India

A Qualitative Analysis of the Introduction & Uptake Pathways, Enablers, & Barriers of Health Interventions in India & Ethiopia

j.harris — Tue, 11 Jan 2022 20:24:26 +0000

A Qualitative Analysis of the Introduction & Uptake Pathways, Enablers, & Barriers of Health Interventions in India & Ethiopia j.harris Tue, 01/11/2022 - 20:24

Every day, women and children around the world die from conditions and diseases for which proven and effective health interventions exist, but are inaccessible or reach them too slowly. Lifesaving interventions addressing the MNCH continuum are imperative at all levels of the health system. Barriers in the pathways to the introduction and scaling of these interventions are part and parcel to the failure to get them to the end-user. Conversely, mechanisms that support the uptake of interventions should be encouraged and explored further to foster their use and speed their delivery to the end user.

The latest research by the Launch and Scale Speedometer team, A Qualitative Analysis of the Introduction and Uptake Pathways, Enablers, and Barriers of Health Interventions in India and Ethiopia, seeks to understand and analyze lifesaving intervention pathway bottlenecks and enablers in India and Ethiopia.

Why India and Ethiopia?

These two middle-income countries represent contrasting health systems (one primarily driven by the private sector and the latter primarily public or government-run) and approaches to health policy from South Asia and East Africa respectively. We identified and prioritized strategies to increase access to interventions for the MNCH population, noted challenges and opportunities in the ecosystem, and developed recommendations to urgently address these barriers and challenges. We organized our findings by presenting recommendations on key factors that influence launch and scale. Comparing the findings in India and Ethiopia we found country specific as well as several common barriers and enablers affecting the provision of MNCH interventions in both countries.

Key Takeaways and Recommendations

India and Ethiopia harbor unique health ecosystems that reflect their respective contexts. Our findings confirmed and aligned with assertions from previous studies that the most important factors (enablers or barriers) that influence scale up are:

The availability of financial and human resources

Health systems capacity

Supply chain capacity

Advocacy, acceptability, partnerships, and engagement of local implementers

Community participation

While there are notable differences between the two countries highlighted in our findings, we identified common push and pull factors that influence the launch and scale up of interventions. Based on the barriers, enablers, and overarching insights we ascertained from our research, we offer the following recommendations to expedite and streamline pathways for effective interventions to reach intended end-users:

Generate stronger qualitative and quantitative evidence in these contexts. Establish a research team within the MNCH service (or within appropriate health systems research division) that is charged with developing and implementing research protocols focusing on scaling up interventions in MNCH, to establish a national evidence base of effective interventions and share it with the health community

Increase accountability mechanisms. Incorporate monitoring and evaluation of scaling up MNCH interventions within national and subnational service delivery programs, including impact targets. Establish mechanisms for regular reporting to health officials, local government and patient population

Strengthen national regulatory approval mechanisms. Build capacity for new medical device regulation and champion more efficient and transparent regulatory processes for introducing new medical devices, with tracking of progress

Seek and promote more proactive early collaboration and engagement across multiple levels. Establish a forum for public and private sector MNCH product developers, including health authorities, policy makers and healthcare providers to regularly exchange ideas, review new evidence, address challenges across the trajectory of launch and scaling innovation, and discuss new challenges

Support an analysis of current status of public and private sector investment in scaling up proven MNCH interventions in these two countries, which can become a template for other countries.

Read the full paper Qualitative Analysis of the Introduction and Uptake Pathways, Enablers, and Barriers of Health Interventions in India and Ethiopia on our website.

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How can India address a potential third wave of SARS-CV-2 infections?

j.harris — Fri, 11 Jun 2021 21:33:11 +0000

How can India address a potential third wave of SARS-CV-2 infections? j.harris Fri, 06/11/2021 - 21:33

INSIGHTS

How can India address a potential third wave of SARS-CoV-2 infections?

