In a decisive act of global solidarity, Norway has offered almost a third of its allocation of COVAX vaccines to poorer countries, according to Dag-Inge Ulstein, Norway’s Minister of International Development.

Norway has only fully vaccinated about 5% of its population – 260,000 people – and unlike many other European countries, it has not stockpiled vaccines and is mainly depending on COVAX for vaccines.

However, it decided to allow COVAX to redistribute 700,000 out of its 1.9 million vaccine doses to lower-income countries despite domestic pressure not to, Ulstein told the Access to COVID-19 Tools (ACT) Accelerator facilitation council meeting on Tuesday.

“People are asking: ‘Why give vaccines away when we need them here?’ And this is a good question, representing an obvious dilemma. But the answer is equally simple: the virus crosses borders. This is not a local outbreak. And this combination of solidarity and self-interest gives me no choice but to stand firmly in the face of domestic criticism,” said Ulstein. 

‘Colossal Task Force’ on Vaccine Manufacturing

He also expressed Norway’s support for a “colossal task force on expanding vaccine production” co-led by the World Health Organization (WHO) and the Coalition on Epidemic Preparedness Innovation (CEPI) to “do better” and expand beyond COVAX’s initial target of vaccinating 20% of the global population by the end of the year.

Earlier, CEPI CEO Richard Hatchett had announced that his organisation was setting up a task force to address vaccine manufacturing and invited all interesting parties to join.

Highlighting global achievements, Hatchett reported that, in little over a year, “we have nine manufacturers that are scaling up rapidly across three technology platforms: inactivated vaccines. viral vector vaccines and mRNA vaccines.”

Between them, the manufacturers had administered 400 million vaccine doses – but only 30-million of these doses had gone to COVAX.

“The nine manufacturers envision manufacturing between 10 and 14 billion doses of vaccine in the coming year,” he added. “Those are very aspirational numbers, and they may be very difficult to achieve. But that is based on the capacity they already have. So I would argue that the immediate problem is supply chains: making sure that the critical inputs of material are provided.”

But Soumya Swaminathan, WHO’s Chief Scientist, said that many countries were still waiting for the first dose of vaccines to arrive “and it’s clear that there has been a mismatch between what manufacturers thought they would be able to produce and what they’ve actually been able to produce”. 

While there was an urgent need to address immediate bottlenecks, Swaminathan urged the global community to take a medium- to long-term approach to solving these problems.

“We need to think about the future and the possibility that we may need booster vaccines,” she said. “We may need vaccines regularly in order to deal with the emerging issue of the variants. We’re not sure about that as yet. But we need to prepare for repeated technologies and it is critical to increase the ability of all regions in the world to respond without being dependent on restricted global supply chains.” 

‘Global Hypocrisy’

Fifa Rahman, the NGO representative on the ACT Accelerator, said that low and middle income countries (LMICs) may only vaccinate 80% of their populations by 2024. 

However, the leaked text of a WHO draft resolution to strengthen local production of health technologies showed that some wealthy countries had deleted text that would enable technology transfer, said Rahman.

“To sit here and talk about global solidarity and then to ask for the deletion of text and important provisions that would help LMICs get access to more vaccines is hypocrisy,” said Rahman. “We thus call upon the United States, Norway, the UK and Switzerland to withdraw their objections to the text.”

Rahman also criticised an over-reliance on industry to address the pandemic. Although the pharmaceutical industry claimed that it had the capacity to produce 14 billion doses by end of 2021, “according to an Airfinity document, industry developed delivered 96% fewer doses in 2020 than it had promised”, she said.

“Why are we blindly trusting that 2021 will be any different? We can’t take industries’ claims at face value. There’s too much at stake to rely on these aspirational projections as our route out of the biggest public health crisis of our generation,” said Rahman.

Instead, she proposed a mapping exercise on manufacturing capacity and expertise available in the global south to ensure viable vaccine manufacturing for entire continents.

Prioritise the Dose-Sharing

John Nkengasong, Director of Africa’s Centers for Disease Control (CDC), made two simple pleas: for any countries with excess doses of vaccines to “release them” to countries that do not have, and to “strengthen regional capabilities to manufacture vaccines across the world as part of our collective security”. 

Wellcome Trust Director Jeremy Farrar urged the ACT Accelerator not to “pretend that everything is going in the right direction”, but to develop a coordinated response to health system, regulatory and human resource challenges.

“We have to also push on with support for the diagnostics – critically, increasingly importantly – of the genomic surveillance globally, for the new variants of concern as they will continue to arise,” said Farrar.

Summarising various country and partner inputs, Ayoade Olatunbosun-Alakija, a member of the Africa Union Africa Vaccine Delivery Alliance, said that “we cannot have equitable outcomes without an equitable process”.

Olatunbosun-Alakija said countries had spoken about “prioritising the dose-sharing of existing vaccines” which meant that a “three-way conversation is required between countries, industry and COVAX to explore the potential sharing modalities”.

“There’s strong support for a task force to explore these options on the table and enforce the options where necessary,” she added.

Image Credits: ABC7 News.