Coronavirus – Part 5 (March 2021)

Dr John Ling has been an authoritative writer and speaker on all matters relating to bioethics for many years and it also a member of Affinity’s Social Issues Team. His personal blog is regularly updated and is well worth a read. He has been following the pandemic very closely and writing informative and wise comment as things develop. This is his latest contribution:

People often say, ‘Avoid this or that like the plague.’
Yet when the plague arrives, millions of people do very little to avoid it.

The first lockdown anniversary

It was last year, on Monday 23 March 2020, that Boris Johnson ordered people to ‘Stay at home, protect the NHS and save lives.’  One year later, on Tuesday 23 March 2021, was regarded by many as a day of reflection, to remember especially the126,172 people, who had died in the UK with Covid-19, as well as the ‘grief and loss felt by so many’, as acknowledged by the Queen.

Then Boris Johnson went and spoiled it.  At a Zoom meeting of the 1922 Committee of MPs later that evening, he explained why the UK’s speedy vaccine roll-out had beaten Europe’s.  He said, ‘The reason we have the vaccine success is because of capitalism, because of greed, my friends.’  OK, he immediately tried to retract his comments, but once out ….  ‘Greed’ and ‘capitalism’ – not seemly topics for a day of reflection.  That PM and his loose tongue!

The Covid-19 numbers

The good news for the UK continues, sort of.  During most of March, Covid-19 cases, hospital admissions and deaths continued to fall and vaccinations continued to rise.  But at the end of March, new case numbers started to plateau, or even rise in some places.  Why?  Certainly there were increasing cases among the 5 to 15 year olds as they returned to school.  And their under 50-year-old parents were still vulnerable because they have not been vaccinated yet.  Could these latest trends of levelling data be the harbingers of a third wave?

Yet overall, March has been a time of remarkable advance.  A month ago, at the end of February, 15,000 UK people were hospitalised and 2,000 were on ventilators.  Now, at the end of March, those figures have plummeted to approximately 4,000 and 600, respectively.

However, there are two stubborn statistics.  First, the number of new cases now remains seemingly stuck at around 4,000 per day.  Second, the UK’s current death rate from Covid-19 is still about 1,800 deaths per million population, still the worst in the world.  This pandemic is far from over.

News on the vaccination roll-out is good, or even better.  By the end of March, 31 million UK residents had received one dose – that is equivalent to 45% of the population, and is the second highest in the world, behind Israel’s 60%.  And another 4 million in the UK had had their second dose.  These figures are in contrast to the roll-out shambles in the EU, where most countries are yet to achieve vaccination rates of 10% or even the 25% of the USA.

Another welcome datum came on 23 March from the Office for National Statistics (ONS).  Deaths in the UK have fallen below the five-year average for the first time since the summer.  In the week up to 12 March, 14% of all deaths involved Covid-19, compared with 44% at the 22 January peak.  Lockdowns and vaccine roll-outs are indisputably saving lives.

The Coronavirus Act 2020

The Coronavirus Bill was presented to Parliament on 19 March 2020 and on 25 March 2020 it received royal assent.  Government ministers promised to use the emergency measures of this Coronavirus Act 2020 only ‘when strictly necessary’.  This legislation is time-limited for 2 years with renewal required every six months.  In its efforts to contain the spread of the virus, the new law gave the government wide-ranging powers, from shutting down pubs, to detaining ‘at risk’ individuals, to introducing furlough and statutory sick pay measures for those self-isolating.

One year later, on 25 March 2021, MPs voted by 484 to 76 to extend these emergency powers for another six months, or ‘only as long as necessary’.  The next scheduled renewal date is in late September 2021.

Covid-19 vaccine shortages

Vaccination programmes need two things – willing arms and loaded syringes.  Supplies of vaccines are essential but they are very susceptible to logistical failures.  And so it was, on 17 March 2021, that NHS England announced that weekly vaccine supplies in the UK would be ‘significantly constrained’ from 29 March for four weeks, ‘as a result of reductions in national inbound vaccines supply.’

