Unless the world’s wealthy nations truly embrace global health, the COVID-19 pandemic will drag on for years to come, causing unnecessary deaths and economic suffering in many parts of the world.
The United Kingdom is currently hosting the G7 leaders’ summit (June 11 to 13), giving the prominent developed nations of the world an opportunity to formulate a coordinated action plan to boost the global supply of COVID-19 vaccine doses. According to the U.K.’s G7 website, Prime Minister Boris Johnson will use the G7 Presidency “to fight and build back better from coronavirus.”
World Health Organization
“We’re very encouraged that cases and deaths from COVID-19 are continuing to decline globally, but it would be a monumental error for any country to think the danger has passed,” Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), stated in a recent address to a meeting of the G7 health ministers hosted by the United Kingdom.
The Director-General told the June 3rd meeting that the inequitable global distribution of COVID vaccine doses has “allowed the virus to continue spreading, increasing the chances of a variant emerging that renders vaccines less effective.” And he used the occasion to restate an appeal made at the World Health Assembly for “a massive global effort to vaccinate at least 10% of the population of all countries by the end of September, and at least 30% by the end of the year.”
The equitable distribution of vaccine doses combined with public health measures remain “the roadmap for ending this pandemic,” Dr. Tedros told the G7 health ministers.
In advance of the G7 summit, the leaders of the WHO, International Monetary Fund (IMF), World Trade Organization (WT0), and World Bank issued a joint plea to the international community to finance efforts to bring the pandemic under control.
According to the joint statement issued on June 1, there won’t be a “broad-based recovery without an end to the health crisis,” and that widespread vaccinations are necessary to ending the pandemic.
“WHO and its COVAX partners have set a goal of vaccinating approximately 30% of the population in all countries by the end of 2021,” the joint statement said of the international vaccine coalition. “But this can reach even 40 per cent through other agreements and surge investment, and at least 60 percent by the first half of 2022.”
The quadrilateral grouping is urging governments to collectively invest US$50 billion in a plan to boost stockpiles of vaccine doses, oxygen, as wells as COVID-19 diagnostic tests and therapeutics.
UNICEF has taken a leading role in the procurement and distribution of vaccines on behalf of the COVAX Facility, the international coalition designed to provide COVID vaccines to low and middle income countries.
Why and how did UNICEF come to play such a pivotal role in the COVID vaccines initiative?
“UNICEF, actually, for a long time has been the leading procuring agency on immunization around the world,” replied Annie Bodmer-Roy, director of international policy at UNICEF Canada. “So what that actually means in practice is in any given year, UNICEF already procured and supplied up to about two billion doses of vaccines around the world. And that meant that we were helping to vaccinate about 45% of the world’s children against preventable diseases.”
As a result, UNICEF had already developed the necessary networks, partnerships, and logistical experience, Bodmer-Roy told the Whig-Standard in a telephone interview. In addition, UNICEF maintains a large stockpile of items necessary for vaccinations, such as syringes.
“We also have teams, in-country, who are used to running immunization programs and used to advising governments on how to design and run immunization campaigns. And then also we have collective global expertise with some of the world’s leading minds on immunization. That was all before the pandemic.”
When the pandemic hit, the international community, led by the WHO and other international organizations, established the ACT (Access to COVID-19 Tools) Accelerator to develop vaccines, testing capabilities and therapeutics.
“UNICEF has become responsible for leading the global effort to procure and supply COVID vaccines as part of the vaccine pillar of that effort,” with a special emphasis on 92 low and middle income countries, Bodmer-Roy said.
How is the lack of sufficient healthcare infrastructure in some African countries hampering vaccination program rollouts even when vaccines are available?
“That is a great question,” the UNICEF staffer replied. “Because there is absolutely, and rightly, a lot of attention on the shortage of doses…That’s part of the puzzle. The other part of the puzzle is when those doses hit the ground, when they arrive in the country, there is so much that already needs to be in place for the vaccinations to be rolled out across the country.
“What we’ve been seeing is that some countries don’t have the capacity. They don’t have the funding. They don’t have the equipment necessarily to run the level of the campaign that is needed to immunize the population quickly.”
For example, the cold chain or refrigeration requirements to keep vaccines viable pose challenges for some countries. “There is a lot of equipment that is needed to make sure that vaccines, once they arrive in the country, get stored at the right temperature,” Bodmer-Roy noted.
As vaccines move through the country from the airport to district health centres to local health clinics, the vaccine doses must be kept at the proper temperature, she continued. And the personnel transporting the vaccine shipment must be trained in how to maintain and safely store the doses.
“The other part of the training is, of course, the administration of vaccines. So there’s a lot of work that needs to be done with frontline healthcare workers to make sure that they have the training they need to safely store and administer the vaccines and to safely dispose of them.”
