COVID-19 Vaccine Distribution: Safety, Efficiency, Equity

STEVE HENDERSHOT

It’s been more than a year since the World Health Organization declared COVID-19 a pandemic. And in a stunning display of innovation and collaboration, vaccines are rolling out. But the success of these efforts varies widely around the globe as project teams scramble to get shots into arms—and to do so quickly, safely, efficiently and equitably.

KATE ELDER

COVID-19 and all of the issues of access to COVID-19 vaccines are certainly at the forefront of everybody’s mind and certainly the top headlines in every outlet now because the world wants to come out of this pandemic. So never before have at least I experienced this sort of universal attention to trying to access a particular medical tool in real time, globally, with the expectations and the demands so high.

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STEVE HENDERSHOT

This is Projectified^®. I’m Steve Hendershot.

The COVID crisis has been marked by devastating twists and turns—outbreaks, breakthroughs and fluctuating curves. Now, with a handful of effective vaccines in tow—thanks to some amazing and fast-moving project development—the world has entered what could be a decisive step toward ending the pandemic. And indeed, vaccination campaigns are off and running in places like the United Arab Emirates, where 73 percent of adults have been vaccinated. In Chile, the U.S. and U.K., more than 80 out of 100 people have received at least one shot.

But much work remains. Outbreaks are raging across Brazil and India. And most of the world is still waiting for vaccines: The global average is just 20 shots per 100 people, and in many poorer countries it’s less than five—in much of sub-Saharan Africa, it’s less than one.

That imbalance led Tedros Adhanom Ghebreyesus, director-general of the WHO, to declare that “vaccine equity is the challenge of our time.” Potential solutions could include more wealthy countries sharing doses with poorer ones. Or there could be patent waivers, which would allow proprietary vaccines to be manufactured more broadly around the world.

Those are the pressing issues right now for Kate Elder, senior vaccines policy adviser for the Médecins Sans Frontières/Doctors Without Borders Access Campaign. I spoke to Kate about how her team is pushing for increased distribution and how they’re gearing up for the moment when her colleagues in the field can accelerate their efforts in countries that have thus far struggled to acquire vaccine doses at scale.

MUSICAL TRANSITION

STEVE HENDERSHOT

How is Médecins Sans Frontières, or MSF, helping COVID-19 vaccine distribution projects right now? Do you have your hands on any supply yet, or are you administering doses anywhere?

KATE ELDER

MSF has not bought any doses of COVID-19 vaccines, but we are supporting governments that do have supply in terms of rolling it out. Our colleagues in places like Lebanon, Palestine, many countries in sub-Saharan Africa, Malawi, Democratic Republic of the Congo, countries in West Africa, we’re supporting the government on the rollout of COVID-19 vaccines when they have them. Of course, in addition to doing many other areas of work on COVID in general, and also trying to acknowledge that there are many other diseases and there are many other health issues that don’t stop because of COVID, so trying to maintain our normal workflow. So it’s a very taxing time for our colleagues that are working in medical operations.

STEVE HENDERSHOT

How challenging is it just given, I know that there are some special storage issues and so forth with this. Is this taxing those developing countries in ways that other vaccines don’t, and are you needing to intervene in particular ways to make sure that they are able to do this correctly?

KATE ELDER

It’s certainly not an easy lift, I would say, but as an organization that has provided immunization services for 50 years, MSF and my colleagues in the field that really do the work, they’re very good at doing immunization programs. Of course, this is different, right? Typically in developing countries, the immunization program is by and large targeted at children. Of course, COVID vaccination is being rolled out for the adult population, the elderly population or the healthcare population first. It’s a different programmatic planning component. Yes, as you note, some of these vaccines require cold chain storage handling conditions that are exceptional because they are in what we call the mRNA technology. But those aren’t insurmountable challenges. There are other vaccines, the Ebola vaccine, which also has ultra-cold chain requirements, special handling conditions. So we can do it.

I think it’s important to note here, as I mentioned before, that COVID vaccination is happening, but we also want to maintain—where they can be safely delivered—other immunization services, because there are measles outbreaks that are ongoing. I mean, there’s Ebola right now, so there’s Ebola vaccination services happening right now. The package of childhood vaccinations is still needed. So, we’re also trying to maintain that to make sure there aren’t too many gaps, because if there are gaps in those other routine immunization programs, that’s just going to come back and result in outbreaks that are going to be very difficult to cope with. And there has been a notable impact on regular immunization services in developing countries because of COVID and the necessary precautions. Thankfully, some of those plans are getting back on track.

STEVE HENDERSHOT

We’re hearing more and more talk of COVID vaccine equity and the specific issues around it—how will vaccines be distributed, where will they be manufactured, patent waivers, etc. There are also global programs like COVAX, which aims to accelerate the development and manufacturing of COVID-19 vaccines and to make sure there’s fair and equitable access to countries around the world. What needs to happen with these vaccines to even out the supply and distribution?

KATE ELDER

We need to work on the imperfect solutions of redistribution of COVID-19 vaccines from the governments that have bought more than their fair share. That is an urgent move that should happen right now. That is charity. That is not a sustainable solution. That is when you are literally at your last straw, and it’s so desperate that you need to beg for something to be shared fairly. But it is the state that we’re in right now. So, we need to put pressure on those governments. They need to turn those verbal commitments of possibly sharing their doses into hard commitments of sending those doses to the global mechanism called COVAX. And then we need to be taking the steps to set the groundwork so that we don’t have this sort of situation again in the future.