Author: Nikki Prattipati

Starting mid-March 2021, India has become the epicenter of COVID-19 as a second wave of infections devastated the country. India reported 50 percent of global cases and 30 percent of global COVID-19 deaths, and an alarming rate of over 400,000 daily new cases at the height of the wave in early May 2021. While official projections estimate 29 million total infections and 360,000 deaths, low testing rates and the lack of available data lead some to place the actual COVID-19 tallies at five to ten times the official numbers.

The new, more contagious B.1617 Delta variant is partially to blame for the intensity of the second wave. However, the premature lifting of initial population-level prevention measures, the paucity in medical supplies including hospital beds and oxygen, and a high proportion of unvaccinated population contributed to the wildfire-like spread of the virus, inflicting untold human suffering across the country.

With the number of cases declining, the second wave is waning, but many experts predict that a third wave is inevitable. India cannot squander this opportunity to prepare itself; the country must take proper precautionary measures to minimize the impacts of a third wave.

India needs to continue urging proper population level prevention measures, including mask wearing and physical distancing.

A study completed during the height of the second wave of COVID-19 revealed only half the population wearing a mask and only fifteen percent of the population wearing a mask properly. With the majority of its population still unvaccinated, India needs to increase proper mask wearing among its constituents.

Moreover, after a strict nationwide lockdown in early 2020 curbed infection transmissions, India prematurely congratulated itself on controlling the pandemic and recklessly allowed large gatherings, such as cricket games attended by more than 130,000 unmasked fans, hosted large election rallies, and permitted gatherings for religious festivals, allowing the virus to spread. In the absence of a national lockdown to address the second wave of infections, many Indian states implemented strict regional lockdowns in May. Unfortunately, these draconian lockdowns disproportionately hurt the poorest and most vulnerable, and cannot be implemented for an extended period of time. However, the country should continue enforcing restrictions against large gatherings until higher proportions of the population are vaccinated.

India needs to enhance its COVID-19 surveillance system, and its collection and use of granular data to better inform their policy response.

India’s low infection testing rates, far below the global average, make it difficult to precisely establish the situation and respond with targeted actions to prevent the spread of COVID-19 in the country. In rural India, for example, where two-thirds of Indians live, the lack of widespread testing makes it impossible to understand the COVID-19 burden in the area. Increasing COVID-19 testing and contact tracing across the country will provide India with more accurate data to control the spread of the virus.

In addition, the government is withholding official granular data on COVID-19 to those outside the government and to many within the government. Good data is at the heart of good policy planning, and allowing public health experts and epidemiologists access to the data will allow them to use their expertise in making recommendations for best allocating scarce resources in combatting this pandemic.

India needs to increase the speed of COVID-19 vaccine rollout, especially to their most vulnerable populations.

After first prioritizing healthcare workers and those over age 65, then those over age 45, the country has opened eligibility to all those over the age of 18. As of early June, only 12.6 percent of India’s population has been administered at least one shot of COVID-19 vaccine, but the country reported slowed vaccine rollout in the midst of the second wave.

Prime Minister Modi’s announcement that vaccines will be free for all adults over the age of 18 should greatly improve the cost barrier in accessing vaccinations, but India can take further steps to improve its vaccine rollout. With huge shortages in vaccines, India needs to prioritize groups not only based on age, but also with other comorbidities and those at risk for acquiring and spreading the virus—those who are unable to properly social distance, practice good preventative hygiene measures, or access information on COVID-19 should be specifically targeted with the limited available doses.

India needs to address some of the shortages highlighted in the second wave.

As the second wave overwhelmed the Indian healthcare system, patients resorted to social media to find medical care and some even tried to make oxygen at home. India has ordered additional oxygen concentrators, but the country is still woefully under oxygen sufficiency levels. In addition, a major problem in India is the distribution of supplies from the central level to individual hospitals, and these additional oxygen concentrators and other medical supplies need to be efficiently distributed to individual facilities to be useful.

India needs to provide centralized, credible information to increase transparency and improve trust in their COVID-19 response.

