Thread by @InfectiousDz

Vaccine equity is not just about ensuring more doses. It's about more doses into more arms

Vaccines don't inject themselves. Funding for distribution and vaccination crucial

Vaccines that arrive free just before expiration will be feared to be a dump of what others do not want

Some areas where vaccination rates are the lowest are also those where substandard excess have been dumped as donations in the past. The protective response has long been jettisoning anything close to the expiration date.

Malawi has already incinerated 20K doses of thee vaccine that arrived less than 3 wks before expiry. WHO and AU had encouraged keeping doses as considered fine until July

https://twitter.com/ajplus/status/1395439903404609538?s=20

South Sudan sent many of its AstraZeneca doses to Kenya, as it could not distribute doses before expiration

https://twitter.com/citizentvkenya/status/1398705078001975300?s=20

Concern was also expressed and hesitancy formed as European countries set pauses and restrictions on AstraZeneca, the vaccine was being sent to less well resourced countries, where populations are younger and health staff often young women who are more likely affected.

Haiti did not apply initially for vaccines, citing low caseloads and concerns over AZ clotting and pauses elsewhere as well as the ability to carryout 2 dose vaccination
Haiti is experiencing a COVID surge now
Vaccines have not yet arrived

https://twitter.com/Jacquiecharles/status/1399462172829184002?s=20

Meanwhile, Canada has extended the lifespan of its current AZ doses from 6 months to 7 months.

https://twitter.com/richard680news/status/1398661876360306690?s=20

Recently, the US FDA extended the fridge shelf life of Pfizer vaccines from 5 days to 1 month

https://twitter.com/NPR/status/1395258693999071232?s=20

Vaccine equity needs to account for the realities
a) transparent information on expiration data (no one wants to feel their receiving a dump of bad goods, but likely expiration dates overly cautious)
b) support for distribution and vaccination campaigns
...

c) recognition of factors that can foster vaccine hesitancy
d) continued discussion around vaccine concerns, risks/benefits