Written by Olivia Young

118,016,389. That’s the number of confirmed COVID-19 cases that have been reported worldwide as of March 9, 2021. 2,617,600 of those cases were fatal. These cases continue to increase everyday, but the world is looking towards vaccines as their source of hope. However, access to vaccines is currently locked in bidding wars with wealthy countries leading the pack. Per 100 people, countries such as Chile, Israel, and the US are currently able to vaccinate an average of over 0.3 people each week. However, countries such as South Africa, Paraguay, and Thailand are only able to vaccinate 0.01 people per 100 people each week. Additionally, as of February 14, 2021, 130 countries have “yet to administer a single dose.” This means that approximately 2.5 billion people have yet to have the opportunity to be vaccinated while high income countries (HIC) such as the US and the UK have purchased more vaccines than are needed to vaccinate their entire population. This creates a massive gap in the reach of the vaccine.

The COVID-19 vaccine is a scarce resource with not nearly enough doses currently available as there are people that need it. There is a growing concern not only in the purchasing of vaccines, but in the quality of the vaccines as well. Latin America, for example, has been purchasing the Sinovac vaccine that is produced by a Chinese pharmaceutical company. The Sinovac vaccine has a 50% effectiveness rate, which is significantly lower than what is promised by Pfizer or Moderna. While the Pfizer and Moderna vaccines are mRNA based, the Sinovac vaccine instead uses killed viral particles to expose the body to the virus without risking a serious disease response. The bidding war for vaccine doses is showing to not only impact who is receiving a vaccine, but also the quality of the care they are receiving. Low income countries (LICs) and developing countries are left with “better than nothing” vaccination results while HICs are able to purchase more than enough effective vaccines. Dr. Michael King, a professor of practice in the department of chemical engineering at the University of Virginia and a member of several COVAX committees, stated that supply is the root of the challenges in getting vaccines to low income and developing countries. “Everything is in short supply. Europe is desperate to get the vaccine out of some of the Indian companies that were going to support COVAX, so right now people will pay almost any price to get a vaccine. Until we get an excess supply, prices are still going to be pretty competitive, so it really has to do with supply right now more than anything else.” Dr. King also put into scale the amount of strain that is being placed on the manufacturing system; before the pandemic, 5 billion total vaccine doses were produced each year. “With COVID, you’re looking to make 8-10 billion on top of that 5 billion.” It is also a challenge, as Dr. King mentioned, to get other needed supplies, such as glass vials and syringes, that are needed to transport and administer the vaccines.

Additionally, there are growing concerns globally over the emergence of new strains. Dr. King mentioned mounting panic in South Africa as the Oxford-AstraZeneca vaccine is not effective against the new strain. “They stopped vaccinating their healthcare workers and tried to get access to the Pfizer or Moderna vaccines that are more effective. In the UK and Scotland, the Oxford vaccine could not prevent mild and moderate disease, but prevented 100% of severe disease and hospitalization.” Again, the presence of the “better than nothing” mentality appears as we are still dealing with supply issues. Dr. Daniel Engel, a professor of microbiology at the University of Virginia School of Medicine, when asked if the new strains pose a threat to vaccines stated, “Potentially, yes. For instance, the AstraZeneca vaccine (Oxford) has no effect against the South Africa variant. On the other hand, other variants that have gotten a lot of attention are quite sensitive to the Moderna and Pfizer vaccines. This is all going to take some more time to understand the science of the variants and of the vaccine.” The current, pressing issue is attempting to vaccinate the global population as soon as possible.

Currently, there are not enough vaccines to go around. When asked why there are not enough vaccines currently available in the market, Dr. Engel replied “There are more than 100 companies working on vaccines. Not all of them have the resources, infrastructure, and academic and government networks that led to the success of the first vaccines. The amount of dollars that went into Moderna, Pfizer, AstraZeneca, and Johnson and Johnson vaccines was enormous. In addition, these companies were pretty much ready to go from Day 1 because of all the basic and applied research from the academic sector that had been going on for decades.” It is a struggle to get enough vaccines into distribution that are safe and effective as fast as possible while maintaining the quality of the product.

