Bank holiday bee: Vaccine nonsense

My regular release of bees from my bonnet

For those new to these emails, a brief explanation. I have taken to using this Substack newsletter service for three purposes: as a way to put down my thoughts roughly every Monday on a topic in the news that is bothering me, generally in global affairs broadly defined; to share the English originals of my articles published in translation in Japan (chiefly Mainichi Shimbun and Nikkei Business) and Italy (chiefly La Stampa and Avanti!); and sometimes to distribute the blog I write as chair of the Japan Society of the UK, if it looks to be of wider interest. Comments and criticisms would be more than welcome, whether publicly or privately, since for every topic I write about there will be many people on this mailing list far more expert on it than I am. I will probably have added you to the mailing list for exactly that reason, when writing about something I know you specialise on. From now on I plan to devote this Monday “bees in my bonnet”email to just one topic at a time, given how full all our inboxes are. But if anyone decides their inbox is just too full, do please feel free to unsubscribe.

Handwringing about vaccine inequality

One trope in media and other public commentary about Covid-19 in recent months that has particularly annoyed me is the notion that some sort of moral offence is being perpetrated by the fact that European and North American countries have had a “disproportionate” or “unequal” share of vaccines so far this year. Even the Director-General of the World Health Organisation, Tedros Abranon Ghebreyesus, who ought to know better, has weighed in on the issue, saying “There remains a shocking imbalance in the global distribution of vaccines.” He had earlier claimed the world was facing a “catastrophic moral failure” over vaccine inequality.

Well, perhaps he is just applying a bit of political pressure, which I suppose is his job. There is certainly a huge disparity, even an imbalance. But the question is, is it shocking? Is it (yet) a sign of moral failure? And how does it actually look from a scientific or public health point of view, which surely ought to be the viewpoint adopted by the WHO? Self-evidently there certainly is a severe shortage of covid-19 vaccines, for those vaccines were developed and tested at an unprecedented speed during 2020 and manufacturing capacity has not yet expanded rapidly enough to satisfy the demand and needs for the vaccines, worldwide.

Here are the figures on vaccine production and hence supply, on the basis of which any judgement about disparities and distribution needs to be made. They come from the Global Commission for Post-Pandemic Policy, of which I am co-director, and from our first collaboration with Airfinity, a life sciences data and analysis start-up. Below is a screenshot, but the snazzy interactive charts of where vaccines are being made, how many each vaccine firm is having made, and firms’ output targets for 2021 can be found here.

What this tells us, beyond the interesting fact that China has produced the largest volume of vaccine doses so far, is that up until April 26th total production of vaccines approved for use in at least one major country is almost 1.2 billion doses, of which 734m are the four approved western vaccines, almost 433m are of the two Chinese vaccines (AstraZeneca has just started having a few of its doses made in China) and 32m are of the Russian Sputnik V vaccine. How should they be distributed? Would it be best if they were shared equally and so thinly among the world’s 7.7 billion population (or roughly 5.8 billion adults)?

The basic accusation of immorality is naturally made against the western vaccine makers, Pfizer/BioNTech, Moderna, AstraZeneca and Johnson & Johnson. So it may be best to focus the arithmetic on their 734m doses which, since J&J has only just begun production, are mainly two-dose jabs and so are enough to vaccinate about 367m people. Would the “moral” approach really be to share those out equally, so that a small percentage of people in every country have been vaccinated, or might it be just as sensible to work in clusters, getting more than 40% of people in a few lucky countries — Israel, the UK, the United States, Chile, Hungary, Bahrain, according to Our World In Data — protected with at least one dose and moving swiftly towards herd immunity in those and other lucky countries over the next few months? Scientifically, I would have thought that blocking off clusters of population in this way makes sense. In fact, it is surely what you would you do inside a single country if a deadly infectious disease were to break out, both through quarantine and isolation, and vaccination.

Clearly, the priority, for everyone, must be to get vaccine output rising sharply enough to spread that good luck as widely as possible as quickly as possible. The reason why it is annoying to hear and read this trope about vaccine inequality so often is that it risks distracting public attention and policy from that vital task. When France announces it plans to “share” with other countries about 5% of doses it has ordered this is mere virtue-signalling, since handing out 5% of doses is going to make hardly any difference to anyone. Far better to use public money, generously and rapidly, to support the development of vaccine manufacturing by pharmaceutical firms in France. Currently, none of the approved vaccines is being made by factories in France.

The tragedy that is unfolding in India underlines this point. There has been idle talk of sending “surplus” vaccine doses to India. Yet India is already one of the world’s largest producers of covid vaccines (200m doses have been produced so far in India, 190m of which are AstraZeneca’s jab and 10m of Bharat Biotech’s Covaxin). Some shortages of raw materials, blocked by the US’s Defence Production Act, have slowed the growth in Indian output but fortunately now the Biden administration has seen sense and removed that blockage. Nevertheless, India’s domestic vaccine rollout could have been a lot further advanced than it is, had its government treated it as a priority. What India urgently does need is oxygen and the drugs to treat and mitigate Covid. The real vaccine issue India’s crisis is causing is a slowdown in its shipments to other poor countries through the COVAX global initiative, for which it was supposed to be making two-thirds of planned supply in the first half of 2021. Again, the urgent need is to build up other production.

Later in the year, vaccine inequality will become a real issue if rich countries stockpile doses even after they have protected their populations. But for now, those of us lucky enough to live in a rich country are fortunate for plenty of other reasons beyond access in the first half of this year to vaccines. We need to stop flagellating ourselves over that and put a lot more money into supporting vaccine production, both for the world and for the boosters and perhaps annual jabs we are all going to need. As we said at the Global Commission,

With 1.2 billion doses of approved vaccines produced so far, the manufacturers’ declared target for those approved vaccines of 14.6 billion by the end of the year requires 13.4 billion more doses to be produced during the next eight months, or an average of 1.675 billion doses per month. That is four times the monthly run-rate seen in April. But there are also major vaccines expecting to achieve approval in major jurisdictions in the near future, notably the American Novavax jab, which has a target of 2 billion doses by the end of the year. The latest indications are that the firm expects emergency use approval from the US Food and Drug Administration during May.

It is an uphill climb. But it can be done, by practical efforts rather than moral handwringing.