Canada seeks out thousands of doses of AstraZeneca vaccines. Hoarding in rich countries poses logistical problems for the poorest, with no scope to prepare their health systems for an arrival with uncertain regularity.
The world has not yet solved the challenge of producing enough vaccines for its entire population, but a great new challenge is beginning to loom on the horizon: preventing hundreds of thousands of already manufactured doses from being destroyed because they expire before being administered. In this situation are countries with very opposite economic situations, such as Canada, Malawi and South Sudan. This week, the federal government of Canada has urged its provinces to “prevent the waste” of thousands of doses of AstraZeneca that expire these days, according to the letter sent Thursday by the Minister of Health, Patty Hajdu.
The rejection of this vaccine and the hiatus of its use in March after the detection of the first cases of thrombi are behind a problem against which Hajdu now offers “logistical and coordination” means aimed at reaching the unused vials in some provinces to others before they expire.
In Africa, with the lowest coverage on the planet, Malawi has had to destroy 20,000 doses and South Sudan another 59,000. They reached their expiration date on April 13th of the current year, without the weak health systems of both countries being able to administer them. In both cases, the doses -manufactured by the Serum Institute of India, also licensed by AstraZeneca- had been forwarded weeks earlier from South Africa, which in turn had stopped using them as they were considered less effective against the variant that plagues the country.
Suspending patents will not solve vaccine shortage
Different countries with very different realities but having the same problem that experts attribute to a common cause. Guillem López-Casasnovas, director of the Center for Research in Economics and Health at Pompeu Fabra University (Barcelona), argues: “The rich countries have applied a security policy with the massive purchase of doses, several times above their needs, and the idea of resending later what they did not need. But it is a system that has a thousand logistical problems and great risks”.
Canada is the country that has contracted the most doses with respect to its population: more than 400 million for 37 million citizens. And although it has not yet reached the point of having more vaccines -most of those commitments are in the future term- citizens’ expectations of receiving those perceived as safer have triggered suspicions towards AstraZeneca’s. A survey has revealed that only 1 out of 3 Canadians would feel comfortable by taking this drug.
Hong Kong, which has also acquired doses to immunize its 7.5 million inhabitants several times, faces the challenge of administering “millions of units of Pfizer-BioNTech in the next 3 months, before they expire”, reports the local press. This territory has started the raffle for a flat valued at more than € 1 million as an incentive. All those who are vaccinated will be able to participate.
At the other end of the world income scale, experts lament that this hoarding has left the poorest countries in the queue, with very few vaccines and no room to plan or prepare their weakened health systems for the arrival of doses with an uncertain regularity and a near expiration date.
Dimitri Eynikel, member of the European office of Doctors Without Borders (MSF) in Brussels, defends: “It is possible to successfully complete mass vaccination campaigns in Africa. We have been doing it for years, but it is something that requires planning. It is not about donating vaccines and that’s it. Their health personnel are already working in the hospitals and cannot be changed since one day to the next”.
Matthew Herder, director of the Institute for Health Law at Dalhousie University (Canada), criticizes “the strictly nationalist response given by governments around the world knowing that the pandemic, by definition, poses a serious threat to health global”. “Every initiative that could have improved access and distribution of vaccines on a global scale has not received the support of rich countries,” he laments.
Irene Bernal, a researcher at the independent organization Salud por Derecho, recalls that Covax, the alliance in which almost 200 countries and organizations such as the WHO participate, had to be a key mechanism for “the purchase of 2,000 million doses and their distribution in 92 countries, in addition to channeling public and private donations to make it possible”. An initiative that, regret all the experts consulted, does not even manage to glimpse the moment when it will achieve its first objective, considered modest, of vaccinating 20% of the population of the poorest countries.
The General Council of the World Trade Organization (WTO) is scheduled to discuss on June 8th and 9th, 2021, the initiative led by India and South Africa, sponsored by more than 60 countries, to release patents on vaccines and other necessary health products to cope with the pandemic. It is an attempt to increase a world production that is still insufficient, but in any case it will grow very notably in the coming months, according to the forecasts and agreements of the pharmaceutical industry.
There is a scenario in which experts fear that there will be an uncoordinated cascade of vaccine donations, from higher-income countries to lower-income ones. López-Casanovas warns: “The risks and costs are enormous.” “If something was to go wrong with any of these lots and the idea spread that the rich countries on top of it harm the health of the poor, the blow would be enormous. But it is that, in addition, the logistics costs are gigantic. If distributing vaccines to every town in a rich country is already very expensive, it is much more expensive to do the reverse process to recover them and send them to a third country”, she adds.
For Dimitri Eynikel, the good news is that “the time has not yet come when rich countries have millions and millions of vaccines left over.” The example is that of the European Union (EU), where practically all the doses that are arriving are administered because the demand continues to be greater than the supply. “Hoarding has existed and this has caused major dysfunctions of which we are already seeing an advance, but that scenario will not foreseeably occur for a few months”, he predicts.
A time that, according to all experts, it is necessary to use to strengthen Covax and the rest of the multilateral mechanisms against the pandemic. A spokesman for the European Commission confirms that the EU has “reserved a significant number of doses also for low- and middle-income countries.” “The Commission and the Member States have agreed on the necessary mechanisms to allow a greater distribution of these doses to the countries that need them”, he added.
Although, ultimately, vaccination strategies depend on the States, the Union’s goal is to donate 100 million doses to third countries, most of them through Covax. These figures represent, however, a minimal part of the alliance’s needs, which is why calculations by The Economist Intelligence Unit indicate that the 85 poorest countries “will not receive the doses they need until 2023.”
At the moment, the EU countries have signed 2 relevant agreements to transfer vaccines to third countries. France donated 100,000 doses to Mauritania at the end of April, and Austria channeled the donation of another 650,000 to various Balkan countries. Spain, for its part, has pledged to donate 7.5 million vaccines to Latin America before the end of 2021.