Vaccine programmes across Africa and much of the developing world will suffer big delays after the world’s biggest producer said it would not be exporting the Oxford/AstraZeneca vaccine until the end of the year.
“We continue to scale up manufacturing and prioritise India … We also hope to start delivering to Covax and other countries by the end of this year,” Adar Poonawalla, chief executive of the Serum Institute of India (SII), said in a statement on Tuesday.
“The Covid-19 crisis has been difficult on people across the globe, including India. In the past few days there has been intense discussion on the decision of our government and Indian vaccine manufacturers, including SII, to export vaccines.”
The delays raise the prospect of hundreds of millions of people around the world waiting until 2022 or even 2023 for vaccination, which will lead to many more deaths and further damage to suffering economies, and could allow new and potentially more harmful variants of the virus to emerge.
SII paused deliveries of the AstraZeneca vaccine in March, diverting for domestic use doses that were to be distributed across the developing world. It had been widely hoped that supplies of the AstraZeneca shot, which is suitable for use in countries with weak infrastructure and many poorer countries, would begin again in June or October.
However, India is battling a wave of infections that has killed more than 283,000 people, according to official figures, which many experts believe are substantial underestimates.
SII’s decision is likely to leave the Covax global vaccine-sharing facility, which helps poorer countries, facing a shortfall of hundreds of millions of doses. More than 40 countries in Africa have already received shots from Covax and are relying on further deliveries.
The World Health Organization (WHO), a co-leader of Covax, has called on vaccine makers outside India to advance supplies to the programme to make up the shortfall. Covax aims to provide 2bn vaccines to the developing world in 2021, a target that was always optimistic and now looks impossible to achieve.
The delays will hit India’s neighbours hard. Nepal and Bangladesh are making frantic diplomatic efforts to secure vaccines to prop up their faltering inoculation drives as their stocks run out. Bangladesh said it urgently needed 1.6m shots of the AstraZeneca vaccine to provide second doses.
Nepal, which started its vaccination drive in January with 2.35m AstraZeneca doses provided by India and Covax, also said it had no stocks and more than 1.5 million people were awaiting second doses.
“People above 65 and others in risk groups who received their first shots of the Indian vaccine are waiting for their second,” said Dr Jhalak Gautam, head of the vaccine section of the ministry of health and population.
“It’s already overdue,” he said, adding the SII had yet to deliver 1m shots that Nepal bought.
Gavi, a public-private global health partnership that aims to increase access to immunisation in poor countries and co-leads Covax, has said at least 140m doses that it had expected from SII by the end of May will now remain in India.
“As India confronts a truly dreadful wave of the pandemic, Indian vaccine production, including the 140m vaccine doses initially destined for Covax, have been committed to protecting its own citizens,” a Gavi spokesperson told Reuters.
Covax has a deal with SII to deliver 1.1bn doses of either the AstraZeneca vaccine or the newer Novavax shot, which has still to obtain regulatory approval.
Dr Abhishek Rimal, Asia health coordinator for the International Federation of the Red Cross, said the delay would also have a major impact on countries in south-east Asia, which are already facing a rise in cases.
“Within one and a half months, the south-east Asia picture has changed completely,” he said. “We are trying to double our primary prevention work going forward so that even if there is no vaccine we are upping our guard.”
After managing to prevent the worst of the pandemic last year, several countries – including Vietnam, Malaysia and Cambodia – have seen new waves of infections in recent months.
Vaccination campaigns have been slow to start across much of the region. The Philippines, one of the worst affected countries, has fully vaccinated less than 1% of the population.
Dr Siti Nadia Tarmizi, the Indonesian health ministry’s vaccination spokeswoman, said the Serum Institute announcement may affect the country’s Covax supplies, but she believed the WHO and other groups would tackle this. “We still have procurement to AstraZeneca directly, which [it] has committed to send [in] June or July,” she said.
As host of next month’s G7 meeting, Boris Johnson is now under intense pressure to ensure that rescue packages, vaccines and drugs are dispatched from rich nations to halt the spiralling rates of Covid deaths in developing countries and stem further mutations of the virus.
Nearly one in three (30.7%) recorded deaths from Covid-19 worldwide are occurring in poor and lower-middle-income countries, statistics from earlier this month revealed, a large rise from 9.3% of global deaths earlier this year.
Gayle Smith, US coordinator on the responses to the pandemic, on Wednesday called on other countries to follow the US lead by increasing financing for Covax and sharing surplus doses with the world’s poorest countries. “The scale that is demanded requires all of us – we cannot do this alone,” she said.
“We are encouraging many other countries to put much more financing on the table for Covax. We have got to fill these gaps as quickly as possible … There is a broad consensus that vaccine dose sharing has to be part of our collective strategy.”
The US has contributed $2bn to Covax in recent months. Joe Biden said on Monday that the US would export at least 20m doses of the Pfizer/BioNTech, Moderna and Johnson & Johnson shots, on top of 60m AstraZeneca doses he had already planned to give to other countries.
The US president’s announcement came as the WHO director general, Tedros Adhanom Ghebreyesus, warned that the world had reached a situation of “vaccine apartheid”. The WHO said last month that Africa had given fewer than 2% of vaccinations administered globally and was being left behind.
There have been 4.7m infections and 126,000 deaths from Covid in Africa, according to official figures, though experts believe these do not reflect the true total.
