access?

A group of countries led by South Africa and India has called for the World Trade Organization to lift intellectual-property protections for makers of Covid vaccines to enable additional plants to produce more shots beyond the current concentration in the U.S., Europe, India and China. The companies argue that few countries have the trained personnel to produce the vaccines even if they had the formulas. Advocates of the waiver say it can serve as leverage to push companies to voluntarily share their expertise more broadly. In the meantime, the World Health Organization took the unusual step of partnering with South African company Afrigen Biologics & Vaccines to undertake the tough challenge of reverse-engineering the Covid vaccine made by Moderna Inc., which says it won’t enforce patents on the shot during the pandemic. The end goal is to establish a center for teaching scientists how to make vaccines using the innovative technology in Moderna’s shot. The African Union’s Centers for Disease Control and Prevention has announced an ambitious plan to establish new vaccine factories with the aim of reducing the continent’s reliance on imports from 99% to 40% of supply by 2040. 

The Reference Shelf

• Related QuickTakes on booster shots, the omicron and delta variants, and the proposal to waive vaccine makers’ intellectual property protections.
• An article in Nature explores what it would take to vaccinate the world against Covid.
• An article in Science examines strategies for addressing vaccine inequality.
• The Associated Press describes how rich countries cornered the market on Covid vaccines.
• An International Monetary Fund paper proposes $50 billion in new investment to increase production and delivery of vaccines and other medical supplies to end the pandemic sooner.

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