Why Covid-19 Vaccination in Poorer Nations Has Slowed, Posing Global Risks

That is widening an already huge vaccination gap between rich and poor countries. While more than 200 million doses have been administered in the U.S., Covax has so far supplied fewer than 41 million of its planned two billion doses by the end of 2021.

Slow uptake of Covid-19 vaccines in developing countries could create problems for the rest of the world. Epidemiologists believe that failure to vaccinate much of the developing world could leave a large reservoir of the coronavirus circulating, giving it the chance to mutate and possibly spill over to developed countries.

Most of the Covax shots planned for the first half of the year were to be manufactured by the world’s biggest vaccine maker, the Serum Institute of India, which has partnered with

AstraZeneca

PLC to make the vaccine the company developed with the University of Oxford. The SII says its output has also been constrained by limits imposed by the U.S. on the export of key raw materials for vaccines, an attempt by Washington to speed up manufacturing at home.

The lack of clarity has made planning difficult.

Officials at the Africa Centers for Disease Control and Prevention and the WHO suggested recently that governments might consider giving priority to a first shot for as many people as possible, even if it means delaying second doses and despite a lack of clear data on how efficacy could drop without a booster.

“We are in a bind as a continent,”

John Nkengasong,

the head of the Africa CDC, said last week. “We cannot predict when the second doses will come and that is not good for our vaccination program.” Dr. Nkengasong added that even without a booster, one dose of the AstraZeneca vaccine should protect against serious Covid-19.

Other countries, meanwhile, are struggling to administer the few vaccines they have received.

One reason for low demand for vaccines in some countries, health officials say, is the decision by some European countries to restrict the use of the AstraZeneca vaccine for younger people amid reports of a rare but severe blood-clotting disorder. Health authorities in the U.S. last week also paused the rollout of a vaccine made by

Johnson & Johnson

as they investigate similar reports. Covax and the African Union have lodged big orders for the J&J shot for the second half of the year.

“There is a lot of misinformation out there and this negative messaging especially in Europe and America is the main reason our vaccinations took off to a slow start,” said Diana Atwine, the permanent secretary at Uganda’s health ministry. “Enthusiasm has been low because people are being told bad things about the vaccine.” Uganda, a country of 45 million, has administered just over 200,000 of the 964,000 doses it received in March.

A lack of investment in vaccination logistics, including messaging to the public, is also slowing the rollout.

U.S.-based health charity CARE estimates that for every $1 spent on vaccine doses, governments need to invest an extra $5 in getting them into people’s arms, including on salaries for healthcare workers, information campaigns and cold-chain logistics.

But the Covax division meant to help countries prepare for vaccine rollouts has received only around $600 million in contributions, leaving a gap of $7.3 billion for this year, and the World Bank has committed just $2 billion of a $12 billion financing package meant to help countries buy and distribute vaccines and strengthen their health systems.

Some $9 billion has been donated to Covax to buy vaccines, even though large purchases by rich countries mean that most doses won’t become available until later in the year.

In Uganda, authorities are running advertisements urging vaccinations, but the posters and billboards that were mainstays of earlier vaccination campaigns, including for measles and polio, are absent. Outside the capital, Kampala, the elderly often lack the transport needed to reach vaccination sites. A high illiteracy rate also means some people struggle to read the consent form they need to sign, health officials said.

“If we got access to more money, we could be able to speed up the process,” said Vera Daves, the finance minister of Angola, which has used less than half of its Covax doses.

The WHO and other agencies are adapting their guidance in light of the supply shortages. In a notice posted on a network for international immunization professionals last month, the WHO suggested that countries dependent on Covax could focus on getting as many people as possible a first dose, even at the risk of delaying a second by more than the recommended 12 weeks.

That “would substantially increase the number of deaths prevented,” the notice says. But the WHO also says the levels of antibodies triggered by the vaccine drop by around a third 90 days after the first dose. There is only limited data on what happens to vaccine efficacy thereafter, it says.

Tulio de Oliveira, a geneticist at the Nelson Mandela School of Medicine in South Africa, said the risk that the shot becomes less efficacious without a timely booster was especially high for countries battling variants that can evade antibodies from previous infections or vaccination, such as the ones that were first discovered in South Africa and Brazil and spread quickly across nearby countries.

But, he added, “If it’s the choice between no vaccine and one vaccine…then one doesn’t have a lot to lose on an individual level. What one can lose is vaccine trust.”

Covax’s current supply plans foresee a resumption of deliveries from India in June, but the SII has said that depends on Indian case numbers declining. Last week, Covax delivered fewer than one million doses. The WHO said Monday it was still in talks with India’s government and had no clear indication of when deliveries would resume and how many doses would be released.

Some countries are already looking elsewhere. Indonesia, which has recorded more Covid-19 cases and deaths than any other country in East Asia, has asked Beijing to help secure an extra 100 million doses of Chinese vaccines on top of the 125 million it already ordered.

Earlier this month, Indonesian Health Minister

Budi Gunadi Sadikin

said the government had taken up the issue of vaccine delivery directly with the head of Gavi, one of the groups behind Covax, as well as with AstraZeneca, which has also delayed orders. The Chinese “have proven to be the most consistent in fulfilling their promises,” Mr. Sadikin said.

Write to Gabriele Steinhauser at [email protected], Nicholas Bariyo at [email protected] and Jon Emont at [email protected]