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 percent of the population in all countries against covid-19 to June 2022.
Now, it is clear that the world will not reach that goal before the deadline. 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 funding from the U.S. States are exhausted and both governments and donors turn to other priorities.
“The reality is that there is a loss of momentum,” said Dr. Isaac Adewole, a former Nigerian health minister who now serves as a consultant to the African Centers for Disease Control and Prevention.
Only a few of the 82 poorest countries in the world, including Bangladesh, Bhutan, Cambodia and Nepal — have reached the 70 percent vaccination threshold. Many are below 20 per cent, according to data compiled from government sources by Oxford University’s Our World in Data project.
By comparison, about two-thirds of the world’s richest countries have reached 70 percent. (The United States has 66 percent.)
The consequences of giving up on achieving high vaccination coverage worldwide could 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 far from over yet, and it is imperative that countries use available doses to protect as many of their populations as possible,” said Dr. Seth Berkeley, executive director of Gavi, the nonprofit organization. company that runs the global vaccine clearinghouse Covax.
Countries in different parts of the world, including some in Eastern Europe and the Middle East, have seen their vaccination rates plateau in recent months at a third or less of their populations. But Africa’s vaccination rate remains the most dismal.
Fewer than 17 percent of Africans have 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 fell 35 percent compared to February. WHO officials attributed the drop to mass vaccination campaigns being replaced by smaller-scale campaigns in several countries.
Some global health experts say the world missed a golden 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 the vaccines weren’t there. And then they realized that without the vaccination, they didn’t die,” said Dr. Adewole, who wants countries to continue with the 70 percent goal.
Remaining momentum in the global vaccination campaign has been hampered by a shortfall in funding the equipment, transportation and personnel needed to vaccinate weapons.
In the United States, a key funder of the vaccination effort, lawmakers have cut $5 billion earmarked for global pandemic aid from the coronavirus response package that is expected to come to a vote in the coming weeks. Biden administration officials have 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 reasons for optimism that the global vaccination campaign is still going strong. Despite the drop from the February peak, the number of Covid vaccines given each day in Africa is still close to a pandemic high. And earlier this month, Gavi attracted a significant new round of funding commitments, securing $4.8 billion in commitments, though it fell short of its $5.2 billion target.
There is also hope that a global Covid summit the White House plans to host next month will be an opportunity to build momentum and funding.
But the drop in public demand has led some officials and health experts to quietly, and in some cases openly, question whether the 70 percent vaccination target is feasible or even sensible.
Reported deaths from Covid-19 remain comparatively low in sub-Saharan Africa, although there is debate about how much of this reflects poor data tracking. However, the perception in many countries in the region is that the disease does not represent a serious threat, certainly not as serious as other widespread health problems that require attention with limited health care resources.
Many low-income governments are focusing on their economies and other health issues like HIV, said Fifa Rahman, a civil society representative on a WHO-launched group coordinating the global Covid response. “There is a feeling of many competing priorities, but that is a symptom that the momentum has gone. Because when the momentum was there, everyone was like, ‘Where are our vaccines?’”
In rural areas of the Democratic Republic of the Congo, for example, where the reported covid mortality rate is very low, there is an increase in measles cases that threaten 20 million children. However, the government says it cannot spare the resources to provide additional 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 diverting resources to widespread Covid vaccination, he said.
As African governments have received more vaccine donated by rich countries and struggle to distribute even those supplies, their interest in ordering more doses has waned.
The African Union still aims to vaccinate 70 percent of its population by the end of 2022. But since countries are slow to run out of donated vaccines, the bloc has not exercised its options to order more doses of Johnson & Johnson’s shots. and Modern.
South African drugmaker Aspen Pharmacare earlier this year finalized a deal to bottle and market Johnson & Johnson’s vaccine in Africa, a deal that was heralded as a first step toward developing a robust vaccine production industry in Africa. . 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, stopped its production of Covid injections in December last year, when its stockpile rose to 200 million doses; Bharat Biotech, another Indian company that was a major producer, has also stopped making vaccines due to low demand. The companies say they have had no more orders since ending their contracts with the Indian government in March.
After the WHO began promoting the 70 percent 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 known to offer very strong protection against even mild illness, and there was still hope that achieving high levels of vaccination coverage would control the virus. But the emergence of new variants and the spread of the virus in Africa changed the calculus.
Vaccine regimens that had been planned for the developing world offered little protection against infection with the Omicron variant. And with sub-Saharan African countries locked out of vaccine distribution for much of the past year, more and more Africans gained protection against the virus from natural infection, which studies have shown works as well as two doses of mRNA to prevent infection. New data from the WHO shows that at least two-thirds of Africans had been infected with the virus before the Omicron wave.
Given these factors, some public health experts in Africa say the broad target of 70 percent no longer makes sense. “It has very little value. In fact, we will gain much more by reaching more than 90 percent of people over the age of 50,” said Shabir Madhi, professor of vaccinology and dean of the school of health sciences at the University of the Witwatersrand in Johannesburg. About two-thirds of South Africans over the age of 50 are currently fully vaccinated.
Dr. Madhi said South Africa could shut down mass vaccination sites and instead redouble its efforts to target the most vulnerable at church services and government offices that pay monthly pension benefits.
Katherine O’Brien, who leads 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 set of 70 percent” of their populations. The aspiration, he said, has always been “100 percent of health workers, 100 percent of older adults, 100 percent of pregnant women, 100 percent of people who fall into those groups. higher risk”.
Of course, countries can make decisions about which health goal they want to prioritize, Dr. O’Brien said, but limited resources shouldn’t be an obstacle to vaccinating against the coronavirus. “The world has enough resources to do this, if countries want to do it,” he said. “And that should really be the North Star.”
Some public health experts said that while the 70 percent vaccination threshold clearly cannot be reached by the original deadline, it would be unwise and unethical to forgo that goal over a longer time horizon. They expressed frustration at the growing gap between rich countries that vaccinate young children and offer healthy adults a fourth dose of vaccine, and regions where most people still don’t have a dose.
“Why are we making it a target for high-income countries and a target for low-income countries?” said Dr. Ayoade Alakija, co-chair of the African Union’s vaccine delivery programme.
He said that even though many people in sub-Saharan Africa have been infected, the additional protection that would come from a high level of vaccination coverage is still needed.
The modest vaccination coverage, he said, “is not considered a good enough level of protection in England, it is not considered a good enough level of protection in the United States. How is it okay not to aim for the maximum, the maximum that we can? Aim for the sky and climb to the top of the tree.