As Countries Worldwide Face Shortages – Appeal for Equitable COVID-19 Vaccine Access on World Health Day
Azerbaijan’s President Ilham Aliyev

Some of the world’s smallest countries joined the World Health Organization (WHO) to appeal for equitable access to COVID-19 vaccines on the eve of World Health Day – as the pipeline of global vaccine supplies to low- and middle-income countries risk drying up for the coming few months. 

Barbados Prime Minister Mia Amor Mottley told the WHO press briefing on Tuesday that her country was simply too small to negotiate with large pharmaceutical companies, while Namibian President Hage Geingob said that his country had only received small donations of vaccines from China and Russia.

“The bald reality is that our market size is simply too small to command the attention of global pharmaceutical companies, or indeed other suppliers of goods,” said Mottley, who added that her country had received its first delivery of COVAX vaccines just today – but only enough to cover 3% of its population.

“We’ve not had access, even when we are prepared to pay,” said Mottley, who also expressed concern for the health of Tom Rowley, Prime Minister of Trinidad and Tobago who had been diagnosed with COVID-19 earlier in the day, a mere hours before he had been due to be vaccinated.

WHO Director-General Dr Tedros Adhanom Ghebreyesus made a five-point global call to action ahead of World Health Day on Wednesday, calling for:

  • Accelerated equitable access to COVID-19 technologies between and within countries;
  • Investment in primary health care;
  • Prioritizing health and social protection;
  • Building safe, healthy and inclusive neighbourhoods;
  • Strengthening data and health information systems.

“At the start of the year, I made a call for every country to start vaccinating health workers and older people in the first 100 days of 2021. This week [10 April] will mark the 100th day, and 190 countries and economies have now started vaccinations.”

Even so, he added that although COVAX has delivered 36 million vaccine doses to 286 countries and economies, “equitable distribution remains the major barrier to ending the acute stage of this pandemic” – with supplies running dry after initial deliveries are completed.

“It is a travesty that health workers and most at-risk groups remain completely unvaccinated” in some countries, the WHO DG said. “We need to invest in equitable production and access to COVID-19 rapid tests, oxygen treatments and vaccines, between and within countries.”  

Azerbaijan’s President Ilham Aliyev, speaking via a recorded video, said that his country had co-sponsored the resolution adopted in the March session of the UN Human Rights Council calling for “equitable, affordable, timely, and universal access for all countries” to COVID-19 vaccines. 

Access to ‘Concessionary Capital’ to Address Pandemic Impact

Appealing for more investment in primary healthcare, Tedros said that the pandemic has “exposed the fragility of our health systems”.

“At least half of the world’s population still lacks access to essential services, and out-of-pocket expenses on health drive almost 100 million people into poverty each year,” he said.

In the past year, the pandemic is estimated to have driven between 119 and 124 million more people into extreme poverty, according to the WHO.

Mottley, who chairs the development committee of the World Bank and the International Monetary Fund, said she would propose to the committee at its meeting this week that it needed to use “different criteria” to determine how countries get access to “serious concessional capital” to stave off the pandemic and its long-lasting consequences.

President Carlos Andrés Alvarado Quesada of Costa Rica also appealed for “multilateral organisations” to provide financing for poorer countries to address the medium and long-term effects of the pandemic. 

“Today, developed economies have managed to achieve special packages to help their countries to overcome the effects of COVID-19 but that’s not something that poorer countries can do,” said Quesada, appealing for “debt forgiveness” and long-term financing at zero or low rates.

“There is no magic bullet. and there is no magic recipe,” concluded Mottley. “The answer is simply for us to work together to get that fairer world and for there to be a level of global moral leadership, recognising that the singular pursuit of individual countries will not rid the world of the major problems because human beings cannot be contained behind boundaries easily in this globally interdependent world.”

Risk-benefit for AstraZeneca Still ‘Positive’ But More Data Expected in Next Day

Rogerio Pinto de Sa Gaspar, the WHO’s Director of Regulation and Prequalification

On a related matter, WHO’s Director of medicines Regulation and Prequalification, told the media briefing that it expected to have more data about possible linkages between the AstraZeneca vaccine and rare “thrombolytic events” in the next few days.

However, Rogerio Pinto de Sa Gaspar, stressed that “at the present moment, and under the assessment that we have from the data submitted up to yesterday, we are confident that the benefit-risk assessment for the vaccine is largely still positive.”

The European Medicines Agency (EMA) was meeting again Tuesday and Wednesday over  the issue, as was the United Kingdom’s Health Products Regulatory Authority following a decision by Germany last week to suspend the vaccine’s use among people under the age of 60 – after further rare blood clot events occurred.

 WHO’s own Global Advisory Committee on vaccine safety was due to meet on Wednesday, said De Sa Gaspar amind the ongoing controversy about the vaccine.

European Medicines Agency Meeting is Viewing All Data

The WHO also has observers at the EMA meeting, which is assessing “the core clinical data that was submitted by AstraZeneca”.

Describing the events as “rare”, De Sa Gaspar said there was “no evidence that the benefit-risk assessment for the vaccine needs to be changed, and we know from the data coming from countries like the UK and others, that the benefits are really important in terms of reduction of the mortality of populations that are being vaccinated”. 

He added that the WHO expected to have “a fresh conclusive assessment from our experts” by Wednesday or Thursday.

 “There’s no link for the moment between the vaccine and thrombolytic events with thrombocytopenia, but of course it’s under evaluation, and we wait for some feedback from those communities in the coming days and coming hours just to give a full assessment,”  asserted De Sa Gaspar.

“WHO is relying heavily on the national pharmacovigilance systems, but also on the assessment committees from national regulatory authorities, and also from regional regulatory authorities like the EMA,” he said.

Mariangela Simão, WHO’s Assistant Director-General, added that data was being assessed from all regions of the world: “Millions and millions of AstraZeneca doses have been distributed and used in Latin America, Africa, India and other countries in Asia so we are very actively proactively collecting data from different national regulatory authorities,” said Simão. “We are also in touch with AstraZeneca, as AstraZeneca has an obligation to monitor the safety data and report to the WHO.”

‘Let’s Not Speculate’ About Serum Institute of India Vaccine Supplies to COVAX 

Dr Bruce Aylward

Related to the vaccine shortage issue, Bruce Aylward, Tedros’ special advisor and the WHO’s lead on COVAX, dismissed a reporter’s question about the possibility that the Serum Institute of India (SII) might delay vaccine deliveries to COVAX until as late as June – well beyond the April suspension date announced by Gavi, The Vaccine Alliance late last month.  SII suspended its exports abroad after being asked by the Indian government to redirect its production to the domestic Indian market – which is seeing a surge in coronavirus cases. 

“Let’s not speculate on what’s going to happen in terms of future deliveries from any of the companies that we’re working with,” said Aylward.

“Right now, every country we talk to, every company, is trying to make sure that they prioritise COVAX and that we get the vaccines that we need. Obviously, if we have an interruption with any one of our suppliers for a short time, a month or so, we can find ways to manage as best we can, but if it prolongs for longer, that would be a challenge.”

Aylward added that some additional supplies from SII had come through in the past few days to enable “which are important to all countries being able to start vaccination by the end of the 100-day period”.

Aylward also stressed that the vaccine supply situation was “fluid” and COVAX also had deals with other pharma manufacturers, most notably Johnson and Johnson and Novavax, which are due to come online in the coming weeks and months.


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