So, there’s a lot of political talk right now about establishing vaccine manufacturing capacity in places where it hasn’t been before. There’s a lot that needs to go behind that. There’s a lot on the political side and there’s a lot on the technical side, but those steps need to be taken too in tandem with sharing the doses so that we’re in a much better position in the future and we don’t repeat this situation. I guess that’s the question. Are we going to learn that lesson, or are we just going to tie ourselves to repeating it in the future?

STEVE HENDERSHOT

Are you part of those advocacy efforts? What can you do to sort of tip the scales?

KATE ELDER

Médecins Sans Frontières/Doctors Without Borders is part of those discussions. We, of course, first and foremost are a medical humanitarian organization, and our core work is to deliver medical care. That is our raison d’être. That’s our reason for existing. The bulk of our work is in firsthand dealing with people, with patients, that need treatment for many other things besides COVID, but also COVID. But we also have an element of our work, which is to try and change that system, to try and improve it so that people like the people we serve aren’t left behind by the global research and development system. And so, we are. We are involved in the work around reforming intellectual property. We’re involved in the work around pushing, advocating for governments to set aside some of their doses, to share their doses. We are involved in the push to share technology, what’s called technology transfer, and share the know-how.

STEVE HENDERSHOT

In terms of diversifying where vaccines are produced, what’s your strategy to help bring that about?

KATE ELDER

The strategy is through bilateral work, through public communications and campaigning, and then through working with governments to amplify the voices of those that want to make a change. It’s really amazing when you look at the steps in some regions, like for example, the Africa region has created its own procurement task force. They’re trying to take the power in their own hands to negotiate with industry, to buy vaccines for continental Africa. They’re speaking very vocally about the need to use this pandemic and not repeat this in the future, to establish indigenous manufacturing capacity, to accelerate the capacity they have on the continent. And there is existing vaccine production capacity in Africa. There’s capacity in South Africa, in Senegal, in North Africa in a couple of countries, and these companies have been doing this work for a long time. They just need a boost to it. So working with the regional bodies there and the governments themselves to see how can we be of service to them in advancing those goals, those goals that are needed. So that’s what I mean in terms of the advocacy work around diversifying manufacturing capacity.

This is a long-term plan, too, I just want to note that. There are not any quick wins in establishing vaccine manufacturing capacity. There are great opportunities. I think the exciting thing about this mRNA technology, the products that Moderna has, the products at Pfizer, BioNTech, that CureVac—we’re eagerly awaiting the clinical trial data of CureVac’s product. This mRNA platform is amazing for many reasons, but one of them primarily being that this way of developing vaccines, you can transfer the technology and the know-how, and you can have a new production plant that’s never made vaccines before up and running and making vaccines in six months or a little more. That is incredible. We’re really focusing on that mRNA technology right now, because we think it provides incredible opportunity.

STEVE HENDERSHOT

What have you learned so far? Obviously, especially in the Doctors Without Borders portfolio of countries, this effort is young, but what have you learned from the pandemic vaccine experience either to take forward or things that you know need to change in a way that maybe the solution is still out there, but you’ve discovered a newly articulated pain point?

KATE ELDER

From the global level, I’d say we’ve learned very clearly that the way we develop medical innovations, the way we share the fruits of that innovation, needs to drastically change. That your best laid intentions really don’t deliver if you don’t change things significantly.

As an example, where the U.S. government poured $12 billion-plus of our taxpayer money into the development of COVID-19 vaccines, into the at-risk manufacturing scale-up, that means just giving money to companies to tell them to start building manufacturing capacities, start producing vaccines that the public finances, and then purchasing it in advance, rights to a certain volume of those doses. That money, that $12-plus billion, if we don’t put strings attached to that to make sure that we have a global dimension of how we share the fruits of that medical innovation, then we will end up in this position again.

I think everybody’s on the same page that we’re in unprecedented times. Everybody seemed to be on the same page that we needed to do things differently, but they just didn’t take the action to do the really hard work, to push the envelope against the status quo. There’s amazing work happening right now. There is unprecedented pushes to try and change the system. I think what’s outstanding is how much are we going to really move the needle on that?

STEVE HENDERSHOT

In a global effort like this—I mean, we’re talking about the WHO leading and advocating, but then when you switch to the 12 billion, that’s U.S. dollars—the difference between the individual government investments and the sort of global coalition course setting, how do you merge those things and get everybody to make that commitment together?

KATE ELDER

That’s hard. I don’t want to pretend that any of this is easy work. Because governments have a commitment to their constituents, and they will tend to prioritize their constituents over commitments and obligations to others. So I understand the political imperative that many of these leaders are operating under. I do hope that they wisely acknowledge just what the pandemic has taught us, that something starts in a certain country and within a matter of a very short period of time, we are all drastically affected by it.

This is the whole reason why it’s so important to engage in multilateral institutions—coming together, the platforms where governments work together and where they broker and hash out agreements. There were attempts to do this in terms of arbitrating the availability of COVID-19 vaccines. That entity is called COVAX. There are now discussions about a global pandemic treaty, and that is very actively under discussion right now, and G7, G20 leaders are talking about those things, too. There are processes happening, of course, at the World Trade Organization around the management of intellectual property, and the World Trade Organization is an intergovernmental, a multilateral institution. So those are the platforms where the change needs to happen. It’s there. I think what’s most important is making sure that every voice has equal weight.

MUSICAL TRANSITION

STEVE HENDERSHOT

This potential turning point in the battle against COVID comes because of some extraordinary projects to create and distribute the vaccines. But it’s also clear that in many countries, those rollouts have yet to meaningfully get underway. They’re mostly waiting on doses. And the longer they wait, the more it becomes clear that in this global, all-hands-on-deck effort, the playing field isn’t level. Addressing challenges from vaccine supply gaps to vaccine hesitancy, and ultimately ending this crisis, will require yet more breakthrough innovation.

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