This is a bump in the roll-out road.  What, why and how?  Who can tell?  The saga is confused and confusing.  First, it was blamed on the EU’s threatened ban of exports of the Pfizer-BioNTech vaccine to the UK.  Second, it was attributed to Oxford-AstraZeneca having production issues both in the UK and across Europe.  Third, the problem was said to be with the Serum Institute based in Pune, India.

The political squabbles with the EU rolled on.  For example, on 24 March, the European Commission announced proposals to toughen controls on Covid-19 vaccine exports.  These would stop short of an export ban, but instead measure each shipment on the recipient country’s vaccine rate and exports.  The controls will assess ‘reciprocity’ and ‘proportionality’.  It was befuddling stuff and the EU-UK bickering continues.

But on 18 March, Boris Johnson stated that the supply problems were caused by a delayed shipment from the Serum Institute and because a batch currently in the UK needed to be retested.  Apparently, 10 million doses of the Oxford-AstraZeneca vaccine had been ordered from the Serum Institute.  Of these, 5 million had already been delivered, but the additional 5 million had been delayed.

Adar Poonawalla, chief executive of the Serum Institute of India, said that the delay, ‘… is solely dependent on India, and it has nothing to do with the Serum Institute of India.  It is to do with the Indian government allowing more doses to the UK.’  The Indian government is thought to be considering whether it needs to stockpile more vaccines to expand its vaccination programme to its own 1.4 billion population.  However, Boris Johnson denied that the Indian government was responsible.  He told journalists that, ‘The Indian government hasn’t stopped any export’ and blamed the delay on ‘various technical reasons’.  Neither the Serum Institute nor the Indian government would comment further.

Also on 18 March, Matt Hancock, the health secretary, told MPs in the House of Commons that 1.7 million doses already in the UK were being retested to check their stability.  And a spokesperson for AstraZeneca confirmed, ‘Our UK domestic supply chain is not experiencing any disruption, and there is no impact on our delivery schedule.’

And the upshot?  The delayed 5 million doses would have enabled vaccination of people under 50 to begin by the end of March.  This will now not happen.  Instead, existing vaccines will be prioritised for the top nine priority high-risk groups and those requiring their second doses.  In addition, vaccine centres will not book any new appointments for April.  Nevertheless, the prime minister reiterated that the UK would meet its targets – offering a first dose to all over 50s and clinically vulnerable people by 15 April, and one to every adult by 31 July.  Whatever the truth behind the announced delay, the boast that every UK adult will receive their primary dose by the end of July remains central to the roll-out plan.

Two supplementary questions arise.  First, will this vaccine delay slow the easing of the lockdown?  The prime minister has said, ‘No.  There is no change to the next steps of the roadmap.’  Second, will this vaccine delay hold up second doses?  The prime minister has said, ‘No.  We will have the second doses that people need within the 12-week window, which means around 12 million people in April.’

A third wave?

While the UK has recently seen less cases, less hospitalisations and less deaths, continental Europe has had more of each.  Numbers of cases in Germany, Italy, France and Poland, for instance, have been increasing almost exponentially.  A third wave is nigh.  Will it reach the UK?  Of course, no-one knows.  However, what seems more certain is that we will experience some imminent increase in cases for at least two reasons.

First, as the UK lockdown measures are relaxed, more people will mix and therefore more cases will occur with consequent rises in hospital admissions and deaths.  It is a tough price to pay for extra freedoms.  Second, there is the additional negative factor of border control, regulating incoming visitors.  OK, we know about border tests, passenger locator forms, tests on days 2 and 8, hotel isolation for 10 days and red list countries, but these measures are neither foolproof nor virus-proof.  Just a few Covid-19 visitors, asymptomatic or otherwise, slipping through the net, accidentally or intentionally, could cause Covid-19 havoc across the UK again.

What else lies ahead?

