This is the first of a two-part interview on global Covid-19 vaccination challenges.
SEOUL – While a number of countries are surging ahead with Covid-19 vaccination drives, the wider world lacks a single overall body to coordinate the global fight against the pandemic, a leading vaccine expert told Asia Times.
Given this – and despite the ongoing vaccination drive being unprecedented in both its speed and scale – inefficiencies are hampering the overall rollout, said Dr Jerome Kim of the Seoul-based International Vaccine Institute.
And while the global Covax facility has been established to ensure the developing world gets its fair share of vaccines, Kim noted that the problem goes far beyond supply. Many low-income countries lack the storage infrastructure, distribution mechanisms, administering staff and recording facilities required for effective vaccination rollout.
“Who is in charge of making sure there is enough supply, who is looking at all the logjams, who is in charge?” asked Kim during an interview with Asia Times. “Who is telling everyone we need to share? Where is this leadership? I don’t know who has been empowered.”
Despite the global nature of the 21st-century world, with its deeply interconnected supply chains and where both cargo seaports and passenger airports have proven to be vectors for virus clusters, there is no over-arching command-and-control.
“Who can Xi Jinping or Joe Biden or the head of the EU pick up the phone to?” he asked. “We need a summit, we need to assign responsibility.”
Multiple national programs, in well-to-do countries like Iceland, Israel, Spain, the UK and the US, have far outpaced the speed of the overall global drive. They were able to accelerate vaccine procurement, distribution and administration efforts under national leadership.
“The beauty of Operation Warp Speed was that there was just one pot of money,” Kim said with reference to the US vaccine development program.
In the fragmented global situation, distribution is being handled not by a supra-national body, but by a range of private vaccine manufacturing companies.
These firms, unsurprisingly, given the unprecedented speed and scale of the vaccination rollout, have hit supply logjams. Some have been explained, such as an early lack of supply of medial glass for vials and an early delay announced by Pfizer while it scaled up its manufacturing facilities.
“There were always going to be slowdowns until systems are working smoothly,” Kim said. He added that many of the companies now producing vaccines are pharmaceutical firms that formerly specialized in treatments and had never previously made a vaccine.
Other bottlenecks, however, are misted with opacity.
Presently, South Korea is facing a vaccine shortfall in the millions after Moderna informed Seoul this month that it would only be able to supply half of the 8.5 million doses it had contracted to deliver in August. While the company has reportedly apologized for the delay, no explanation has appeared in public.
“There is this leadership vacuum, and this is why the pieces are bumping into each other,” Kim said. “Who does policy, who does development, who is saying, ‘I have total oversight of manufacturing, contracting and implementation?’”
Are we winning the race?
The vaccination drive is proceeding on a scale unprecedented in history: The 400 million doses of Covid-19 vaccines now being manufactured every two weeks around the world are equivalent to the total number of vaccinations (for other diseases) that are administered worldwide in a normal year, Kim noted.
With a global population of 7.8 billion, demanding roughly 16 billion vaccines doses for full vaccination, UNICEF has projected – after conducting a survey of manufacturers – that 13 billion doses would be administered by the end of 2021, Kim noted.
It is unclear, on present output, if that goal will be reached.
“Now were are at 4.5 billion, which is remarkable, but we have a lot of work to do,” Kim said. “We are making huge amounts, but not enough.”
In addition to the logistical bottlenecks noted above, OEM companies in recognized vaccine-manufacturing hubs – notably Brazil, India, Indonesia and South Korea – appear to be facing speed bumps.
Many of these are contractual issues with the patent holders.
“Gavi [The Vaccine Alliance] was finding lawyers that could help them with contracts,” Kim said. “If a company is going to transfer the ability to manufacture a vaccine, it has to be protected so there are all these legal intellectual property questions, licensing and technology transfers, so that the company cannot make the vaccine on its own under a different label. That process takes time.”
Third World last
There has been widespread condemnation in global society of unfairness, as high-income countries outpace low-income countries in their vaccination drives.
Our World in Data notes that 31.7% of the world’s population has received at least one dose of a Covid-19 vaccine and 23.7% are fully vaccinated. Overall, 4.76 billion doses have been administered globally, with 37.24 million being administered each day.
However, only 1.3% of people in low-income countries have received at least one dose, the online research firm noted.
The Western-funded Covax program was designed to deal with this issue but is itself splintered in its responsibilities and operations.
Covax is co-led by CEPI (the Coalition for Epidemic Preparedness Innovations), Gavi (The Vaccine Alliance) and the WHO (World Health Organization), all operating alongside UNICEF, the “key delivery partner.” In the Americas, the PAHO Revolving Fund is the recognized procurement agent.
Gavi coordinates and legally administers the Covax Facility, CEPI oversees the vaccines and the WHO has set up a “fair allocation” framework. A number of regional banks are supplying funds to low-income countries which want to buy in.
Yet vaccine inequality is not simply the result of the greed and self-prioritization of prosperous countries. It is also a natural side-effect of differing national capacities.
“The higher the income level of a country, the more able a country is able to deal with this, and the lower down the scale, the more it impacts its ability to deliver a vaccine,” Kim said. “In Covax, hundreds of thousands of doses are being destroyed because they could not be used in time – they expired.”
The issue is not simply one of vaccine storage or refrigeration. Many low-income countries lack the necessary infrastructure to distribute vaccines, administer them and record them. This suggests massive efforts will have to be made in capacity building.
“In Africa, you may have one health worker in 10 kilometers,” Kim said.“Needles are something nurses handle, so you may have to train soldiers, or teachers.”
Then there is the issue of tracking vaccinations – type, time, date and place.
“And how do you keep track of it?” Kim asked. “If you are in campaign mode, you are not necessarily keeping records – you are distributing till you run out.”
And even in first-world nations, there are discrepancies in the recording of vaccination histories.
This writer, having been vaccinated in South Korea, was immediately entered into the national medical insurance database with a record of the vaccine used and the time, date and place of administration.
Kim noted scathingly that in the US, he had received only paper certification after being jabbed. “I have a piece of paper that some soldier wrote on, that is my proof,” he said. “Nothing electronic, nothing permanent.”
In the second part of this two-part interview, Kim addresses misreporting the pandemic, the wide variations in effectiveness between different vaccines, the worrying rise of new variants of Covid and how the medical community may deal with them.