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People work inside the UNICEF warehouse in Copenhagen, Denmark, on Oct. 13, 2020.The Associated Press

Nearly two billion doses of COVID-19 vaccines have been secured for lower-income countries, doubling the previous supply, but there are still key questions about the affordability and availability of the vaccines for the developing world.

The expanded supply under the COVAX program will allow 190 countries to begin vaccinating their most vulnerable people in the first half of next year, global health officials said at an online briefing on Friday. But for many of the poorest countries, the vaccines are expected to cover a maximum of one-fifth of their population by the end of 2021.

While vaccination has already begun in a few wealthier countries, including Canada, there are widespread concerns about the uncertainties of vaccine distribution in Africa and other parts of the developing world. The South African government has complained of “vaccine apartheid” and “chasms of inequity” in the deals signed by pharmaceutical companies with rich countries.

Canada has sparked criticism by signing deals to secure up to 414 million doses of various vaccines – up to five times more than its population requires.

Prime Minister Justin Trudeau promised this week that Canada would share any surplus with the rest of the world. But his government has not explained whether these donations would be delayed until the completion of Canada’s full vaccination program, or whether they could begin sooner – a key question for developing countries that are desperately awaiting the vaccines.

When will Canadians get COVID-19 vaccines? The federal and provincial rollout plans so far

Karina Gould, Minister of International Development, did not answer this question when it was asked by a journalist at the online briefing on Friday. Her press secretary, Guillaume Dumas, also declined to answer when asked by The Globe and Mail.

“We will absolutely donate any vaccine excess capacity Canada has,” Ms. Gould said. “However, we will be taking it a day at a time. We have approvals in Canada for just one vaccine at the moment, and doses are just starting to arrive.”

Under the COVAX distribution plan for lower-income countries, deliveries of vaccines will probably begin in the first quarter of next year, depending on regulatory approvals and the readiness of countries, the health officials said in their announcement.

The vaccines from the COVAX program in the first half of 2021 should be enough to protect health and social care workers, they said. There would then be further deliveries in the second half of next year and in 2022.

The expanded supply of nearly two billion doses is a result of new deals between COVAX and several leading producers. “For the vast majority of these deals, COVAX has guaranteed access to a portion of the first wave of production,” the officials from the World Health Organization and other agencies said.

The United Nations children’s agency, UNICEF, announced on Friday that it could transport up to 850 tonnes of COVID-19 vaccines each month for lower-income countries next year. This is a “mammoth and historic undertaking,” UNICEF executive director Henrietta Fore said.

The distribution of vaccines is “a glimpse of the light at the end of the tunnel,” said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization. “But we will only truly end the pandemic if we end it everywhere at the same time, which means it’s essential to vaccinate some people in all countries, rather than all people in some countries.”

The Canadian government announced this week that it will provide $485-million to support COVID-19 vaccines, tests and treatments in low-income and middle-income countries.

“We need to make sure that all countries are able to roll out COVID-19 vaccines to immunize their health workers and their highest-risk populations as soon as possible,” Ms. Gould told the briefing on Friday.

But there are still key problems. The COVAX organizers estimate that it needs to raise an additional US$6.8-billion next year for its vaccine goals. And there are still uncertainties about the cost of the vaccines in the developing world, partly because of secrecy in the agreements between COVAX and the vaccine producers.

In another sign of the challenges ahead, South African scientists announced on Friday that a new variant of COVID-19 has become the main driver of the country’s second wave of the pandemic, making it potentially worse than the first wave. This will oblige researchers to verify whether the current vaccines will be effective on the new variant, they said.

Health advocacy groups, which had raised concerns about “vaccine hoarding” by wealthy countries, said they were pleased by Friday’s announcement of an expanded COVAX supply. But they noted that COVAX by itself will be insufficient for the world’s most vulnerable people.

“It will depend on whether the corporations agree to the right price and donors give them enough money to pay for it,” said Niko Lusiani, a senior adviser to Oxfam, in a statement on Friday.

“Lack of transparency continues to leave too much room for doubt. Rich country charity and vaccine donations are not sustainable solutions. … Sharing the crumbs from the table does not fix the real barriers to addressing the vaccine inequality crisis.”

Jason Nickerson, humanitarian affairs adviser at Médecins Sans Frontières (Doctors Without Borders), said it will probably take months for high-risk people in developing countries to have the same vaccine access as health workers who are being immunized today in Canada.

It’s difficult to determine whether the COVAX vaccine contracts are fair, since the terms and prices are still not public, Dr. Nickerson told The Globe and Mail.

The initial COVID-19 vaccinations in Canada and around the world raise questions about how people react to the shot, how pregnant women should approach it and how far away herd immunity may be. Globe health reporter Kelly Grant and science reporter Ivan Semeniuk discuss the answers.

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