In the midst of severe medical shortages and absence of a central, trusted authority on COVID-19 information, misinformation on miracle cures such as lemon juice or cow urine led individuals to reject proper prevention measures for one of these spurious hopes. Credible and transparent information on the proper COVID-19 prevention measures is essential to ensure that everyone is taking the appropriate measures to protect themselves and their families.

After its first lockdown curbed COVID-19 cases in India, the country failed to take continued pandemic prevention measures leading to the second wave of infections across the country. But there are key steps that India can take now to prevent the same devastation in the next wave.

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

US President Biden announces a 500 million-dose Pfizer vaccine donation at $1.5 billion to lower income countries through COVAX, the coalition working to provide equitable access to COVID-19 vaccines globally, with delivery starting in August 2021.

UK Prime Minister Johnson announces a donation of 100 million surplus vaccine doses, 30 million by the end of 2021. About 20 million of the doses will be donated bilaterally and the rest through COVAX.

Preliminary research finds evidence for a stronger immune response when mix-and-matching doses for two dose COVID-19 vaccine regiments, leading Canada’s public health agency to permit the mixing of COVID-19 vaccines.

US FDA rejects emergency authorization of Bharat Biotech’s Covaxin vaccine, but will welcome an application for full authorization when complete results from the Phase 3 trial are available.

China approves emergency use of Sinovac for children over the age of 3.

US is investing $500 million in establishing a new Center for Epidemic Forecasting and Outbreak Analytics at the US Centers for Disease Control and Prevention, which will help lead a new global pandemic early warning network.

Mastercard Foundation will provide $1.3 billion to Africa CDC over the next three years to support the acquisition and delivery of COVID-19 vaccines.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

High-income country confirmed dose total:	6 billion
Upper-middle-income country total:	2.2 billion
Lower-middle-income country total:	1.4 billion
Low-income country total:	271 million
COVAX total:	2.4 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	12.2 billion doses

Three reflections from a wild week

j.harris — Mon, 03 May 2021 18:58:13 +0000

Three reflections from a wild week j.harris Mon, 05/03/2021 - 18:58

INSIGHTS

Three reflections from a wild week

Author: Andrea Taylor

There is a lot of ground to cover this week. The pandemic continues to rage throughout the world, with countries in South Asia and Latin America battling the worst surges. India has set new world records for daily infections and deaths, while eschewing a nation-wide lockdown and struggling to implement a mass vaccination campaign with limited supply.

Meanwhile, high-income countries are planning for the vaccination of children and annual boosters for the entire population. The inequities in global access to Covid-19 vaccines are starker now than ever before and the consequences of the unequal rollout across the world are beginning to be felt in terms of preventable deaths, dangerous variants, and economic loss.

We published three opinion pieces recently, in which we reflect on these developments and the implications for global equity, and provide recommendations for leaders.

In Politico Magazine, we write about why and how the US should actively support Covid-19 vaccination in other countries. As of this week, 70% of vaccinations have taken place in the US, EU, China, and India, and we face a long wait before most of the world will have enough doses to approach herd immunity. Based on analysis of our data on vaccine purchases and manufacturing, we recommend that excess does be shared immediately, rather than being stored for later use, as the global need is urgent now and speed counts. We also make the case that the US can and should lead efforts to fund development of manufacturing hubs in Africa and Asia, to improve global access to safe and effective vaccines.

In The Hill, we explore how the communication and messaging from leaders in the US and EU about potential risks from Covid-19 vaccines can have unintended and dangerous impacts in other parts of the world. We note that the risk-benefit ratio is very different for countries where Janssen (J&J) and Oxford-AstraZeneca vaccine make up the bulk of supply than for countries like the US, which have enough vaccine doses from other makers to cover the entire population. Clear communication about the factors leading to regulatory pauses or restrictions can help leaders in other countries to put these risks into perspective and help to inform their own risk-benefit calculations.

In the MIT Technology Review, we write about the factors contributing to India’s current crisis and what is needed now. While India’s export restrictions on Covid-19 vaccines are important and understandable, the country will not be able to vaccinate its way out of this surge. India urgently needs to implement national public health measures to reduce spread of the virus and buy time to manufacture and administer vaccines. International support, in the form of oxygen, medication, testing kits, and masks are also desperately needed. (The MIT Technology Review requires a subscription, but non-subscribers can read up to three articles free.)

