Posted inGlobal Affairs

The Race to Rollout: A look at how the vaccine is being administered around the world.

Over the last month, countries across the globe have begun distributing long-awaited vaccines. They are not, however, the quick-fix many had hoped for. Not only are there multiple versions of the vaccine, but there are competing regulatory agencies, arguments over who should receive it first, and prices that range from $3- $62 per dose, depending on the deals governments have managed to negotiate. The horses in the race are the Belgian-manufactured Pfizer-BioNTech, the Oxford-AstraZeneca and American outsider Moderna. The hopeful jockeys? Just about everyone in the world. 

How are we doing?

Ninety-year old British pensioner Margaret Keenan made history as the first person to receive the Pfizer-BioNTech Covid-19 vaccine outside trial conditions. In the battle to stop rising case numbers, there has since been increasing pressure put on the UK vaccine rollout. The most recent stats suggest over 2.4 million people (around a quarter of those over 80 in England) have received their first shot since the rollout began on 8th December. The government’s goal is 2 million a week. 

With all three vaccines now approved, and with the UK receiving early access to the most easily transportable and storable of them- the Oxford AstraZeneca vaccine- this may not be an impossible target. 

The strategy that will supposedly allow this speed increase is the UK’s decision to stretch out the time between doses to 12 weeks. Whilst this has been recommended for the Oxford vaccine, BioNTech, the manufacturer of the Pfizer vaccine, has warned that lengthening the time between their doses from the recommended 21 days could cause the vaccine’s protection to weaken. Prime Minister Boris Johnson has defended this move as one that will enable them to save “the most lives the fastest”.

The nationalised health services in the UK, as in many of the most effective rollouts, have permitted the population to be grouped and invited for vaccination according to vulnerability. This has begun with over-80s and will be extended to all those classified as ‘clinically extremely vulnerable’ by mid-February. Frontline care and healthcare workers and over-70s will also be included. It is at this point, the government hopes, that lockdown measures will finally be reviewed and relaxed.

Europe Lags Behind

Perhaps the more surprising turn of events is the fact that the whole EU has vaccinated fewer people than Britain has alone. With only around one million on the continent vaccinated with Pfizer’s solution so far, this has led to widespread speculation about what has ‘gone wrong’ in Europe.

One of the main issues seems to be the delay in regulatory approval for other vaccines. The EU rollout started weeks after the UK’s, with access to only the single vaccine that had been approved. The Oxford AstraZeneca jab is still yet to receive EU certification. This will further slow EU progress, as the Oxford vaccine is easier to distribute and store. Their hopes are pinned, for now, on the recently approved Moderna vaccine. Even then, difficulties in shipping it from America are likely to produce delays. 

There is also mixed opinion among national health ministries as to whether they should approve the UK’s new strategy of lengthening the time between doses. Some, such as Denmark, have already gone ahead with this, whilst it has been deemed too risky by the Spanish government. Germany is still undecided.

In other countries, the issue appears to simply be one of local preparation. Spain has been accused of not training enough nurses to administer the vaccine. This resulted in Catalonia using only around a fifth of its available doses because of staffing issues. Similarly in Italy, one region reported that their hospitals had received the ‘wrong needles’ for the Pfizer vaccine. Even in Germany, which has been comparatively successful, their ‘mobile’ vaccine teams, which visit nursing homes and careworkers in lieu of appointment-based systems at immunisation centres, have reduced their ability to vaccinate en masse substantially. 

Perhaps the biggest mishap in Europe, however, has been in the Netherlands, whose rollout began less than a week ago. They will be among the last Western nations to start vaccinating, making them look, as populist party leader Geert Wilders said indelicately in Parliament recently, like “the village idiot of Europe”. Vaccines arrived in the nation on Boxing Day, but the delay in their subsequent distribution has been almost inexplicable. Many have jumped to blame the country’s slow bureaucracy. 

Israel’s Surprise Lead

The somewhat unexpected forerunner in this race has been Israel. 

