In the middle of last year, the World Health Organization began promoting an ambitious goal, which it said was essential to ending the pandemic: to fully vaccinate 70% of the population in all countries against Covid-19 by June 2022.
Now, it’s clear that the world will fall far short of that goal on time. And there is a growing sense of resignation among public health experts that high Covid vaccination coverage may never be achieved in most low-income countries as much-needed US funding dries up and governments and donors alike. turn to other priorities.
“The reality is there is a loss of momentum,” said Dr. Isaac Adewole, former Nigerian Minister of Health who now serves as a consultant to the African Centers for Disease Control and Prevention.
Only a few of the world’s 82 poorest countries – including Bangladesh, Bhutan, Cambodia and Nepal — reached the 70 percent vaccination threshold. Many are below 20%, according to data compiled from government sources by the University of Oxford’s Our World in Data project.
By comparison, about two-thirds of the world’s richest countries have reached 70%. (The United States is at 66 percent.)
The consequences of giving up on achieving high vaccination coverage worldwide can be severe. Public health experts say abandoning the global effort could lead to the emergence of dangerous new variants that would threaten the world’s precarious efforts to live with the virus.
“This pandemic is not over yet – far from it – and it is imperative that countries use the available doses to protect as much of their population as possible,” said Dr. Seth Berkeley, chief executive of Gavi, the nonprofit organization that runs the Covax global vaccine clearinghouse.
Countries in different parts of the world, including some in Eastern Europe and the Middle East, have seen their vaccination rates stagnate in recent months at a third or less of their populations. But Africa’s vaccination rate remains the grimmest.
Less than 17% of Africans received a primary immunization against Covid. Almost half of the vaccine doses delivered to the continent so far have not been used. Last month, the number of doses injected on the mainland dropped 35% compared to February. WHO officials attributed the drop to mass vaccination being replaced by smaller-scale campaigns in several countries.
Some global health experts say the world missed an excellent opportunity last year to provide vaccines to low-income countries, when the public was most fearful of Covid and motivated to get vaccinated.
“There was a time when people were very desperate to get vaccinated, but vaccines didn’t exist. And then they realized that without the vaccination, they didn’t die,” said Dr. Adewole, who wants countries to continue to pursue the 70% target.
The remaining momentum in the global vaccination campaign has been hampered by a lack of funding for the equipment, transport and personnel needed to receive gunshots.
In the United States, one of the main funders of the vaccination effort, lawmakers withdrew $5 billion for global pandemic relief from the coronavirus response package due to be voted on in the coming weeks. Biden administration officials said that without the funds, they will not be able to provide support for vaccine delivery to more than 20 undervaccinated countries.
Some public health experts point to reason for optimism that the global vaccination campaign is still on the rise. Despite the drop from February’s peak, the number of Covid vaccines being administered every day in Africa is still close to a pandemic high. And Gavi earlier this month made a significant new round of funding pledges, securing $4.8 billion in commitments, although it fell short of its $5.2 billion target.
There is also hope that a global Covid summit that the White House plans to co-host next month could be an opportunity to generate momentum and funding.
But falling public demand has led some health officials and experts to question discreetly and, in some cases, openly, whether the 70% vaccination target is feasible or even sensible.
Reported Covid-19 fatalities remain comparatively low in sub-Saharan Africa, although there is debate over how much of this reflects inadequate tracking data. The perception, however, in many countries in the region is that the disease does not pose a serious threat, certainly not as much as other widespread health problems that require attention with scarce health resources.
Many low-income governments are turning their focus to their economies and other health issues like HIV, said FIFA Rahman, civil society representative for a group launched by the WHO that coordinates the global response to Covid. “There is a sense of too many competing priorities, but this is a symptom that the momentum has run out. Because when the moment was there, everyone was like, ‘Where are our vaccines?’”