On 23 March, the Royal Academy marked the anniversary of the first lockdown by publishing its 172-page report entitled, The COVID Decade: understanding the long-term societal impacts of COVID-19.  It was commissioned by the Government Office for Science.

The review makes for grim reading.  It concludes that major long-term changes will be needed to reverse the profound social, educational and economic damage caused by Covid-19.  And it predicts that the pandemic will cause a decade-long shadow with declining public trust in government, worsening mental health and widening social inequalities.  For example, it expects young people to suffer disproportionately in terms of their mental well-being and their educational losses caused by school closures.  The take-home message?  We need to think way beyond 2021.

Oxford-AstraZeneca troubles

It is said that troubles often come in threes.  First, several European countries, such as Germany and France, banned the use of the Oxford-AstraZeneca vaccine for the over-65s ostensibly because of limited data.  That precautionary stance has now been lifted.  Second, there was – and still is – a hoo-hah concerning supply, and threats of embargoes, of the vaccine from EU countries to the UK.  Third, there was concern that the Oxford-AstraZeneca vaccine was causing blood clots – at least 15 countries, including, France, Iceland, Germany, Spain, Latvia and Italy, halted its use as a precautionary measure.  Has the EU been playing politics?  Certainly, president Macron of France claimed that the Oxford-AstraZeneca vaccine was ‘quasi-ineffective’ for the over-65s just hours before it was approved for all adults across the EU.  Similarly unhelpful have been those who have derogatorily nicknamed it the ‘Aldi vaccine’ as some sort of budget option.

Consequently, EU and UK regulators dug deep into the available clinical data.  On 18 March, both the European Medicines Agency (EMA) and the UK’s MHRA (Medicines and Healthcare products Regulatory Agency) confirmed, after a ‘thorough and careful review’, that there is no evidence the Oxford-AstraZeneca vaccine is unsafe and specifically that it is not linked to an increased risk of blood clots.  Most countries promptly resumed their roll-out of the jab.

The scare was based on reports that a very small number of recently vaccinated people had suffered an extremely rare form of blood clot in the brain known as, cerebral sinus vein thrombosis (CSVT).  There had been 13 cases across Europe and five cases in the UK – one of them fatal.  Five cases, in men aged between 19 and 59 years old with low blood platelet counts, among 11 million vaccinated people is considered to be extremely uncommon.  In addition, it was noted that CSVT can occur naturally and that Covid-19 infections themselves can make clots more likely.  In other words, the benefits of the vaccine, with an 80% reduction in hospitalisation and death, far outweigh any possible risks of serious side effects.  However, as a precaution, the situation will be closely monitored and after being vaccinated, anyone with unusual bruising or a persistent headache for more than four days, should seek medical advice.

Whether this information and these data reassure the EU counties and others to resume their roll-outs of the Oxford-AstraZeneca vaccine and whether their citizens will queue up to use this particular vaccine is another issue.

Oxford Astra-Zeneca trial in the USA

On 22 March, Oxford Astra-Zeneca published results from a phase 3 trial of its Covid-19 vaccine that confirmed it to be safe and effective.  The trial, conducted by scientists at Columbia University and the University of Rochester in collaboration with AstraZeneca, involved 32,449 volunteers from America, Chile and Peru, who were given two doses, four weeks apart.  The key results were that the vaccine was 79% effective at preventing symptomatic Covid-19 disease and 100% effective against severe or critical disease and hospitalisation across all ethnicities and age groups.  In addition, there were no safety issues regarding blood clots.

An extra feature of this US trial was that approximately 20% of the participants were 65 and over.  Yet the vaccine was found to provide as much protection for them as to the younger age groups, namely 80%.  This is an important finding because of those countries which initially refused to authorise the vaccine’s use in adults over 65, citing a lack of evidence.

On 25 March, Astra-Zeneca published updated results from this US trial.  The general efficacy rate of its vaccine was adjusted from 79% to 76% and from 80% to 85% for the over 65s age group.  The previous and these amended results should allow the US regulator, the FDA (the Food and Drug Administration), to approve its use in the USA within the next month or two.