While LICs have not been able to purchase vaccines or a large amount of doses on their own, there are international organizations, such as COVAX, that purchase vaccines to distribute to qualifying countries. COVAX is the vaccine pillar of the Access to COVID-19 Tools (ACT) Accelerator that works on a global scale to increase equitable access of resources such as tests, treatments, and vaccines. They promise enough vaccine doses to vaccinate 20% of the participating countries’ populations; they view equitable access to the vaccine essential to maneuver through economic and public health impacts. The distribution of COVID-19 vaccines in an equitable manner, however, has many meanings. When Dr. David Leblang, a professor of politics and public policy and director of the Global Policy Center at the University of Virginia, was asked in an interview if HICs were justified in buying as many vaccines as they could upfront stated, “There’s arguments both ways. There’s an argument that says rich countries have an obligation just based on the fact that they are rich and based upon the fact that a lot of the wealth that they have amassed has come at the expense of developing countries and emerging markets. On the other hand, countries that have the technological capacities to produce these vaccines should be able to protect their people first. There is not a clear answer.” In reference to HICs purchasing more vaccines than needed to vaccinate their entire population, he remarked, “the ethical concern arises if and when everyone has been vaccinated and you are hoarding. Hoarding is where it would be unethical. Part of it is a function of are we hoarding and then charging exorbitant amounts for it or not distributing it but we are not at that point yet.”

A common emphasis of those with an anti-vaccine nationalism view is that “nobody wins the race until everyone wins” meaning that until everyone is vaccinated, we will continue to deal with the repercussions of the pandemic. Equitable distribution of the COVID-19 vaccine will lead to the biggest reduction in deaths. Mathematical models have indicated that there will be almost twice as many deaths if the HICs stockpile COVID-19 vaccines in lieu of if the vaccines were shared equally across the globe. In fact, one model showed that if a vaccine with 80% effectiveness was distributed equitably based on the population size of a country rather than on income, 61% of deaths could have been prevented. Meanwhile, the same model showed that vaccine stockpiling by HICs will only prevent 33% of deaths. On an internal basis, HIC countries are less impacted by vaccine efficacy than LIC countries. HIC countries in Western Europe in a scenario where a vaccine is 80% effective is distributed based on population size will prevent 55% of deaths, while stockpiling would prevent 74% of deaths. In Western Africa, however, vaccine efficacy could increase a 13% death prevention to a 93% death prevention. Similarly, in South-East Asia they would increase from 5% to 62% death prevention. While the deaths that are being prevented in HICs, such as those in Western Europe, are by no means negligible, it is also impossible to miss stark differences an effective vaccine would make in LICs.

The future distribution of COVID-19 vaccines will also depend on the will of other nations to aid those in need. Organizations such as COVAX are not able to force countries with extra vaccines to donate those surpluses to their cause. Additionally, storage issues of the vaccine will come into play when surpluses have to be distributed. This might influence those with excess supplies to give extra doses to surrounding countries as it is more feasible for distribution purposes. One concern addressed by Dr. Taison Bell, the Director of the medical intensive care unit and assistant professor in medicine at the University of Virginia, is the idea that LIC or developing countries would have difficulties in distributing vaccines internally. Dr. Bell referenced Alaska as an example stating that they use “dog sleds every year when they vaccinate people and now I think they’re one of the top states when it comes to a (COVID-19 vaccine) distribution.” LICs and developing countries have been vaccinating their populations for years, so they know the systems that work for them in terms of distribution; the problem is they need access to the vaccine in order to start this distribution.

The global distribution of vaccines thus far has been accomplished through bidding wars rather than on an equitable basis. As math models have shown, this has caused greater amounts of worldwide deaths compared to what otherwise could have been prevented. However, when it comes to saving lives, it is arguable that HICs had no choice other than to try to purchase enough vaccines to vaccinate all of their citizens. International organizations, such as COVAX, are working to vaccinate the populations of LICs and developing countries to prevent as many future deaths as possible. Furthermore, the COVID-19 pandemic has placed strains on the medical supply chain as it is trying to produce an exponential surplus of vaccines compared to that of a normal year, causing additional roadblocks in vaccine distribution. The COVID-19 virus will continue to challenge countries across the globe, but as more vaccines are produced and distributed, more deaths will be prevented, the only question is whose lives are going to be saved.

Edited by Blair Hoeting