In rural areas of the Democratic Republic of Congo, for example, where the reported Covid death rate is very low, there is an increase in measles cases threatening 20 million children. However, the government says it cannot spare the resources to provide supplemental measles vaccines this year, said Christopher Mambula, medical manager for Doctors Without Borders in East Africa. In this kind of context, it makes little sense to continue to divert resources towards widespread Covid vaccination, he said.
As African governments received more vaccines donated from wealthy countries and struggled to distribute even those supplies, their interest in ordering more doses waned.
The African Union still aims to vaccinate 70% of its population by the end of 2022. But as countries are slow to run out of donated vaccines, the bloc has not exercised its options to order more doses of injections from Johnson & Johnson and Moderna.
South African drugmaker Aspen Pharmacare earlier this year finalized an agreement to bottle and market the Johnson & Johnson vaccine across Africa, a contract that was billed as an initial step in Africa’s development of a robust vaccine production industry. . Aspen has prepared for production, but no buyers, including the African Union and Covax, have placed orders yet, said Stephen Saad, Aspen’s chief executive.
The Serum Institute of India, the world’s largest vaccine maker, halted its production of Covid vaccines in December last year, when its inventory grew to 200 million doses; Bharat Biotech, another Indian company that was a major producer, also stopped making the vaccine in the face of low demand. The companies say they have no more orders since their contracts with the Indian government ended in March.
After the WHO began promoting the 70% vaccination target, many low-income governments adopted the target for their own populations. The Biden administration also endorsed it last September, setting a deadline of September 2022.
At the time, two doses of the Pfizer and Moderna vaccines were believed to offer very strong protection against even mild disease, and there was still hope that achieving high levels of vaccine coverage would tame the virus. But the emergence of new variants and the spread of the virus in Africa changed the calculus.
Vaccine schedules planned for the developing world offered little protection against infection with the Omicron variant. And as sub-Saharan African countries have been excluded from vaccine distribution for much of the past year, more and more Africans have gained protection against the naturally occurring virus, which studies have shown works well as two doses of mRNA in preventing infection. New WHO data show that at least two-thirds of Africans were infected with the virus before the Omicron wave.
Given these factors, some public health experts in Africa say the broad target of 70% no longer makes sense. “There is very little value in that. In fact, we will earn a lot more by reaching over 90% of people over 50,” said Shabir Madhi, professor of vaccinology and dean of the faculty of health sciences at the University of the Witwatersrand in Johannesburg. About two-thirds of South Africans over 50 are currently fully vaccinated.
Dr. Madhi said South Africa could close mass vaccination sites and instead redouble its efforts to seek out the most vulnerable in church services and government offices that pay monthly pension benefits.
Katherine O’Brien, who directs the WHO’s work on vaccines and immunizations, said the agency encourages countries to focus on their most vulnerable citizens, rather than vaccinating “a random pool of 70%” of their populations. The aspiration, according to her, has always been “100% of health professionals, 100% of the elderly, 100% of pregnant women, 100% of people who fall into the highest risk groups”.
Of course, countries can make decisions about which health goal they want to prioritize, O’Brien said, but finite resources should not be the obstacle to vaccinating against the coronavirus. “The world has enough resources to do this, if countries want to do it,” she said. “And that must really be the North Star.”
Some public health experts have said that while the 70% vaccination limit is clearly not achievable in the original timeframe, it would be unwise and unethical to give up on that goal over a longer time horizon. They expressed frustration with the widening chasm between wealthy countries vaccinating young children and giving healthy adults four doses of the vaccine, and regions where most people still don’t get a dose.
“Why are we making this a target for high-income countries and a target for low-income countries?” said Dr. Ayoade Alakija, co-chair of the African Union vaccine distribution programme.
She said that while many people in sub-Saharan Africa have been infected, there is still a need for additional protection that would come from a high level of vaccination coverage.
Modest vaccination coverage, she said, “is not considered a good enough level of protection in England, not a good enough level of protection in America. How good is it that we’re not looking for as much, as much as we can? Aim for the sky and reach the top of the tree.”