According to the most recent figures, the Middle-Eastern nation has inoculated a higher proportion of its population than any other country. An estimated 12% of Israelis have received their initial dose. The rollout only began on 20th December, but their efficiency is thought to be due to their small size and nationalised health system. All Israeli citizens have identity cards and are placed on a national vaccination registry for childhood vaccines, which is now being used to track the progress of inoculations. 

It helps too that Pfizer, the producer of the vaccine being rolled out in Israel, also has a strong presence in the country. Associate Professor of Diseases Ran Nir-Paz said recently that Pfizer views Israel as their “test case” for the vaccine, hoping to prove its efficacy on a smaller scale.

The country has been vaccinating so quickly, in fact, that they have had to announce a pause whilst they secure more supplies of the jab. As in the UK, the ambitious pace has been set by the government’s race against rapidly rising case numbers. Its effective rollout thus far has not saved Israel from the necessity of a third national lockdown, announced earlier this week. Israel, like many others, places its hopes on incoming deliveries of the new Moderna vaccine to keep up with the pressure.

Questions have been raised by global health and human rights agencies, however, about the transparency of Israel’s rollout. Professor of Epidemiology Ronit Calderon-Margalit recently said it was unclear ‘how priorities are being set’ in terms of who can receive the vaccine. Officially, Israel has gone down the same route as most other countries in initially giving priority to the over 60s. However, there are several reports of young and influential people also being inoculated. The Times of Israel reported recently that hundreds of the Prime Minister’s staffers were allegedly receiving early vaccination.

The second area of controversy is Israel’s refusal to vaccinate its estimated 2.7 million Palestinians. Whilst the Israeli government claims that the Palestinian Authority is responsible for their health provisions, many international and Palestinian rights groups have accused Israel of neglecting humanitarian obligations. They point to the fact that Gaza and the West Bank areas have been some of the hardest-hit by the virus, but will be among the last to get vaccinated. 

Director-General of the Palestinian Health Ministry, Ali Abed Rabbo, estimated that vaccine roll-out for the Palestinians would probably not begin until February at the earliest. Even then, this will rely on donations of surplus vaccines from Israel and the WHO’s Covax scheme, which has pledged to inoculate 20% of Palestinians.

What about the developing world?

The situation outside of rich nations is starkly different. Virtually no middle or lower-income countries have secured enough orders to vaccinate their whole population. Compare this to Canada, where they have secured enough to vaccinate all of its citizens five times, or the US that has already ordered over 400million doses.

Even if enough vaccines were to be purchased by the developing world, many nations do not have the healthcare infrastructure or public trust that mass vaccination programmes require. Even the requirement of transportable fridges and freezers for vaccines such as Pfizer’s presents a huge challenge.

It is the Covax scheme, partially organised by the World Health Organisation, that is providing hope to the many countries who cannot afford the competitive prices of the Pfizer and Moderna vaccines. They aim to provide vaccinations to around 20% of the world’s poorer countries by the end of 2021. 

However, the scheme has gotten off to a very bumpy start. Having raised just over $2.1bn, reports suggest they will require at least another $4.9bn to reach targets. It also relies largely on the Oxford-AstraZeneca partnership for the vaccine which, unlike Pfizer-BioNTech and Moderna, has agreed to manufacture on a not-for-profit basis ($3 per dose for middle-lower income countries). Whilst this is brilliant news for the world’s most vulnerable, the Oxford vaccine has been slower than intended in completing trials and receiving regulatory approval, stalling the scheme in many parts of the world. For many, the vaccine is not the landmark of 2021, but of 2022 or ‘23.

This has become a global race: not just against coronavirus and its rising cases, but against the mounting pressure from publics within, and from international competition without. Coming first means respite from a year of national emergency with countless fatalities. Thus far only New Zealand has been deemed an international ‘success story’ in dealing with COVID-19. Coming last risks losing the respect of your people and the international community, not to mention the countless lives that will be needlessly lost. We must also think, however, of the millions who cannot even afford to enter the race, and the continued struggles that lay before them.