US vaccine nationalism puts us all in quagmire

It is a global pandemic and so united efforts are needed to stop it from wreaking havoc. This was the concept behind World Health Organisation-backed Covax, a vaccine sharing programme to ensure that lower income nations also have access to coronavirus vaccines.

But, the US administration in the first week of February this year announced its plan to use the Defence Production Act that gives the president "broad industrial mobilisation powers", as reported by The Economist, to ban exports of raw materials that are critical for vaccine production.

That led to Adar Poonawalla, chief executive officer of Serum Institute of India, tweeting, "If we are to truly unite in beating this virus, on behalf of the vaccine industry outside the US, I humbly request you to lift the embargo of raw material exports out of the US."

 All these are happening when a second wave is sweeping across India, raising the number of caseloads and deaths.

Grappling to bring the situation under control within its own territory, India stopped supplying vaccine doses to Covax and exports to the countries it had made deals with.

India's immunisation programme has just covered over 1% of its 1.3 billion people, according to John Hopkins University, and now it is trying to mobilise all its resources to vaccinate its own population.

The stymied supply of raw materials to India from the US will have larger impacts than what might be thought of in other parts of the world because India produces 60% of all vaccines sold globally.

And Serum Institute is a major player in the Covax initiative for supplying doses of AstraZeneca and Novavax vaccines to 92 low and middle-income nations. Bangladesh is one of them.

According to a tripartite agreement between the health ministry, Beximco Pharmaceuticals and Serum Institute, Bangladesh was supposed to get 50 lakh doses of AstraZeneca vaccine a month from January to June.

But, the country received only 1.2 crore doses, including gifts. It is yet to get 30 lakh doses of February and 50 lakh doses of March and April as per the agreement. When the next consignment will arrive is uncertain.

Meanwhile, 13.6 lakh people have been given the second shot since 7 April and more than 57 lakh citizens have got the first shot.

With a little over 31 lakh doses in the stock, the recipients of the first jab are facing an uncertainty whether they would get the second shot on time, which is necessary to get desired protection against the novel coronavirus.

"It is the authorities' obligation now to make second doses available for those who have got the first jab," said Prof Sayedur Rahman, chairman of the Department of Pharmacology at Bangabandhu Sheikh Mujib Medical University.

Vaccination has turned into a diplomatic issue to form future global economic alliances, he said, adding that it was a mistake on the part of Bangladesh not to take part in any vaccine trial process and not to look for more options.

Sayedur fears that the country is at risk of developing unique strains of the virus for running a vaccination programme without strict restrictions on public movement.

If the concern is translated into reality, a quick economic recovery is inconceivable. Bangladesh will be standing with many other countries in such a situation of misery.

On 24 March, Micheál Martin, Ireland's prime minister, warned that export bans – not just from America – would undermine global vaccine production, noting that Pfizer vaccine involves 280 components from 86 suppliers in 19 countries, according to a recent report of The Economist.

The US embargo is intended to ensure that American pharmaceutical companies have raw materials and equipment necessary to roll out more vaccines. But the restrictions are appalling when many American states have a surplus of vaccines with one in three doses going unused.

The world could wipe out the virus, should the vaccines be equally accessible. As many as 14 billion vaccine doses would have been manufactured this year only without any hindrance to the production lines. 

When the ban is in effect, it is not even easy to get substitutes because those have to be approved by regulatory bodies and quality of the materials is a matter of concern.

As Nirmal Kumar Ganguly, former director general of Indian Council of Medical Research said, the vaccine formulas and required materials "cannot be changed overnight".  India "has the capacity to produce," but supply chains have been disrupted, he said.

Against this backdrop, rich countries will successfully reduce the health and economic threats caused by the virus, while poor nations will have to deal with them for long, said Be-Nazir Ahmed, a member of the National Immunisation Technical Advisory Groups. S

Bangladesh has failed to put in place transmission-containing mechanisms, such as test, trace, isolation, quarantine and social distancing and has been highly depending on the vaccination programme.

Since rich countries are equally or more affected by the pandemic, it is expected that poor nations will fall behind them in the race of acquiring vaccine doses, Be-Nazir said.

"As soon as the lockdown is lifted, public movement will resume and the cycle of virus transmission will ramp up again. Unfortunately, I don't see it possible to vaccinate a large part of the population by the end of this year."

To achieve herd immunity, more than 70% of the population will have to be inoculated within a year, Prof Sayedur said.

"It is not realistic. Even if we get vaccines from other sources, we are not going to get the volume we need. So, we will have to focus on breaking the chain of transmission by containing it in hotspot areas and strictly enforcing measures like wearing masks," he added.