COVID vaccine equity: protecting the world

The good news is that half the world's population have now had at least one dose of a COVID-19 vaccine. That's an outstanding achievement. But the bad news is that the picture looks a lot less rosy when we focus exclusively on some countries in the global south, where literally a few percent of the population of each country have been vaccinated so far. Apart from the obvious threat to life there, this matters to all of us, because high disease turnover in a population increases the likelihood of further COVID variants emerging that can threaten everyone. But, as Richard Hatchett, CEO of CEPI - the Coalition for Epidemic Preparedness Innovations - one of the organisations working to solve the present situation, explained to Chris Smith, the low vaccination rates are not because of a lack of vaccines; it's how they're being distributed that we need to pay attention to and plan for…

Richard - Vaccine production globally is scaling up with astonishing rapidity. We've already delivered over 6 billion doses of vaccines. There are some estimates that by the end of the year, we may even get to 11 or 12 billion doses of vaccine being distributed globally. So that would potentially be enough to vaccinate five and a half or 6 billion people. The problem is that countries have different capabilities, different resources to receive and deliver that vaccine. And so I think we may very rapidly move from a situation where the global vaccine situation was characterized by scarcity to one in which the rate limiter is how quickly can countries receive and then deploy and dispense that vaccine to their populations and poorer countries with less developed public health systems are going to face the greatest challenges

Chris - Are all the vaccines fit for purpose in all places though? Because we've struggled in the UK, at least initially, to get the Pfizer vaccine deployed because the demands of keeping that vaccine at minus 80 degrees were really very extreme. So that means that that's not going to be a useful vaccine for a resource poor setting where they don't even have a fridge let alone electricity to run that fridge. So have we got the right sorts of vaccines fit for purpose, for deployment into resource poor settings?

Richard - Well, we've used a number of technologies to develop the many vaccines that we now have. And, and you're right. Some vaccines like the MRNA vaccines do have cold chain requirements, where you have to keep them cold the entire time, almost until the point that you put the vaccine into a person's arm. Vaccines with complicated logistical requirements, present added challenges, even poor countries have some ability to receive and use even vaccines like the Pfizer and Moderna. But you're exactly right. If that vaccine presented a challenge in the UK, you can imagine what kind of a challenge it would present in Chad or the democratic Republic of Congo or Somalia. Some of the vaccines are easier to use and what we're trying to do. We have many, many vaccines coming into COVAX, and we're trying to match the vaccines to the countries as well as we can, but it's a huge challenge.

Chris - The other thing that we've considered here in the UK is what to do about boosters and whether or not just giving two doses of the same thing, a certain period of time apart, is best practice? And obviously it's a learning process and we're learning all the time. So what mechanism is being used when we give these vaccines to other countries in order to make sure that they actually use them most optimally?

Richard - I would say on the whole, the rush that many high-income countries are in providing boosters to their entire population is a concern because every dose that is allocated to providing a booster dose is potentially a dose that is not being provided to provide someone a first dose. And what we know, even the incremental value that the boosters provide in terms of protecting people is not greater than the value that a first and second dose would provide to somebody who has not been vaccinated at all. So we have called for prioritizing the existing supply of vaccine to make sure that people who have not been vaccinated at all can have access to vaccines before we start providing boosters to the vaccinated population

Chris - And with your crystal ball in your hand, how do you see this playing out over the next 12 months? Where do you see us if we're talking together at this time next year, where are we going to be?

Richard - The United States and the WHO have both set an aspiration for a global level of vaccination to reach approximately 70% by this time next year, that's a hugely ambitious aspiration. There are many countries that have barely begun to vaccinate their populations and are going to face substantial logistical challenges in accomplishing that goal. I think we will have enough vaccines globally to accomplish that goal by this time next year, whether we will have been able to package that vaccine up, deliver it and get it out to people remains to be seen. And I think that will only be accomplished if there is a very substantial, coordinated global effort led by countries that have resources like the UK, the US, and European partners to make sure that that happens.