Moderna is on its way

Sometime during April, Moderna, the US biotech company, expects to deliver the first batch of its vaccine to the UK.  Moderna will therefore become the third supplier to the UK, alongside Oxford-AstraZeneca and Pfizer-BioNTech – this may help alleviate future supply problems.

On 18 December 2020, the USA’s Food and Drug Administration (FDA) approved the Moderna vaccine for individuals 18 years of age and older, with each person requiring two jabs, 28 days apart.  On 8 January 2021, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) did the same.  The UK government has already ordered 17 million doses.

In a large clinical trial last year in the US, Moderna reported that its vaccine was 94.1% effective against preventing Covid-19 and it showed no signs of being less effective against the Kent variant, now the dominant Covid-19 variant in the UK.  In laboratory tests, the vaccine was less effective against the South African variant, but Moderna reported that the response was still, ‘above levels expected to be protective’ even though immunity may not last as long.

Moderna is already working on a modified version.  And it has also begun clinical trials to assess whether its vaccine is safe for children aged between six months and 11 years.  As the first western company to test a vaccine on infants, it plans to enrol 6,750 children in America and Canada for that trial.

Based in Cambridge, Massachusetts, Moderna was founded in 2010 and now employs about 1,000 staff.  Since the proven success of its vaccine the company’s market value has rocketed to $62 billion.  Its vaccine development and production has been financed by the US government, plus a $1 million donation from the singer Dolly Parton.

As an mRNA (messenger RNA) vaccine it is based on novel technology, similar to that of the Pfizer-BioNTech product.  The Moderna vaccine, like all other currently-available vaccines, comes with bioethically-questionable baggage.  During its production the HEK-293 cell line is used in laboratory quality testing of the final product, but not as a component of the vaccine.  The original HEK (Human Embryonic Kidney) cell line was obtained from an abortion performed in 1972 in the Netherlands.  For more details of bioethical concerns see Coronavirus Part 1 (October 2020).

Both Moderna and Pfizer-BioNTech have been criticised for charging, respectively, £26 and £15 per dose for the required two shots.  These are expensive compared with the Oxford-AstraZeneca vaccine, which costs about £3 per dose, and which the company has committed to selling on a not-for-profit basis during the pandemic.

Novavax and Janssen vaccines waiting in the wings

So far the UK has deployed two vaccines from Oxford-AstraZeneca and Pfizer-BioNTech, with a third, Moderna, on its way.  But there are two others, namely from Novavax and Janssen, waiting in the wings for approval by the MHRA.

The Novavax vaccine is a protein-subunit type engineered from the genetic code of the spike protein, which is inserted into an insect cell to produce the spike proteins.  These are harvested, mixed with synthetic soap-like particles plus an adjuvant to stimulate the immune response once injected.

During mid-March, the American company, Novavax, released revised data from a UK-based phase 3 trial with 15,000 participants, aged between 18 and 84, and including 27% over the age of 65.  After primary and booster doses, the vaccine was shown, to be 96.4% effective against the original, non-variant form of the coronavirus in preventing mild-to-severe Covid-19 effects.  And it was 86.3% effective against the Kent variant.  In a smaller trial, conducted in South Africa, the Novavax vaccine showed an efficacy 55.4% against that country’s variant.  Across both trials, the vaccine demonstrated 100% protection against severe disease, including hospitalisation and death.

The Novavax vaccine is stable and can be stored in a domestic refrigerator.  The UK has 60 million doses on order of this two-shot vaccine.  Its UK production began in February at a site in Billingham, Co Durham.  Authorisation by the MHRA for its use in the UK is awaited.

The other vaccine waiting in the wings is made by Janssen, which is owned by the American pharmaceutical giant, Johnson & Johnson.  Incidentally, the parent company states on its website that, ‘We are blending our heart, science and ingenuity to profoundly change the trajectory of health for humanity.’  Nice schmaltz!

