Supply chain & logistics

12 million


30 million


Doses of the Chinese vaccine Sinovac administered to people in Chile. Our World in Data

AZ doses delivered of the 80–120 million the EU

expected by the end of March 2021. AstraZeneca

alluded to a contract manufacturing site in Baltimore, where a mix-up of AZ and Johnson & Johnson vaccine ingredients resulted in the loss of 15 million doses, while issues at AZ production plants in Europe have caused similar breakdowns in the continent’s politics, negatively impacting both the global supply of numerous different vaccines and overall vaccine confidence. Citing lower than expected yields and difficulties moving materials through different territories, AZ only delivered 30 million of the 80–120 million doses the EU expected by the end of March 2021, and projects that it will deliver less than 100 million of the 260–300 million ordered by June. In response, the EU has blamed its slower than expected vaccine rollout “solely” on the company, limited vaccine exports from the bloc (though it remains one of the globe’s biggest vaccine exporters, sharing more than it distributed internally between the end of January and mid-April 2021) and taken legal action against AZ. It also attempted to buy ten million doses of the AZ vaccine from the Serum Institute, which was originally only supposed to make vaccines for low and middle- income countries and has pledged 1.1 billion doses to Covax. Fearing for its supply of the Pfizer/BioNTech vaccine from EU manufacturing plants, the UK also put pressure on the Serum Institute to fast-track a delivery of another five million AZ doses.

Stock of AZ vaccines sat in one plant in Ohio, US. The New York Times

Both were scuppered by the Indian government’s decision to pause all vaccine exports and prioritise its own vaccination campaign. Essentially, a host of rich European nations ended up competing to buy vaccines from a poor country in the middle of a surge, despite the fact one of them is producing its own doses at a high rate and many of the others had gone out of their way to disparage the product. The US, meanwhile, has a stock of 30 million AZ vaccines – which it has suggested it may never approve for use domestically – sat in one plant in Ohio. Its attitudes have left its territory more easily. In line with the established pattern, India’s rise in cases followed quickly on from Prime Minister Narendra Modi’s declaration of victory in the war against the coronavirus. The country’s surge has months left to run and will hamstring Covax for much of the year. So much for Prasad’s better heads. Any material shortages can always be supplemented with intrigue and suspicion, and every success is liable to spread complacency. Similar formulations of poor communication, manufacturing inexperience, yield variability and politics will continue to sow discord and uncertainty in the months ahead.

Vaccine diplomacy But it’s wrong to suggest IP isn’t a contributing factor. After such a publicised development race, there’s no way it couldn’t be. Most starkly, instead of using political tools to accelerate the use of its cheap and effective Sputnik V vaccine (another Cold War


callback) domestically, Russia has focused on using the IP as a political tool for improving its international standing. While importing doses to support its own vaccine rollout, it has capitalised on the perceived failures of European and North American governments to support equitable distribution by signing (relatively small) manufacturing and export agreements with countries across the world, all while trumpeting the fact that Russia has produced ‘a vaccine for all mankind’. That focus on the politics of the pandemic is giving it opportunities to become even more deadly. It’s presenting a particular image internationally, but Russia’s efforts to vaccinate its own population have been compromised by low stocks, poor distribution and governmental insistence that Covid-19 is not a problem for the country. China has far greater production capacity, but its success in stopping the spread of the virus has also resulted in a sort of vaccine apathy among its populace. These conditions mirror India’s earlier in the year.

The most impressive rollout of a Chinese vaccine might be in Chile, which has administered 12 million Sinovac doses (along with two million from Pfizer/ BioNTech) to its 18 million people. Troublingly, that makes the South American country a geographical outlier. As the southern hemisphere enters its second Covid-19 winter, even advanced economies like Australia and New Zealand have struggled to source raw materials and completed vaccines, while Brazil, where the US and Russia have both tried to exert influence over vaccine imports, has manufacturing capacity and very little supply. Bancel finds this particularly concerning. “The last six months have been really horrific in terms of what’s happened across the northern hemisphere,” he told the IFPMA panel. “Especially with such a large immunocompromised population [south of the equator], a lot of people that are unfortunately HIV-positive, I worry deeply, on the guidance of my epidemiologists, that we should be seeing many more variants.”

When compared with the HIV/AIDS pandemic, which had continued for close to ten years before antivirals reached patients in Sub-Saharan Africa, the global response to Covid-19 should be appreciated as an impressive step forward. IFPMA director general Thomas Cueni believes there’s a realistic chance to produce ten billion Covid-19 vaccine doses this year, a staggering achievement that would mean tripling the pre-pandemic vaccine output. The only issue is that half of those doses are going to high-income countries, freeing them to vaccinate their populations twice over and leaving the rest of the world with much less than 50% coverage. If the excess doses aren’t distributed quickly and fairly, that leaves plenty of room for variants. “Until everyone is safe,” warned Cueni, “no one is safe.” To stop the virus, leaders will need bigger ideas than they can fit in old metaphors. ●

World Pharmaceutical Frontiers /

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