The Global COVID-19 Supply Problem

IRA FLATOW: This is Science Friday. I’m Ira Flatow. All winter, vaccines for COVID-19 have been rolling out to the arms of health care workers and other high-risk populations around the globe. More than a quarter, though, of the 200 million vaccine doses worldwide have been given in the US, home to only 4% of the global population. Meanwhile, poorer countries are lagging far behind, unable to compete with the rich nations that paid high premiums to reserve doses early.

World Health Organization Director General Tedros Adhanom Ghebreyesus has advocated for vaccinations to begin in all countries within the first hundred days of this year.

TEDROS ADHANOM GHEBREYESUS: I need to be blunt. The world is on the brink of a catastrophic moral failure. And the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.

IRA FLATOW: COVAX, a project that includes the WHO, has set a goal of providing 2 billion vaccines for priority populations in poor countries. Just this week, Ghana became the first country to receive a shipment of vaccine via COVAX. And President Biden last week pledged $4 billion to that effort. But what will it take to ensure equitable vaccine distribution around the world?

Here to talk about this is Dr. Saad Omer, director of the Institute for Global Health, Yale University, in New Haven, Connecticut. Welcome to Science Friday.

SAAD OMER: It’s my pleasure.

IRA FLATOW: Saad, first of all, let’s talk more about this gap in vaccine access. The US and the UK have some of the highest per capita vaccine rates right now. Israel is posting very high good numbers. Tell us what’s happening everywhere else.

SAAD OMER: It’s very patchy. In a few countries in the Middle East, for example, there is more access. But beyond that, especially in low- and middle-income countries, particularly in low-income countries, the access is very patchy. Some countries have received from other places already or have purchased outside the COVAX facility. Right now, this week, the good news is that the COVAX vaccines have started arriving.

In Africa, there’s a dual system. There is the COVAX agreements, but also the African Union has purchased or in the process of acquiring its own doses in addition to that, and there are specific country-level agreements as well. The vaccination access is very modest in low- and middle-income countries as of now.

IRA FLATOW: Can you tell us what’s happening outside of COVAX in terms of other countries working to address inequities?

SAAD OMER: A lot of countries, and not just high-income countries, but low- and middle-income countries, have these individual bilateral deals with companies and other countries to get their own vaccine. And you can’t blame them for that because if you don’t have a global system for that, then it’s each country for itself kind of a scenario. So that’s what is happening. There are bilateral deals with companies. There are bilateral deals with a sort of group purchasing mechanisms, et cetera.

In Europe, European Union countries are acting as individuals, but also as EU. In countries like India, there is domestic production, since they are a major producer of vaccines. For example, the Oxford vaccine is produced by AstraZeneca as well as the Serum Institute of India, which has a license from AstraZeneca to produce this vaccine. And they have their own endogenously developed product as well. So they have a share marked for their domestic market as well.

Pakistan has obtained, for example, vaccines from China directly, but they are also part of COVAX, so they’re getting those vaccines as well. So it’s a mishmash of things that is going on. And various countries are trying their best to obtain vaccines under difficult circumstances.

IRA FLATOW: You have research connections in many countries around the world. Do you have a sense of how people are feeling to see rich nations already well along in vaccination? All citizens are getting their doses, while these countries can’t get vaccines for even their health care workers.

SAAD OMER: So there is actually a lot of heterogeneity in responses. The first, there is frustration. But the frustration is with their own governments as well as the global system. But also, there is resignation, and that’s sad. That’s the sad part of it. I’ve heard more than once, what did you expect, Saad? What did you expect, Dr. Omer? We knew this was going to happen.

On the other hand, the fact that COVAX has done a remarkable job of bringing these vaccines, even if it doesn’t meet the complete demand that you have in these countries, does give people hope. So it’s a mix of frustration, resignation, and hope that I hear from– that I see in my colleagues in various parts of the world.

IRA FLATOW: I said in my introduction that COVAX has set its goal of buying and distributing 2 billion doses by the end of 2021, enough to vaccinate all the health care workers and vulnerable populations. Is that ambitious enough?

SAAD OMER: As I said, I think if they had more doses, and if they had a real possibility, and if they had early money, if they had their requests fulfilled in March, for example– because we knew that this was bad, this was a bad pandemic, soon after the pandemic was declared. If they weren’t starved for money without projecting any decisions that would have happened, I think they would– safe to say they would have had a lot more options.

The doses will cover all health care workers and some of the highest risk groups, not all high-risk groups, but some of the highest risk groups, like the elderly, et cetera, will cover even certain teachers, like a good chunk of teachers, so that schools can open up safely. But even with this facility, there will not be enough vaccines to reach the so-called herd immunity threshold in these countries for sustainable control of these outbreaks.

IRA FLATOW: So the real problem was that because these are poor countries, they could not get in early for bidding for the early doses, the high prices early doses of those early vaccines, so they’re way behind now. Is that a fair way of looking at it?

SAAD OMER: That’s part of it. And the other part of it, that the global mechanisms that were created to address that gap were also starved of resources. So it’s not just the country level, but COVAX level. The third thing is, look, even if there were resources, there would have been some limitations. But I believe we would have had more options.

Look what putting money on the table did for the US domestic market. If there were similar higher incentives– these are Moderna and Pfizer and Novavax are not the only players in the world. If there was more serious money on the table in March, I would like to think there would have been even more players farther along. I’ll give you an example of Chinese vaccines. So some of them have decent emerging data, but they don’t have 30,000 people large trials. And it takes resources to do trials. It takes infrastructure to do these trials.

If SEPI or COVAX had money earlier on, you could have seen much larger trials globally for these kinds of vaccines and trials of more vaccines out there. We wouldn’t have gotten into this zero-sum game, or would have gotten into it a little less. The size of the pie would have been or could have been bigger itself.