In addition, Bodmer-Roy said that it is important to work directly on the community level to educate the population about the risks of COVID-19 and how to protect themselves using public health measures. UNICEF also helps to educate local communities about the importance of getting vaccinated, providing “accurate and context specific information about the vaccines” in order to counter misinformation about vaccines.
COVAX and vaccine shortages
“It’s nowhere near where we need to be right now,” Bodmer-Roy said of the supply of vaccine doses available to COVAX. “Particularly, when we consider the situation in India, and how quickly the virus is getting ahead of us. And that’s really where this call of sharing doses comes from. It’s really the urgency of ensuring that vaccines reach these countries before the virus is able to mutate further and before more lives are lost.”
To what does UNICEF attribute the shortage of vaccines doses available to COVAX?
“There are a lot of different components to this,” Bodmer-Roy replied. “I think we do need to recognize that there has been a huge amount of progress in the past year. Just over a year ago, there weren’t any COVID vaccines.”
However, the ACT Accelerator needs to be adequately funded, she explained. “And that includes ensuring that there are adequate doses internationally,” as well as helping to fund health systems in order to help them rollout vaccination programs.”
COVAX is currently undersupplied, “because there are countries that have secured more doses than they need,” she added. “And right now, that does include Canada. We’re not the only ones, but we are definitely one of the countries on the list.”
What role does the for-profit pharmaceutical model play in the current COVID vaccine shortage?
“There is an effort underway to lift barriers to intellectual property and to really also diversify manufacturing capacity worldwide, so that more countries are able to manufacture their own COVID-19 vaccines,” replied Bodmer-Roy
One way to expand availability of vaccines is through the voluntary licensing of intellectual property by rights holders, “so that more countries and more companies can actually make vaccines,” she said. “So that does need to happen.”
However, the UNICEF policy expert stressed that those measures on their own won’t boost vaccine production to the level that is required, because the process is so technically complex. There is also a need to issue intellectual property licences for technology transfers. And the sharing of expertise is also required.
Export bans on raw materials used to make vaccines present another barrier to increasing the global supply.
“UNICEF is supportive of voluntary pro-active licensing by holders of intellectual property rights, so that more manufactures can make vaccines,” Bodmer-Roy said for clarity.
Sharing is caring
Countries such as France, New Zealand, Sweden, Spain, Norway, and the United States have committed to sharing COVID vaccines with the world even as they continue to vaccinate their populations. What should Canada do?
The Canadian government has sent clear and consistent signals that it is committed in principle to sharing surplus vaccine doses, said Bodmer-Roy. “And we have welcomed that. It’s good to see that commitment. I think what is really needed now, though, is that urgency.” And that’s why UNICEF is asking Canada to immediately share doses, she added.
“We know that Canada has ordered more doses per capita than any other country. And now we’re at a stage where more and more Canadians are getting vaccinated every day.”
UNICEF is urging Canada to set a timetable for donating surplus doses. For every ten vaccine doses Canada receives by the end of June, UNICEF is asking Canada to donate one dose to COVAX.
“It can’t just be just countries like Canada or the United States or France or the U.K. that are vaccinating health workers. There are health workers around the world who are trying to support their populations, trying to administer COVID vaccines, but also doing their day-to-day work on ensuring that children have access to life-saving immunization for preventable disease; ensuring that women have assisted birth; ensuring there is screening for malnutrition,” Bodmer-Roy said.
“All of this work needs to continue, and it happens at the community level. And right now, there are so many frontline healthcare workers in these countries who aren’t even vaccinated themselves. So that really, really needs to change,” she declared.
“With the analysis that we’ve done—whereby Canada can start donating just one vaccine for every ten that Canada will have received by the end of June—that would actually get us quite quickly to four million doses. And by using these doses to protect vulnerable people, Canada can really make a contribution in slowing the spread of the pandemic further, and slowing the acceleration of future variants.”
The UNICEF proposal goes even further, recommending that Canada scale up donations, “so that by the end of the year, Canada will have donated all of its expected excess doses, which we estimate should be around 94 million,” she said.
Looking ahead to 2022 and 2023 and beyond, it seems likely that everyone in the world will need COIVD-19 booster shots. What needs to happen to ensure vaccine equity in the future?
“That’s a great question. Part of that does relate to what we talking about earlier around intellectual property and enabling more manufacturers to make vaccines.”
In addition, Bodmer-Roy said that health systems need to be strengthened. “To be honest, before the pandemic and during the pandemic, we had gotten off track globally with immunizations for children, for example. And so when there are these investments in immunization for COVID, we need to be sure that these investments are sustainable, that they’re helping build the scaffolding for stronger, more resilient health systems,” she explained.
“When we’re talking about vaccine equity, it’s a broader question of health equity,” Bodmer-Roy concluded. And that means ensuring that there is adequate funding for global health, she said.
Follow Geoffrey P. Johnston on Twitter @GeoffyPJohnston