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

US will divert supplies ordered for its own vaccine manufacturing to India, to support production at the Serum Institute. This is a great start towards equity, but there is more that the US can do (see our comments above for our take on what can and should be done).

US, EU, UK, and Russia send help to India including oxygen, ventilatiors and medication to address the Covid-19 crisis, as India registered more than 300,000 new cases daily this week.

South American countries are also seeing record-high death rates and last week accounted for 38% of Covid-19 deaths worldwide but only represent 8% of the world’s population, according to the New York Times.

Israel, which has vaccinated 62% of their population, purchased more Pfizer-BioNTech and Moderna doses this week but is still not providing vaccines to Palestinians, including those living in the West Bank.

Bharat Biotech in India reports that it will double manufacturing capacity to 20 million doses per month by June and then will reach 60 to 70 million doses per month by August.

Brazilian health regulators unanimously voted to not approve the Sputnik V vaccine, citing a lack of data on safety, quality, and effectiveness. Regulators in the Czech Republic made a similar announcement this week, saying they had not received enough documentation properly assess the vaccine. Russia has denied both claims and plans to sue Brazil’s regulator.

Pfizer is shipping doses produced in the US to Mexico, the first such global export from the company’s US production. More shipments abroad are expected to follow, as US manufacturing plants expect to have excess capacity by mid-year.

Mexico announced its Birmex firm will provide fill-finish capacity for Sputnik V, using active ingredient produced in Russia. Mexican officials hope this will speed up production and delivery of their order, which has been repeatedly delayed.

Moderna is expanding manufacturing plans in the US and Europe to increase production capacity. The company now expects to produce 800 million to 1 billion doses in 2021 and to further increase capacity up to 3 billion doses in 2022.

The WHO has approved the Moderna vaccine for Emergency Use Listing (EUL), which makes it eligible for distribution through COVAX. Decisions on Sinopharm (Beijing) and Sinovac are expected within the next week.

France is the first country to donate vaccine doses through the COVAX dose-sharing scheme, pledging 500,000 doses by mid-June. France intends to donate at least 5% of their total supply to COVAX through 2021. New Zealand and Spain have also signaled that they will donate doses through COVAX.

The EU is taking legal action against AstraZeneca for “not respecting” terms of their contract.

A new report from the IQVIA Institute for Human Data Science forecasts that global spending on Covid-19 vaccines will exceed $150 billion by 2025, including $53 billion in 2021.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

High-income country confirmed dose total:	4.9 billion
Upper-middle-income country total:	1.5 billion
Lower-middle-income country total:	713 million
Low-income country total:	770 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	9 billion doses

What have we learned in one year of COVAX?

j.harris — Fri, 23 Apr 2021 21:56:33 +0000

What have we learned in one year of COVAX? j.harris Fri, 04/23/2021 - 21:56

INSIGHTS

What have we learned in one year of COVAX?

Author: Andrea Taylor

Launched as a global cross-organization collaboration only one month after the pandemic was declared, COVAX was built to facilitate global equity in the pandemic response. As COVAX passes the one-year mark this month, there are some early lessons and insights that can inform its further development and help us prepare for future crises.

In terms of numbers, COVAX is short of the mark. Photo ops of government officials on the tarmac to meet planes full of doses and declarations of the numbers of countries reached can paint an optimistic picture. But the truth is that COVAX has delivered 43 million doses to 119 countries. This is only 2% of the way towards the 2 billion dose goal for 2021 and about 70 COVAX-participating countries have not yet received any doses (though some of these countries have waived their doses).