Like the Oxford-AstraZeneca vaccine, the Janssen jab is based on an adenoviral vector, as opposed to the mRNA products produced by Pfizer-BioNTech and Moderna.  It also has distinct advantages – chiefly, it requires only one dose.  And it can be stored at 2 to 8⁰C in a domestic refrigerator for up to 3 months.

On 27 February 2021, the FDA issued emergency authorisation for the Janssen vaccine to be distributed in the USA for individuals 18 years of age and older.  That permission was based on results from clinical trials published by Janssen on 29 January 2021.  They involved more than 44,000 people across 10 countries with 34% of participants over the age of 60.  The vaccine proved to be safe and effective.

More specifically, 28 days after vaccination, it was 85% effective in preventing severe and critical Covid-19 that does not require hospitalisation.  Overall, it proved to be 72% effective in the US against moderate and severe Covid-19, and 66% effective when figures from all the test countries are included.  However, it was less effective at 57% in South Africa where that variant is widespread.  Even so, the vaccine was 100% effective in preventing hospitalisation and death.

Trials are currently being conducted by Janssen to test the efficacy of a two-dose regimen.  The UK government has already ordered 30 million doses even though it has yet to be approved by the MHRA.

Variants and vaccines now and later

Kent, South African and Brazilian, or B.1.1.7, B.1.351 and P.1 are now old news.  News of new variants has seemingly, though undoubtedly not for too long, gone off the boil – thankfully.  Nevertheless, UK health authorities are currently reported to be tracking at least four Covid-19 ‘variants of concern’.  In addition, widespread genomic sequencing is continuing to hunt down other possible variants.

Moreover, aware of the looming threats created by new and old variants, biotech companies are busy modifying their current vaccines.  For example, this month Moderna initiated a clinical trial of updated versions of its vaccine, specifically developed to combat the vaccine-resistant South African variant.

And the quest is now on for so-called ‘universal vaccines’ or ‘broad-spectrum vaccines’ that would protect against all or most variants of a particular virus.  The existing Covid-19 vaccines work by targeting the specific spike protein on the surface of the virus.  Though this strategy is currently successful, the spike protein is prone to mutate creating new variants which may render present-day vaccines less effective.  A ‘universal vaccine’ requires a different approach.  For example, ConserV Bioscience is a European biotech company targeting the non-mutating parts of the virus, known as conserved regions, usually found in internal or structural proteins.  The company has identified several conserved regions that can stimulate the immune system.  Further, it has produced a cocktail of these antigens and formulated them in mRNA.  And furthermore, it has started preclinical studies in animals.  Phase 1 human trials are expected to start in early 2022.

Even though unprecedented financial and novel regulatory hurdles remain, these examples of innovative science are exciting.  Could the next-generation of vaccines be variant-proof, universal vaccines?  And could these pioneer the next leap forward in fighting Covid-19?

Vaccine hesitancy

The needle on the ‘jab-o-meter’ now appears to be swinging in favour of taking the needle.  For example, researchers at University College London tracked the responses of 14,713 adults in England and Wales over a recent two-month period.  Last December, they identified a cohort of 1,432 from among all the respondents who were vaccine hesitant – uncertain about or intending to refuse a Covid-19 vaccination.  But two months later, by February, 86% of this cohort, had changed their minds and had either had a jab or were planning to.  This shift from hesitancy was consistent across all levels of social deprivation and across all ethnic groups.  These results are encouraging because deprived and BAME communities have been the most vaccine hesitant and also the hardest hit by the Covid-19 pandemic.

Results from global surveys show similar trends.  A study of 13,500 people across 14 countries by Imperial College London’s Institute of Global Health Innovation (IGHI), conducted between November 2020 and February 2021, found that 58% of respondents would take a vaccine if offered.  People in the UK were the most willing at 77% in February, up from 55% last November.  Whereas France, Singapore and Japan are among the least willing at 40%, 48% and 48%, respectively.  However, even these countries have all become less hesitant since November when only 25%, 36% and 39% of individuals were willing, respectively.

