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The Bill & Melinda Gates Foundation has joined others in calling on high-income countries to share at least 1 billion doses of COVID-19 vaccines in 2021. Nicolas Theopold answers questions on why dose sharing is so important, why sharing 1 billion doses is a realistic goal, and what other steps can be taken to achieve more equitable access to COVID-19 vaccines worldwide.
Why is the foundation calling for dose sharing now?
Early in the journey to develop COVID-19 vaccines, we joined many others in raising concerns that the inequitable distribution of vaccines could prolong the pandemic and cause unnecessary suffering. Unfortunately, that’s exactly the outcome that we’re seeing now. Case numbers have declined sharply in many higher income countries where vaccines are widely available. In these places, life has begun to return to normal. Elsewhere, the virus continues to spread with devastating consequences. The situation in Brazil, India, Nepal, Bangladesh, and many other countries, is heartbreaking. Much of this suffering could also be prevented.
Last year, before any vaccines had become available, high-income countries negotiated deals to secure large quantities of doses. They sought such quantities because there was uncertainty around which vaccines candidates would work and how quickly they would be approved for use. By reaching deals to purchase multiple types of vaccines in large quantities, these countries used their ample resources to increase the likelihood that they would receive sufficient doses of a safe and effective vaccine.
Fortunately, many of these vaccines have since been determined to be safe and effective and have reached the market. There are also several other vaccine candidates that remain in development. Because high-income countries were able to strike extensive deals early, they are first in line to receive the vaccines and now have orders for many more doses than they require to vaccinate their populations. That’s why dose sharing makes so much sense—a huge volume of vaccine doses has already been secured and will be delivered over the course of this year. By year’s end, we expect that high-income countries will have at least 1 billion more doses than they will use.
Quickly sharing these doses will benefit everyone: it will expand vaccine coverage across the globe and lower or interrupt transmission of the virus. It will help reduce the risk that new, more dangerous variants emerge. It will help ease the severe economic disruptions caused by the pandemic. And it will save countless lives.
How did you come to the 1 billion doses number?
First, we calculated how many vaccine doses high-income countries are likely to receive in 2021 and totaled those numbers. However, we know that countries won't receive all the doses they ordered for this year due to manufacturing delays or because a vaccine candidate may not receive regulatory approval. Working with our partners, we used data on actual vaccine production and adjusted our numbers accordingly. We concluded that high-income countries will receive approximately 3.3 billion COVID-19 vaccine doses in 2021.
Next, we calculated how many of those 3.3 billion doses the countries will use this year. For that, we started by establishing the total population of people 12 years of age or older across these countries. In evaluating how many doses it will take to vaccinate that population, we made three key assumptions: first, that 80% of the 12 years of age or older population could be reached and would be willing to take the vaccine. Second, that each person would receive three doses—two doses in an initial vaccination series and one booster dose, which may be required later in case of waning protection. Third, that 10% of vaccines would go to waste, for example if a vial isn’t used in time before it must be discarded.
Based on our calculations, we expect that high-income countries will use approximately 2.3 billion of their 3.3 billion vaccine doses in this year. That leaves an excess of at least 1 billion doses to share with lower income countries.
It’s important to note that the assumptions we built into our calculations are quite conservative. The actual vaccination rates of eligible populations may be lower than 80%. It’s also unlikely that every person will receive a booster vaccine this year, as countries haven’t determined the need or timing of boosters yet. We used these conservative assumptions to ensure that our dose sharing recommendation is achievable.
Vaccination campaigns in higher income countries are still ongoing. When should countries begin to share doses?
Ideally, starting now. Or at the very least, they can now make clear commitments with an established timeline for dose sharing.
Many high-income countries have already made incredible progress in their vaccine rollout. Most have been able to expand eligibility to all adults, and some countries are even vaccinating young people—often without any wait times. In these countries, we’re seeing vaccination rates slow as coverage expands and the vaccine supply simultaneously increases. Countries where that is happening can begin to share doses immediately without risk to their domestic vaccine campaigns. Of course, the situation will vary by country and policymakers need to consider their specific contexts.
Meanwhile, many lower income countries haven’t yet started their campaigns—or if they started, there are insufficient doses to cover even the most at-risk populations. The logistics of dose sharing aren’t trivial, and vaccine campaigns take time to scale up. That’s why it’s essential that high-income countries move to share doses as quickly as they can.
How should countries share doses?
While there are a number of ways that doses can be shared, we encourage countries to share doses through Gavi’s COVAX Advanced Market Commitment (AMC) whenever possible. Bilateral or regional sharing may help a few specific countries, but that approach won’t address the global risk posed by continued transmission in any single country. COVAX will facilitate the efficient sharing of doses and ensure that these doses are allocated equitably, based on principles set out by the global community.
Is dose sharing the only way to achieve equitable access to COVID-19 vaccines?
Dose sharing is one step that higher income countries can take in the near term. We, and many others, continue to also emphasize the importance of fully funding Gavi’s COVAX Advanced Market Commitment (AMC). The more resources COVAX receives, the quicker it can purchase large volumes of vaccines for use in lower income countries.
At the COVAX AMC Summit on June 2, Gavi aims to raise the additional funding that is so critical to expanding vaccine access worldwide. But because orders from COVAX will be behind those of higher income countries in the queue, it will take some time to purchase, receive, and distribute these vaccines to lower income countries. The excess doses that will be available in higher income countries throughout the year can be shared and reach people sooner.
Dose sharing through the COVAX AMC and fully funding its vaccine procurement efforts are the most promising avenues to quickly increase vaccine access in lower income countries. In the longer term, more comprehensive approaches that address the structural inequities in vaccine access between lower and higher income countries are necessary.
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