As Dr. Tedros wrote in the New York Times this week, we are nowhere near the 20% mark, and with significant supply constraints set to continue through the second quarter of 2021, this is not likely to change soon. COVAX is also However, it is not all bad news. COVAX has supported manufacturing deals and bulk purchases that would not have been feasible without its pooled procurement approach. And while distribution of vaccines is coming in more of a trickle than a wave, it is still getting doses to some of the most remote and poorest regions of the world. One year in, we can look back and begin to see what has worked and what needs rethinking.

Iterating in the midst of a crisis is difficult

COVAX was pulled together by a group of people who foresaw the dangers of inequitable access to vaccines in a pandemic, part of the ACT Accelerator that also focused on access to diagnostics and therapeutics. But at the time it was launched, the shape and timeline of the pandemic were unknown, the symptoms and impact of Covid-19 were still not well understood, and no one yet knew if or which vaccine would work. There was not the luxury of time to wait for these answers before designing and market testing an equity solution.

It is a difficult thing to build the car while you are driving it. The designers of COVAX and the partners who have steered its implementation have had to iterate as they go along, adding this, removing that. They have navigated the same dynamic landscape as national leaders, responding to changes in disease patterns, infection rates, vaccine trial results, manufacturing supply. But they’ve had to do all of this while keeping the world’s leaders engaged, maintaining a vision and strategy that would hold both wealthy and poor countries and everyone in between. It is worth keeping in mind the sheer difficulty of this task. To large degree, COVAX was down to grit and persistence.

Nationalism will win, so let’s plan for it

COVAX was premised on an all-for-one-and-one-for-all approach to defeating the pandemic. It was a way to invest together in a portfolio of vaccines and therapeutics and then ensure that the successful ones were shared out equally, regardless of country wealth or geopolitics. We know from economic and epidemiolocal modeling that this would have led to the best outcomes for everyone and was our best hope for ending the pandemic quickly. But we also know from experience that the world doesn’t really work this way. And COVAX used a traditional donor-aid model to drive an all-in-this-together program, leading to, as the Lancet put it this week, “a funding shortfall and a system not based on solidarity but rather one that reinforces inequities.”

Vaccine purchase decisions are made (for the most part) by national leaders, whose primary responsibility is to protect their own population. If leaders have the opportunity to control the purchase (and production) of vaccines for their country, they will. If they have the opportunity to prioritize their population over others, they will. This is their job.

For future iterations of COVAX, nationalism must be baked into the design from the beginning. COVAX needs to assume that government leaders will prioritize their own, and work with that. Perhaps vaccine makers could commit that 20% of every batch produced goes to supply COVAX, while 80% can go to the wealthy countries first in line. The important thing is to bake it in from the beginning so that it not a choice of “giving up” doses that leaders have to explain to their voting population.

Messaging matters

COVAX can be described in many ways but transparent is not one of them. The risk-averse partnership has consistently kept its cards close to its chest, providing information only in broad strokes and only when absolutely necessary. While we can understand why, we also think this may be a strategic error.

When COVAX does share information, the tone tends to be defensive and protective and the data shared is difficult to parse. The risks and dangers inherent in the COVAX design are not lost on the watching world and simply choosing not to talk about them doesn’t make them disappear. Rather, clear messaging about the benefits of vaccine equity (which are well documented by others), what is needed to get there, and the potential pitfalls on the way could allow COVAX to drive and shape the story. Unfortunately, opaque supply updates built on data that cannot be externally validated undermine, rather than build, confidence.

COVAX is the largest purchaser in the Covid-19 vaccine market and could use its platform and purchasing power to push for more transparency and accountability in Covid-19 vaccine purchases and manufacturing. Making its supply deals public, including prices and delivery schedules, and clearly communicating about the gaps, could drive urgency and more transparency across the board.

Equitable distribution must begin with equitable manufacturing

The location of manufacturing matters and countries with domestic manufacturing of Covid-19 vaccines are better able to ensure supply. While COVAX was quick to secure manufacturing capacity, this is less relevant in the context of export controls. COVAX does not have a country or government and is unable to use policy levers to commandeer manufacturing when the going gets tough.

