Relatives and family members carry the dead body of a Covid-19 victim for a cremation at Nigambodh Ghat Crematorium, on the banks of the Yamuna river in New Delhi in the early hour of April 22, 2021. Photo: AFP / Sajjad Hussain

SEOUL – A leading vaccine expert suggested Tuesday that countries holding, but not using, doses of the controversial AstraZeneca vaccine should release them so they can be supplied to the developing world.

“We need all the vaccines we have,” said Dr Jerome Kim, head of the Seoul-based International Vaccine Institute that supplies vaccines across the developing world. “If a country opts not to use a vaccine, it should provide it to an international mechanism that will distribute the vaccine.”

His suggestion came hours after the United States said that it will release 60 million AstraZeneca doses to other countries. However, regulatory clearance is still pending and it is not known which countries will be the recipients.

Due to concerns about blood clots, a number of countries have postponed the use of the vaccine, while Denmark has halted its use. Meanwhile, the United States has millions of doses of it, but has not approved its use for its domestic population.  However, Kim noted that in defiance of concerns, other advanced countries, such as South Korea and the United Kingdom, are proceeding with mass AstraZeneca vaccinations..

Citing the risk of the vaccine causing blood clots approximately 100,000 to one he said it was similar to the risk of “being struck by lightning.” Given this, he said the AstraZeneca shots need to be released to help control crises in the Global South.

“It is important for COVAX to have as much vaccine as possible,” he said, referring to the global initiative that supplies Covid-19 vaccines to developing nations at reduced or no cost.

“We know that Africa, and Latin American and South Asia have tremendous problems,” Kim said. “And even in countries that don’t have explosive outbreaks, they have the potential to become so.”

Urgency is essential for two reasons. One is the hideous carnage the virus is wreaking in India, Brazil and elsewhere. The other is the unknown lifespan of the Astra Zeneca shot.

“Shelf life is something a company determines over time, and this is not a vaccine we had 10 years ago with a lot of data, so we don’t have a good answer,” Kim said. “Companies will periodically take the vaccine out and subject it to testing. They are extending the shelf life as we go along.”

Kim, who spoke previously to Asia Times in March, made his suggestion while briefing foreign reporters in Seoul.

In a wide-ranging presentation and question and answer session, Kim addressed vaccine supply bottlenecks, equitable distribution, the risks posed by ongoing mass outbreaks in the developing world – and some possible silver linings to the crisis.

Virus bottlenecks, bottle bottlenecks

Despite widespread global impatience at the rate of supply, some 7.2 billion doses of the currently in-use vaccines should have been produced by the first half of this year, Kim said, citing data from countries supplying vaccines.

By the end of this year, that number should rise to 12.6 billion. And in 2022, there should be 30 billion doses available – more than enough to take care of the entire global population of 7.8 billion.

Still, Kim admitted that this was “rosy” data. Regardless of manufacturing projections, there remain major questions about supply bottlenecks.

“There are difficulties with scaling up production,” Kim admitted. He gave the example of Pfizer, which had to temporarily halt production to massively upscale capabilities, which caused “frustrating delays.” 

There have also been snafus –such was at the Baltimore plant that mixed up ingredients of AstraZeneca and Johnson&Johnson vaccines, reportedly spoiling 15 million doses of the latter.

And “vaccine nationalism” has warped supply chains. India, a major manufacturer of vaccines, has indefinitely halted overseas shipments of AstraZeneca to deal with its domestic catastrophe.

But supply bottlenecks are impacting not just the vaccines, but also the production of collateral materials – such as vials stoppers and syringes, Kim said. When the US initiated “Operation Warp Speed,” contracts were signed with glass manufacturers to massively increase the supply of medical glass, he said. These steps, however, were not taken elsewhere.

Then there is the issue of equitable distribution.

An elderly woman receives the Pfizer-BioNTech vaccine in Guadalupe Ixcotla, Mexico. Photo: Pedro Pardo/AFP

Why rich must help poor

Getting wide access to vaccines is not simply about being prosperous: some countries, particularly those which were successful at pandemic containment, were late to order and/or slow to approve vaccines.

