That is the phrase that Dag-Inge Ulstein, Norway’s minister of international development, said he has been using these days to describe the move by fellow high-income countries to reserve millions of COVID-19 vaccine doses that they may never use.
It’s creating a “vaccine apartheid with very dramatic consequences,” Ulstein recently told The World.
“It is the best recipe for prolonging the pandemic, and secondly, it threatens our own populations through new mutations, and it will continue to do great damage to our own economies and jobs,” he said. “And, of course, it is extremely selfish.”
Ulstein, a leader in COVAX, the main international initiative to equitably distribute vaccines globally — especially to those most at risk in middle- and low-income countries — has watched as vaccine inequities grow wider. Just a handful of countries are gobbling up most of the world’s vaccine supply.
Just a few months into its rollout, COVAX is now short tens of millions of doses. It has shipped some 50 million vaccines to low- and middle-income countries. It’s a fraction of what it had hoped to get out by now, and an even tinier fraction of what’s actually needed. On top of that, it’s a minuscule sliver of the more than 1 billion vaccine doses that have been given globally.
Ulstein has a simple request: that countries begin to share. As in, donate some of their vaccines. In fact, by following Norway’s lead.
Early on, Norway decided to forgo buying doses that it would be eligible to get through COVAX — about 700,000 — and instead donated those funds and vaccine shares to lower-income countries. Norway has also led efforts to set up a logistical mechanism that would make it easier for European countries to donate vaccines to COVAX.
Donations have not been a popular approach to addressing access challenges during the pandemic, but attitudes have shifted in recent weeks amid shortages, according to Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies (CSIS) in Washington, DC.
"Finding the doses and getting them quickly and rapidly is imperative."
“In the early phase of setting up the COVAX facility, there was a kind of attitude that [the] sharing of surpluses was neocolonial or, you know, an afterthought of the wealthiest countries that were engaging in very nationalistic behavior. And [that] it's far better to provide cash,” Morrison said. “Well, now it's becoming apparent that doses are the problem, not cash. And so, finding the doses and getting them quickly and rapidly is imperative.”
At the G-7 meeting in February, leaders of the United Kingdom and Germany made a big deal of the need to donate vaccines. French President Emmanuel Macron said countries like his should share up to 5% of their doses. He told African leaders that same week, it was in everyone’s interest to help.
New Zealand recently said it would donate back the vaccines it had originally reserved through COVAX. On Monday, the White House told The Associated Press that the US would begin sharing some of its Oxford-AstraZeneca vaccine stock, which has yet to be approved domestically, and that as many as 60 million doses could be available in the coming months for export.
Despite current and future commitments, donations haven’t made much of a dent yet.
“Compared to the global supply of vaccines and the pre-purchase arrangements, [the donations are] miniscule.”
“Compared to the global supply of vaccines and the prepurchase arrangements, it’s minuscule,” said Anna Bezruki, a researcher of vaccine agreements and donations at the Graduate Institute in Geneva.
Based on her count as of mid-April, countries had donated a total of about 40 million doses.
China and India were the largest donors. Bezruki added that Russian donations are harder to track and may not be reflected in her tally.
What determines which places receive these donations doesn’t really come down to who needs them most.
“Instead, they can be grouped on more of these diplomatic or geopolitical considerations, neighbors, friends, allies, hoped allies,” Bezruki said. “It’s much easier to sort them by those categories than by anything related to the pandemic.”
Vaccine donations have been slow for other big reasons: Pharmaceutical companies and manufacturers are struggling to ramp up supply and fulfill contracts. These contracts are generally private and contain clauses that can make donations tricky.
This has also prompted a global movement and debate as to how to expand the global manufacturing infrastructure, and to lessen dependency on any one country or company for vaccines.
But when it comes to donations, there’s the added headache of working out the technical issues for making any kind of transfer, according to Gian Gandhi, COVAX’s coordinator for vaccines through UNICEF.
Vaccines have to meet safety and regulatory standards. It has to be clear who is liable if there’s any kind of problem with the vaccine.
“There are mundane and kind of operational, legal and logistical challenges for sharing now,” Gandhi said.
“It’s an exciting test case,” Gandhi said. “Of course, it’s one donor country, one manufacturer, one recipient country, but the test case demonstrates that it’s feasible for each of those parties, which suggests that it should be feasible to do for a larger scale.”
Still, whether this actually happens in a larger way is a matter of political will, according to Morrison with CSIS. The United States has an outsized role to play. His group estimates that by the summer, the US will have a surplus of hundreds of millions of vaccines.
“We need a diversified strategy for sharing.”
“We need a diversified strategy for sharing,” Morrison said, referring to a key recommendation proposed by his bipartisan group of US stakeholders.
A spokesperson from the US State Department told The World by email last week that, given the unpredictability of this virus, “the country must be prepared for a variety of scenarios.”
As confidence increases in the supply, the government will look at options for sharing doses globally.
In Norway, vaccine donations have been controversial, too. The public only recently learned that leaders there had declined vaccine options through COVAX, and instead opted to join the European Union’s arrangement to purchase doses directly, according to Katerini Storeng, a professor at the University of Oslo researching the politics of global health.
It prompted a showdown with political leaders and Ulstein himself on national television.
“Opposition from our center party and our progressive-right party argued that the government had basically neglected its duty to the people and should have bought these [COVAX] doses for our own population,” Storeng said.
Surveys have found the Norwegian public generally backs the country’s approach, but the vaccine issue has become more sensitive in an election year.
And so, even in countries with a strong tradition of global solidarity, the pandemic is putting everyone to the test.
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