Ensuring equitable access to vaccines globally means that manufacturing must be global. There are a very limited number of manufacturing partners who could provide the scale of vaccine needed for COVAX and this led to an overreliance on Serum Institute of India (SII). When a second wave of Covid-19 infections hit India and sent it into crisis, export controls cut short the COVAX supply. There was no Plan B and no clear options for making up the shortage in production for countries counting on COVAX.

The world needs more regional manufacturing hubs that can produce vaccine independently and do not require drug substance to be imported from other regions. There is a particularly acute need in Latin America, the African continent, South East Asia, and the Pacific. With more equitably distributed manufacturing, COVAX or a similar future effort could draw on a broad network of manufacturing partners to supply the world and lower-income regions could control their own supply.

The world is better off with COVAX than without it. But one year in, we can see how far we are from the goal and the factors that have prevented success. One of the strengths of COVAX is its ability to iterate and it will continue to do so in a continually changing environment. And importantly, we now have something on which to build and improve for future global crises.

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

India’s health systems are collapsing from the pressure of a near-vertical rise in infections. With more than 330,000 new cases on Friday, India set a world record for the second day in a row.

In response, India is opening up vaccine eligibility to all adults aged 18 and older, starting May 1. The country is facing a significant vaccine shortage, however, and has declared that domestic manufacturers must sell 50% of their doses to the government but can sell the other 50% on the private market within India. Prices for the private market can be different than the government rate but must be transparent and set in advance.

The European Medicines Agency (EMA) found a possible link between a very rare blood clotting disorder and the Janssen (J&J) vaccine, similar to that identified with the Oxford-AstraZeneca vaccine, but stressed that “the vaccine’s benefits in preventing Covid-19 outweigh the risks of these very rare side effects.”

Dr Tedros offered a scathing indictment of the choices wealthy countries have made in the pandemic in a NYT opinion article, and called on rich countries to support COVAX financially, to donate vaccine doses, and to share manufacturing expertise to allow production to scale up globally.

Japan will host the next fundraising summit for COVAX in June, bringing together leaders from the US, Japan, and European countries.

New Zealand, France, and Spain announced plans this week to donate excess vaccine doses through the COVAX Facility.

The ACT Accelerator released a report in honor of its first anniversary: ACT Now, ACT Together: 2021 Impact Report.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

High-income country confirmed dose total:	4.7 billion
Upper-middle-income country total:	1.5 billion
Lower-middle-income country total:	732 million
Low-income country total:	770 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	8.9 billion doses

Will India’s export controls doom supply for low- and middle-income countries?

j.harris — Fri, 26 Mar 2021 21:34:53 +0000

Will India’s export controls doom supply for low- and middle-income countries? j.harris Fri, 03/26/2021 - 21:34

Weekly Insights and Interesting Trends

Will India’s export controls doom supply for low- and middle-income countries?

Author: Andrea Taylor

India’s announcement this week that it would halt exports of domestically produced Covid-19 vaccines in the short term seemed to take the world by surprise. It probably shouldn’t have.

For months, India’s Covid-19 cases appeared to plateau. As wealthier countries dithered about donations and paused exports, India led the way on donations and was lauded for their significant part in supplying COVAX and lower-income countries. The Serum Institute of India (SII) is frequently seen as the key to vaccine equity and is expected to produce the bulk of COVAX 2021 supply, as well as making bilateral deals with low- and middle-income countries.

But cases in India began to spike this month and a new “double mutant variant” was identified in the country. (Health officials say that the variant has not been linked to the rise in cases.) Facing a daily caseload that has more than tripled in three weeks, India is following the path paved by the US, EU, and others. As domestic need rises, governments prioritize their citizens over neighbors.

India’s export controls are bad news for COVAX and global equity. COVAX allocated 110,328,000 doses of SII’s version of the Oxford-AstraZeneca vaccine to ship out to 60 countries by May. Indian government reports that 17.9 million doses have been exported to COVAX so far.

The remaining doses will now be delayed and shipments expected beyond May are in question. COVAX is negotiating additional supply deals, which may help to fill the gap later this year. But it is unlikely that any manufacturer will be able to provide a significant number of doses to COVAX in the next quarter.