Additional results from the USA demonstrate a widely hesitant population with fluctuating responses.  According to the latest figures released by the Pew Research Center, 69% of US adults said in mid-February 2021 that they would definitely or probably take a coronavirus vaccine.  In May 2020, that figure was 72%, though this plummeted in September 2020 to 51% before rising in November 2020 to 60%.  Of course, the converse is that 30% of Americans in February 2021 said they would definitely or probably not get a jab.  The main groupings among these decliners were the young, the poor, black citizens and white evangelicals.

Vaccine passports

Here is another controversial proposal – so-called vaccine passports.  After a moment’s thought, up pop at least four complex legal, ethical and logistical questions.  For instance, would they be compulsory for some, or for all?  What form would they take, paper or phone app?  Would they be needed for all/some employment and/or to attend say, a football match, or even a church?  How and when would they be updated?  See what I mean?

Past governments have shilly-shallied about the need for identification cards, now the current government has bitten the bullet and launched a two-week consultation on the issue on what it calls ‘COVID-status certification’.  It closed on Monday 29 March.  In the near future, Michael Gove, the prime minister’s appointee to lead a review into the need and style of such documentation, will no doubt reveal more.  The consultation contained just three questions, the issue raises many more.

The NHS Test and Trace service in England

On 28 May 2020, Boris Johnson announced the launch of the NHS Test and Trace (NHST&T) service for England – ‘a world-beating contact tracing programme.’  Its aim was to enable mass testing for Covid-19 in England with the capability to trace the contacts of those testing positive, to isolate them, to thereby break the chains of transmission and to enable people to return to a normal way of life.  The service, headed by Baroness Dido Harding, had an initial a budget of £22 billion plus an extra allocation of £15 billion – a total of £37 billion over two years.

From the start it was a scheme riddled with doubt and controversy.  For instance, the means of mass testing were contested.  Depending on the make and brand used, the lateral flow test (LFT) can be cheap – less than £10 per kit.  It can be fast – between 15 and 30 minutes.  But it can be flawed – in some reported instances giving up to 50% false negative results.  The more reliable PCR (polymerase chain reaction) test can be expensive – up to about £100 per test.  But it can be slow – about 48 hours.  Then there were grumbles about the 2,500 overpaid and underworked ‘consultants’ on an average daily rate of £1,000 with some being paid £6,624 a day.  And with its huge ambitions to test between two and four million people each day and to track their contacts, and its eye-watering costs, the service was always going to be open to harsh criticisms.

Moreover, NHST&T seemed to be beholden to no-one.  Except that on 10 March 2021, the service was the subject of a report by the House of Commons Public Accounts Committee.  It was damning.  Nevertheless, the Committee did recognise that the service was ‘… set up and staffed at incredible speed’.  And it praised some of NHST&T’s achievements, such as contacting over 2.5 million people testing positive for COVID-19 in England and advising more than 4.5 million of their associated contacts to self-isolate, in the 10 months since its inception.

However, the Committee stated that NHST&T, ‘… now needs to wean itself off its persistent reliance on consultants and temporary staff.’  And, ‘There is still no clear evidence to judge NHST&T’s overall effectiveness.  It is unclear whether its specific contribution to reducing infection levels, as opposed to the other measures introduced to tackle the pandemic has justified its costs.’

Or as Meg Hillier, the Committee’s chairwoman, put it, ‘Despite the unimaginable resources thrown at this project, NHS Test and Trace cannot point to a measurable difference to the progress of the pandemic, and the promise on which this huge expense was justified – avoiding another lockdown – has been broken, twice.’

The Committee’s report also detailed a number of other serious failings, such as a lack of clear planning and poor control of costs.  Nevertheless, the Committee welcomed NHST&T’s increasing collaboration with local authorities and it encouraged partnerships with the wider public health establishment and other sectors including local government, schools, and the hospitality industry.  In addition, the Committee called for better data handling and publication of results so that people can assess NHST&T’s effectiveness in, for example, the time taken to trace the contacts of an infected person – the so-called ‘cough to contact’ period – and the degree of compliance with self-isolation.

