supply

Are third shots vs first shots a “false choice?” Then the US and other high-income countries should prove it

j.harris — Fri, 20 Aug 2021 22:35:02 +0000

Are third shots vs first shots a “false choice?” Then the US and other high-income countries should prove it j.harris Fri, 08/20/2021 - 22:35

INSIGHTS

Are third shots vs first shots a “false choice?” Then the US and other high-income countries should prove it.

Author: Andrea Taylor

The US has continued to advance plans for boosters since we wrote about the issue earlier this month, with an announcement that a third dose will be offered to all residents (not just the highly vulnerable), eight months after the second dose. Israel has already begun its booster campaign, while Germany, France, and the UK are expected to begin boosters for the elderly and immunocompromised next month.

Data from the US, Israel, and the UK help explain why. Despite relatively high levels of vaccination and early vaccine roll-out campaigns, all three countries (and many others) have experienced significant surges in infection over the past few months. Breakthrough infections (those occurring among fully vaccinated people) are increasing, particularly for people over the age of 60 and those with underlying conditions. While full vaccination clearly provides powerful protection against Covid-19, efficacy appears to diminish over time, particularly against Delta.

Brushing aside criticism from the WHO and other global advocates, the US government continues to say that boosters versus vaccines for the world is a false dichotomy and we can (and must) do both. The US Surgeon General Dr. Murthy echoed a frequently repeated line from government spokespeople, saying, “I do not accept the idea that we have to choose between America and the world. We clearly see our responsibility to both.”

Supply is improving

The increasingly good news on the supply front supports this view. Our estimates of manufacturing indicate that the world is now producing close to 1 billion doses of Covid-19 vaccines per month. This represents an enormous scale-up of manufacturing, across all of the vaccine platforms, since the beginning of the year.

There are also new candidates poised to enter the market with significant production capacity (including Novavax, Bio E’s Corbevax, and Medicago) which will further improve the supply picture. Even our conservative estimate indicates that the world can make 5 billion vaccine doses between August and December this year. When we consider that most wealthy countries are nearing the demand ceiling for full vaccination and have hundreds of millions of doses on hand already, this bodes well for global exports.

Can political will keep up?

But supply is only part of the equation – political will is another. Just saying that boosters vs global vaccine access is a false choice does not make it so. The US government (and other high-income nations) now have the opportunity to prove it.

The US talking points consistently include a reminder that the US is doing more than its peers. As White House Coronavirus Response Coordinator Jeff Zients said this week, “the 115 million doses that we’ve already donated is more than all the other countries combined.” But this rather misses the point. The measure of success is not “have we done more than others?” but “do all countries have enough vaccine to slow transmission?”

The gaps in vaccine access globally remain dismally wide. High-income countries have purchased nearly half of the total vaccine doses bought so far but represent only 16 percent of the world’s population. More than 80 percent of vaccines administered worldwide went to people in high- and upper-middle income countries. Meanwhile, less than 1 percent of people living in low-income countries are fully vaccinated.

If other wealthy countries are not pulling their weight (spoiler: they are not), the US can work to bring them along. As the first country to approve boosters for the general population, the US should set an example by coupling the rollout of boosters with a coordinated plan of action to get vaccine doses where they are needed most around the world. Along with other global health and policy experts, we recently proposed a specific path through which the US can demonstrate this type of necessary global leadership.

Slowing transmission of the virus everywhere is critical. We cannot stop the pandemic at home (wherever home may be) until every part of the world is able to reduce infections.

INTERESTING TRENDS

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

The US government announced that Covid-19 booster shots will be made available to the general population, eight months after the second shot, in order to combat waning efficacy. (See the post above for our take on this.)

A new study from Oxford University found that both the Pfizer-BioNTech and Oxford-AstraZeneca vaccines provide strong protection against the Delta variant but that the efficacy does wane over time.

Australia extends lockdown for Sydney until end of September

Millions of the Janssen (J&J) vaccine doses coming from the Aspen plant in South Africa are being exported to Europe, while South Africa is still waiting for its order of 31 million to be filled.

New article in Science looks at the evolution of Covid-19 variants and what we can learn from other viruses.

Also in Science this month, insights on how the “super immunity” of those who survived the 2003 SARS epidemic contribute to development of a pan-coronavirus vaccine.

WHO flags counterfeit versions of the Serum Institute’s Covishield (Oxford-AstraZeneca) vaccine in both India and Africa.

Pope Francis encouraged Covid-19 vaccination, calling it an “act of love” and stating that “vaccination is a simple but profound way of promoting the common good and caring for each other, especially the most vulnerable."

The US Centers for Disease Control and Prevention (CDC) announced a new Center for Forecasting and Outbreak Analytics, to increase the availability and use of data in public health decision making. new disease forecasting

Australia’s government faced criticism this week for ordering 500,000 doses of Pfizer-BioNTech’s vaccine from COVAX. Faced with a population suspicious of the Oxford-AstraZeneca vaccine, which was meant to form the bulk of Australia’s national supply, the government is scrambling to secure additional doses of Pfizer-BioNTech.

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

Weekly COVID Vaccine Research Update

Vaccines

Boosters

supply

High-income country confirmed dose total:	6.8 billion
Upper-middle-income country total:	2.5 billion
Lower-middle-income country total:	3.2 billion
Low-income country total:	288 million
COVAX total:	3.3 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	15 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