Thread by @TelGlobalHealth

🚨Experts have long warned of a “two-track pandemic” emerging, where rich countries have greater access to the tools to fight Covid-19, while the poorest are left behind

But are things as bad as they seem? And what can be done to vaccinate the world? 🧵
telegraph.co.uk/global-health/…

The hurdles – and the solutions – can be split into three broad categories:

🧪Making
💸Buying
🌐And distributing the shots

Here, @sneweyy, @jriggers and @annegulland take a look at each

💉Making the vaccines💉

Conversations with vaccine manufacturers about “vaccinating the world” tend to start a little tetchily, with them pointing out how far we’ve come.

And, from a standing start last January, this is undoubtedly true

But the inequalities around distribution are acute.

Roughly 75% of the 1.8 billion vaccine doses administered worldwide have gone to just 10 countries.

Meanwhile nations including Madagascar, South Sudan and Papua New Guinea have vaccinated less than 0.01% of their population

This has led to prominent figures, including President Biden, to call for a patent or intellectual property waiver to make the “recipe” for each vaccine publicly available, allowing other companies to produce them too

❓But is this really the solution❓
telegraph.co.uk/global-health/…

Much of the industry has concerns about the implications of any waiver around recouping costs and stifling innovation.

Even with a waiver, it would take between 6-9 months for new producers to start turning out product and there are other hurdles too...

🤝In an unprecedented move, companies are already collaborating to help boost supply.

But perhaps the strongest argument against waivers is this: in October Moderna actually offered an IP waiver. No-one has yet taken it up

Instead, “the biggest obstacle is raw materials,” says @TorbettR.

These are all in high demand and complex.

The Pfizer vaccine, for example, has 260 ingredients that come from 60 companies in 19 different countries – which presents a challenge to ramping up production

🧪Another challenge is perhaps harder to tackle.

Vaccines are biological products and the manufacturing process does not always go smoothly

Many of the solutions proposed are long term: the European Union, for instance, has promised to invest €1bn in building capacity across Africa to reduce the continent’s reliance on imports.

But this will not come to fruition for years
telegraph.co.uk/global-health/…

💸 Buying the vaccines 💸

Most commentators agree that the key to vaccinating the world is sharing what is already available.

Ahead of the G7 meeting in Cornwall this month, these calls are becoming more urgent amid fears unvaccinated regions could be the next India

The foundations for today’s unbalanced roll out were laid early last year, when wealthy countries were able to splash the cash early and secure supply ahead of others.

Most contracts also give wealthy nations the first call on future doses

By the end of the year, six countries and blocs are expected to have a combined surplus of more than 2.6bn doses: the EU with 885m; US with 539m; Japan with 300m; UK with 297m; Brazil with 177m and Canada with 175m

⚖️Schemes have been launched to try to counteract this imbalance.

@CEPIvaccines – a co-founder of the Covax distribution scheme, alongside the @WHO and @gavi – also invested in a dozen candidates early, to the tune of $1.4bn (£1bn)

But Covax – formed last April with the aim of protecting 20% of the world by the end of 2021 – simply didn’t have the money to secure large supply deals until last summer; the first deal for 300m doses from AstraZeneca was announced in June

A year later, distribution through Covax has been disappointing.

According to @UNICEF, which coordinates shipping, 77.7m doses have been sent worldwide – just a third of the 252.5m shots the scheme predicted it would deliver by the end of June

Part of the problem has been an overreliance on one manufacturer: the Serum Institute of India, which was set to produce two thirds of vaccines delivered by Covax by June.

As India’s coronavirus crisis escalated the government banned exports to focus on domestic rollout

Much of the wealthy world has already pulled similar moves.

But this decision has had a disproportionate impact on lower income countries set to receive shots for free through Covax. Of these 92 countries, 60 were earmarked to receive SII shots

Richer nations sharing doses will be the quickest way to address stark imbalances in the global rollout, says a @UNICEF official.

Their analysis suggests that most G7 countries could share vaccines immediately without substantially delaying domestic vaccination programmes

🌐 Distributing the vaccines 🌐

Supply is one thing but actually getting shots into arms is a huge undertaking for any country
telegraph.co.uk/global-health/…

According to a review of low and middle income countries’ readiness to implement vaccine campaigns conducted by the World Bank, 95% have developed national plans and 82% have worked out which groups should be vaccinated first

However, crucial gaps remain.

Only 59% have plans to train vaccinators and less than half (48%) have implemented communications strategies to encourage people to take up vaccines

While low and middle income countries are used to delivering childhood vaccines, so have cold chain systems in place, a mass vaccine campaign for adults is a very different beast, says @MamtaMurthi, vice president for human development at @WorldBank

In addition, no developing country has begun vaccinating at scale – and this is where any problems are likely to become apparent.

“You only truly road-test a system when it has a big throughput,” she says

Vaccine hesitancy has also reared its head, with concerns around rare blood clots linked to the AstraZeneca and J&J vaccines hitting public confidence in Africa.

The DRC sent 1.3m unwanted doses to neighbouring countries in late June, while Malawi destroyed 20,000 unused shots

However many workers on the ground agree that it is supply, rather than hesitancy, that presents the biggest hurdles to vaccinating their communities right now

@sneweyy, @jriggers and @annegulland report
telegraph.co.uk/global-health/…