The news from India highlights the risks of the complex supply chains and uneven distribution of manufacturing capacity around the world. Countries manufacturing vaccine can commandeer doses when domestic need requires it. Countries without the means to produce vaccine (which is most countries) are left to wait through their own crisis until the crisis elsewhere subsides.

Even before the export controls were announced, SII was facing manufacturing shortfalls. They linked shortfalls to a lack of materials (cell cultures, filters, pumps, chemicals) needed from countries like the US, a complaint that has been echoed by other vaccine makers. The US government, meanwhile, is using the Defense Production Act to keep key components within the country and speed up domestic manufacturing.

Our analysis of the global manufacturing landscape identifies 100 manufacturing partners in more than 30 countries currently working to produce Covid-19 vaccine (add to this the hundreds of suppliers of parts and materials). This is amazing. But if materials get stopped at borders and cannot get to all of the manufacturers, then they cannot do their job and we are wasting desperately needed capacity.

There may be a negative feedback loop at work here: the perception of scarcity is driving nationalism, which is in fact driving further scarcity. This is inefficient, and we cannot afford inefficiency.

Vaccine makers are projecting they can make a total of about 12 billion doses of Covid-19 vaccine this year. We think that is a best-case scenario; recent history indicates these projections will likely be lowered as the production process encounters problems. But it is realistic to expect that manufacturing is going to ramp up exponentially in the second half of 2021. Whether or not these doses will be efficiently distributed may be decided by governments in a few countries that are home to much of the manufacturing capacity.

Interesting Trends

Significant updates, news, and trends we saw last week:

The WHO Director-General spoke on Monday about the disparities in access to Covid-19 vaccines, saying, “We have the means to avert this failure, but it’s shocking how little has been done to avert it. The gap between the number of vaccines administered in rich countries, and the number of vaccines administered through COVAX is growing every single day, and becoming more grotesque every day.”

India has covered 55 million people so far in their national vaccine drive, though recent export controls will impact doses going to low- and middle-income countries, both through COVAX and bilateral deals. Read our take on this above.

China accelerated its national vaccine campaign this week and has now administered nearly 75 million doses, according to a government spokesperson. (CanSino is a one-dose vaccine, while Sinovac and both Sinopharm vaccines are two doses, so it is not clear exactly how many people have been covered.) A government official reported that China’s production capacity can fully meet the nation’s needs.

South Africa worked with the African Union to sell its unused doses of Oxford-AstraZeneca vaccine to 14 other African countries. South Africa ordered the vaccine from Serum Institute but later decided not to roll it out because of reduced efficacy against the dominant variant in the country.

Two biotech companies in India, Virchow and Stelis, recently signed on to manufacture 200 million doses each of the Sputnik V vaccine, with production expected to begin in the summer.

This week also saw a number of new bilateral purchases for the Sputnik V vaccine.

Cuba announced the final phase of clinical trials for their homegrown vaccine Soberana 2. As part of the trial, Cuba will vaccinate 150,000 frontline workers. Cuba is also testing a second vaccine, Abdala, which is entering late-stage trials.

Catalent is partnering with J&J to produce “millions” of doses of the Janssen vaccine for the US market.

Norway donated 700,000 doses from its COVAX allocation to poorer countries, while still in the early stages of its national vaccine roll out.

New report in Nature breaks down the manufacturing landscape, why it is difficult to scale, and how we can do better.

After some confusion over the data originally submitted by AstraZeneca to US regulators, the company has resubmitted data with an adjusted efficacy of 76% (from 79%), though efficacy for over 65s in the US trial was 85%.

EU leaders met this week and agreed to maintain (or strengthen) export controls on vaccines, while stopping short of an outright export ban. They also agreed to increase production within the EU.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

High-income country confirmed dose total:	4.6 billion
Upper-middle-income country total:	1.5 billion
Lower-middle-income country total:	711 million
Low-income country total:	670 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	8.6 billion doses