For example, G10 economies Japan and South Korea are, in terms of percentage of population vaccinated, behind Bangladesh, Dominican Republic, Mexico, Nepal and Rwanda, according to the Financial Times’ Global Vaccination Tracker.

Even so, as a general rule, the wealthier the country, the more likely they are to have vaccinated significant parts of their population, Kim said.

A number of high-income nations fast-tracked regulatory approval and made early pre-orders for vaccines. These countries were assisted by having highly regarded regulatory authorities with the credibility to swiftly approve vaccines. Customarily, countries which lack top-tier regulatory bodies follow the lead set by the most advanced nations, Kim told Asia Times in March.

A health worker collects a nasal swab sample from a child to test for the Covid-19 coronavirus at a residential area in Mumbai. Photo: AFP/Indranil Mukherjee

Given the interconnectivity of modern human life, it is essential that vaccinations spread beyond the First World. Kim, a former US Army officer, noted that US intelligence has recently restated what the UN had already said, “No one is safe until everyone is safe.”

If high-income countries corner global supply, it will be a “disaster” Kim said. Modeling suggests it may result in doubling the number of Covid deaths worldwide.

The real danger, Kim suggested, lies in the developing world: sub-Saharan Africa, Latin American and South Asia.

How rich can help poor

His biggest fear concerned the race between vaccinations and mutant strains of the virus. Runaway outbreaks – such as the UK’s, and currently, Brazil’s and India’s – are where mutations occur. These mutations, he warned, are less sensitive to vaccines and could undermine the vaccines we now have.

He praised COVAX.

“A year ago we did not have any vaccinations. Now 2 billion doses should be available [to COVAX] by the end of 2021,” Kim said. While that would only cover 20% of the vaccinations necessary, it should protect the high-risk populations – healthcare workers and the aged.

“I think COVAX will succeed, but I would like it to succeed better,” Kim said. “The prediction is 20% of global needs will be met in 2021, but we have to talk about what countries will need it more desperately. That will be the true test of COVAX.”

Good news could come this week. The WHO will be making decisions on two Chinese vaccines this week that have not been approved by Western regulatory bodies. If they get the WHO nod, they could be supplied to COVAX, increasing that body’s supply.

Uganda’s Health Minister Jane Ruth Aceng (2ndR) with AstraZeneca vaccines delivered under the Covax initiative. Photo: Tina Smole/AFP

The Global North’s efforts to assist the Global South must extend beyond supplying vaccines to upgrading medical infrastructure to enable efficient distribution, storage and administration – and monitoring.

“We don’t know how big the infections are, and what mutations are emerging in Africa,” he said. “This can put the vaccines we have developed at risk. We have to invest in surveillance.”

However, while he emphasized the need to get vaccines to the developing world, Kim warned that one demand currently being aired is not going to be of help.

Populist voices around the world are demanding the release of vaccine patents, thereby enabling manufacturers in developing countries to start producing.

Dr Jerome Kim, head of the International Vaccine Institute. Photo: IVI

“Can many countries make vaccines? This is very complex,” he said. “Every step in the process is a quality check, so this is not just experience in making biologics, this is about the ability to regulate: Would the [local] regulatory body be able to do the necessary inspections?”

Dark clouds and silver linings

With massive outbreaks underway in Brazil and India, and infection and death tolls still climbing, Kim admitted that he is not as upbeat about the conclusion of the battle against the virus as he was in 2020.

“If you asked a year ago, I would have said we could vaccinate and control it with 10 billion doses,” he said. “But now with the generation of mutations and explosive outbreaks and ensuring equitable access to vaccines, I am not so positive.”

Still, as a dedicated pro-vaxxer, Kim does see one potential upside.

Covid-19 poses mortal perils to the aged, but minimal risks to the young. This dynamic may help shift the world’s conventional attitude toward vaccinations.  

“80% of children around the world get the vaccinations that the WHO recommends,” he said. “Now we need to change from pediatric immunization to universal immunizations.”

That change agent could be the current pandemic.

“Covid could be a silver lining in the move to lifetime, universal vaccinations,” Kim said.