IRA FLATOW: And where would that money have come from? Or where should it have come from?

SAAD OMER: I think it should have come from US taxpayers. We have $2 billion. It’s been noncontroversial now. The $4 billion offered, $2 billion now and $2 billion later, that could have come from the US in June. And that money has attracted even more money from Europe and other players now after the president announced this investment. So that money plus that leadership could have sped up that process.

IRA FLATOW: So you’re saying it was a failure of the Trump administration to get in early with the money.

SAAD OMER: Partially. Partially it was the Trump administration, but I do think the Europeans should have put in more money than they did. But you can’t blame them for putting less money when the US put zero money for this kind of enterprise. So there’s plenty of blame to go around.

There’s another nuance. The entity that I talked about, SEPI, that was created very recently, the whole idea was to have a lot of candidate vaccines in advanced stages for these global health emergencies. It had funding before this pandemic. It had funding from countries ranging from Norway to Ethiopia or the UK to Ethiopia, although not sort of universal funding. But one country that was conspicuous by its absence was the US.

And we could have and should have invested in this endeavor before the pandemic so that there were more candidates available for the whole world, including ourselves. Because it’s not a zero-sum game. If technology moves forward, everyone wins in this game. And just to say that it’s not, that the US is not a major player in global health funding. So I’m not saying that universally the US hasn’t invested in global health. The US is a huge supporter of Gavi, and there’s bipartisan support for that.

It’s a huge supporter for the Global Fund for AIDS, TB, and Malaria, and so on and so forth. But I wish we had made some strategic investments even before the pandemic in the last three or four years and should have made more investments in the early part of the pandemic. And that goes to the US, Europe, and certain other countries as well.

IRA FLATOW: People have been talking about this for years, about once you get from one virus to the next, right? From Ebola to whatever– we’re never ready for the next one, are we?

SAAD OMER: Yeah. And in the pandemic world, there’s a term that is used, and without even thinking a lot of times. So you have the pandemic, and then you have the inter-pandemic period. So we will enter an inter-pandemic period, meaning we assume that there will be another pandemic. And so when the field has internalized, when a certain group of people have internalized that there will always be a threat of pandemics, it is even more frustrating when other key players who are responsible for our collective well-being, national governments, global mechanisms, et cetera, they do not put in the right amount of resources in the inter-pandemic period.

IRA FLATOW: Is there any reason to believe when this pandemic is over that anything is going to work any differently in the next inter-pandemic?

SAAD OMER: So yes. Look, I’m in global health, and you have to be an optimist to remain in global health. And I often say that the glass is always at least 10% full, never 90% empty. So you have to hope that there will be a change. And there were positive things that were put in place, even before the pandemic. I’m just saying there wasn’t enough.

I’ll give you an example. After the H5N1 threat that was in 2005-2006, the Bush administration made a major investment in preparing CDC and, through CDC, another mechanism, the global community, and invested in certain technologies, created BARDA, or supported an expanded BARDA’s role. And that happened in the Obama administration as well. BARDA is an entity within the Department of Health and Human Services to create and prepare the US and then, as a secondary mission, the rest of the world with technologies like platform technologies, like manufacturing technologies.

And so a lot of investments that went into viral vectors and some investments in terms of mRNA vaccines came through that work that happened during that inter-pandemic period. In certain parts, it really worked. The investment in mRNA technology, both within NIH and outside, paid off. The fact that there was investment in viral vectors, which is the basis of the J&J vaccine, and the AstraZeneca Oxford vaccine, and the Russian vaccine, and so and so forth, that also happened in that period.

So I think there will be a change in how we look at pandemics, how we invest in pandemics as a global community after this. Whether that is enough, that remains to be seen.

IRA FLATOW: Quick reminder. This is Science Friday from WNYC Studios. Before we go, I want to talk about the impact of vaccine inequity on the entire planet. Here’s Dr. Ahmed Ogwell, deputy director of the Africa Centers for Disease Control at a recent Duke Global Health Institute panel.

AHMED OGWELL: So for us, it makes absolutely no sense for a very healthy, relatively young individual in one part of the world to be getting vaccinated while a health worker in the front lines in another part of the world is not getting vaccinated. For us, South Africa CDC and the African Union, there is really no option but equitable distribution of vaccines. If we don’t do that, then the virus will never go away.

IRA FLATOW: Saad, this is especially true given the variants rising up in different countries, isn’t it?

SAAD OMER: Absolutely. Absolutely. So in global health, more often than not, a good thing is a good thing for everyone. These are not zero-sum games. And our self-interest has to be enlightened self-interest in the sense that we sink or swim together. And I’m not just saying that because it sounds warm and fuzzy. It has been shown from economic models, as well as we did– we have a preprint out, and we’re hoping to sort of get it out in peer-reviewed literature– that shows that there’s a strong case once any country reaches herd immunity, the next best use of that doses in that country is to vaccinate other populations, rather than continue to increase coverage.

That also means– so in a practical level, that may mean that it makes the case of pretty substantial investment in the global vaccine supply. And so we have shown it from an epidemiological perspective. Economists have shown it from an economic perspective that it’s in our shared interest to ensure equity in vaccine distribution. So besides being the right thing to do, ensuring equity is the smart thing to do for us as well.

IRA FLATOW: Thank you very much. Very interesting. Dr. Saad Omer, director of the Institute for Global Health at Yale University in New Haven, Connecticut, thanks for joining us today.

SAAD OMER: My pleasure.

IRA FLATOW: And that’s about all the time we have. I want to thank our guest, Dr. Saad Omer, director of the Institute for Global Health at Yale University in New Haven, Connecticut.

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