Among the Committee’s other recommendations was a call for the government to plan for the integration of the NHST&T service into the newly-formed National Institute for Health Protection.  And finally, the Committee said it intends to follow the progress and performance of NHST&T later in the year with a second report.

COVAX and the world

Here is a fact – the UK has a population of less than 70 million, consisting of about 50 million adults over the age of 18.  Here is a question – so why have we ordered at least 400 million doses of Covid-19 vaccines?  If every adult were to have the recommended two jabs, we would still need only 100 million doses.  If an extra autumn booster vaccination is required, which seems more likely as the weeks go by, that still amounts to only about 150 million doses.  OK, so ‘vaccines ordered’ are not necessarily the same as ‘vaccines produced’ and in storage, ready for use right now, but why are we preparing to future stockpile millions of doses?

But here are questions underlying the real issue.  If we in the UK have so far managed to vaccinate those at greatest risk, our elderly, vulnerable and healthcare workers plus our top 9 priority groups, what about those same cohorts in other, particularly poorer, countries?  Until there is a more global dimension to vaccination, the wretched Covid-19 virus will remain a threat.  Should we not make some of our stockpile available to others worldwide?  Are we guilty of a rather ugly case of self-interest and smug satisfaction and vaccine nationalism?

Even when the entire UK adult population is vaccinated, the virus will not disappear – it will be circulating somewhere and it will return to infect us sometime, perhaps repeatedly, for many years to come.  And the longer it is allowed to spread, the greater the probability that dangerous variants will emerge.  And until we are all safe, none of us is safe.  What we need is an altruistic sense of ‘enlightened self-interest’ and that is best served by vaccinating the rest of the world.

Enter Covid-19 Vaccines Global Access, known as COVAX.  It was launched on 4 June 2020 and is co-led by Gavi, aka the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations and the World Health Organization. This international partnership of over 190 countries aims to distribute vaccines more equitably.  It has an uphill task.  By mid-March, of all the global 191 million shots so far jabbed about 75% were deployed in just 10 countries, while about 60% or 130 of all the countries of the world, accounting for 2.5 billion people, had so far received no Covid-19 vaccines.  High-income countries, like the UK, represent only 16% of the world’s population, but they have already purchased more than half of all global Covid-19 vaccine doses.

The COVAX primary strategy is to create a ‘buyers’ pool’ of richer nations that can fund collective purchases of vaccines, fund vaccine development and vaccine manufacturing and ensure that vaccine supplies go to poorer countries.  It is a worthy plan, but COVAX is continually getting pushed to the back of the queue.  Rich nations are buying vaccines by direct deals with manufacturers rather than through the COVAX pool.  Nevertheless, COVAX expects to secure some 2 billion doses by the end of 2021.  Another possible COVAX strategy is ‘vaccine tithing’.  For every nine doses administered by rich countries, one dose could be donated to COVAX – a 10% tithe scheme.  Though this would still be far from ‘equitable’, it is perhaps possible.

True, the UK has already promised, though without specific details, to share some of its vaccine surplus with less-developed countries.  Dominic Raab, the Foreign Secretary stated in January 2021 that, ‘As one of the biggest donors to COVAX, the UK is ensuring that more than one billion vaccine doses will be sent to 92 countries so that no one is left behind in this global fight.’  And the UK has already pledged £548 million to COVAX.  But promises, warm words and cash alone will not help poor countries if the rich ones continue to hoard vaccines.  Nevertheless, by late March, COVAX had managed to ship 32 million vaccine doses to 60 countries.  Is it time we moved towards sharing vaccines more equitably around the world?  Until we do, we are prolonging the pandemic.  And another question – just who is ‘my brother and sister and mother’? (Matthew 12:50).

John Ling