Midway through last year, the World Health Organization began promoting an ambitious goal, one it believes was essential to ending the pandemic: to fully vaccinate 70 percent of the population in every country against Covid-19 by June 2022.
Now it is clear that the world will fall far short of that target by the deadline. And there is a growing sense of resignation among public health experts that high Covid vaccination coverage in most low-income countries may never be achieved as much-needed funding from the United States dries up 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 Africa Centers for Disease Control and Prevention.
Just some of the 82 poorest countries in the world – including Bangladesh, Bhutan, Cambodia and Nepal — have reached the 70 per cent vaccination threshold. Many are below 20 percent, according to data collected from government sources by the Our World in Data project at the University of Oxford.
By comparison, about two-thirds of the world’s richest countries have reached 70 percent. (The United States is at 66 percent.)
The consequences of giving up on achieving high vaccination coverage worldwide can be serious. Public health experts say the cessation of the global effort could lead to the emergence of dangerous new variants that would threaten the world’s precarious attempts to live with the virus.
“This pandemic is not over — far from it — and it is imperative that countries use the available doses to protect as much of their populations as possible,” said Dr. Seth Berkeley, CEO of Gavi, the nonprofit that runs the global vaccine clearinghouse Covax.
Countries in various parts of the world, including some in Eastern Europe and the Middle East, have seen their vaccination rates stagnate in a third or less of their populations in recent months. But Africa’s vaccination rate remains the most bleak.
Less than 17 percent of Africans have received a primary Covid vaccination. Nearly half of the vaccine doses delivered to the continent so far have gone unused. Last month, the number of injected doses on the continent dropped 35 percent from February. WHO officials attributed the decline to mass vaccination campaigns that were replaced by smaller-scale campaigns in several countries.
Some global health experts say the world missed an excellent opportunity to provide vaccines to lower-income countries last year when the public was more fearful of Covid and motivated to get vaccinated.
“There was a time when people were really desperate to get vaccinated, but the vaccines weren’t there. And that’s when they realized they wouldn’t die without the vaccine,” says Dr Adewole, who wants countries to continue pursuing the 70 percent target.
The momentum remaining in the global vaccination campaign has been hampered by a lack of funding for the equipment, transport and personnel needed to fire up arms.
In the United States, a major funder of vaccination efforts, lawmakers have stripped $5 billion earmarked for global pandemic relief from the coronavirus response package expected to go to a vote in the coming weeks. Biden administration officials have said they cannot support the delivery of vaccines to more than 20 undervaccinated countries without the funds.
Some public health experts are pointing to reasons for optimism that the global vaccination campaign is still picking up steam. Despite falling from the February peak, the number of Covid vaccinations administered each day in Africa is still close to a pandemic. And Gavi made a major new round of funding commitments earlier this month, securing $4.8 billion in pledges, though it fell short of its $5.2 billion target.
There is also hope that a global Covid summit that the White House plans to co-host next month could be an opportunity to generate momentum and funding.
But the decline in public demand has left some health officials and experts quietly and in some cases outright questioning whether the 70 percent vaccination target is achievable or even sensible.
The reported death toll from Covid-19 remains relatively low in sub-Saharan Africa, although there is debate about how much of this is due to poor data recording. However, the perception in many countries in the region is that the disease poses no serious threat, certainly not as much as other ubiquitous health problems that demand attention with scarce healthcare resources.
Many lower-income governments are turning their attention to their economies and other health problems such as HIV, said Fifa Rahman, a civil society representative with a WHO-launched group coordinating the global Covid response. “There’s a sense of a lot of competing priorities, but that’s a symptom that the momentum is gone. Because when the momentum was there, everyone thought, ‘Where are our vaccines?’”
In rural areas of the Democratic Republic of Congo, for example, where the reported Covid death rate is very low, there is an increase in measles cases threatening 20 million children. Still, the government says it cannot afford to miss the resources to provide additional measles vaccinations this year, said Christopher Mambula, MSF medical manager in East Africa. In this kind of context, there’s little point in continuing to spend resources on widespread Covid vaccination, he said.
As African governments have received more vaccines that come from 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 the population by the end of 2022. But with countries slow to use up the donated vaccines, the bloc has not exercised its options to order more doses of the injections from Johnson & Johnson and Moderna.
South African drugmaker Aspen Pharmacare signed a deal earlier this year to bottle and market the Johnson & Johnson vaccine across Africa, a contract announced as an early step toward developing a robust vaccine manufacturing industry in Africa. Aspen is ready for production, but no buyers, including the African Union and Covax, have placed orders yet, said Stephen Saad, Aspen’s CEO.
The Serum Institute of India, the world’s largest vaccine producer, stopped producing Covid shots last December, as the stock grew to 200 million doses; Bharat Biotech, another Indian company that was a major producer, also stopped making vaccines due to low demand. The companies say they are out of orders since their contracts with the Indian government expired in March.
After the WHO began promoting the 70 percent vaccination target, many lower-income governments adopted the target for their own populations. The Biden administration also approved it last September and set a deadline of September 2022.
At the time, two doses of Pfizer and Moderna’s vaccines were believed to provide very strong protection against even mild illness, and there was still hope that achieving high vaccination coverage would tame the virus. But the emergence of new variants and the spread of the virus in Africa changed the calculus.
The vaccine regimens planned for the developing world offered little protection against infection with the Omicron variant. And as sub-Saharan African countries were banned from vaccine distribution for much of last year, more and more Africans were given protection against the virus from natural infection, which studies have shown work as well as two doses of mRNA. preventing infection. New data from the WHO shows that at least two-thirds of Africans were 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 little value. In fact, we will gain a lot more by reaching more than 90 percent of people over the age of 50,” said Shabir Madhi, professor of vaccinology and dean of the Faculty of Health Sciences at the University of 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 track down the most vulnerable at church services and government offices that pay monthly pension benefits.
Katherine O’Brien, who leads WHO’s work on vaccines and inoculations, said the agency is encouraging countries to focus on their most vulnerable citizens rather than “an arbitrary 70 percent” group of their citizens. population to be vaccinated. The ambition she said has always been “100 percent of health professionals, 100 percent of older adults, 100 percent of pregnant women, 100 percent of people who fall into those groups at the highest risk.”
Countries can, of course, make decisions about which health goal to prioritize, said Dr. O’Brien, but finite resources should not be an obstacle to coronavirus vaccination. “The world has enough resources to do this, if countries want it,” she said. “And that really should be the North Star.”
Some public health experts said that while the 70 percent vaccination threshold is clearly not achievable by the original deadline, it would be unwise and unethical to abandon that target over a longer time horizon. They expressed frustration at the growing gap between wealthy countries that vaccinate young children and offer healthy adults a fourth dose of vaccine, and the regions where the majority of people still don’t have a single dose.
“Why are we making it a target for high-income countries and a target for low-income countries?” said Dr. Ayoade Alakija, a co-chair of the African Union’s vaccine delivery program.
She said that while many people in sub-Saharan Africa are infected, there is still a need for the extra protection that would come from high vaccination coverage.
Modest vaccination coverage, she said, “isn’t considered a high enough level of protection in England, it’s not a high enough level of protection in America. How is it OK not to aim for the maximum, the maximum we can? Aim for the sky and reach the top of the tree.”
