Kenyan politicians were ecstatic when their first COVAX vaccines landed at a Nairobi airport this week. “It’s truly a great day for Kenya,” Health Minister Mutahi Kagwe told the media. “We now have the equivalent of a bazooka or a machine gun in our fight against the virus.”
But in the battle against COVID-19, the bazookas are unlikely to be enough for victory. Under the plans announced by the Kenyan government, just 30 per cent of the country’s people are to be vaccinated over the next two years – far less than the percentage who will be vaccinated in wealthier countries this year alone.
Kenya, like most of the world’s developing countries, is heavily dependent on vaccines from COVAX, a global program of pooled purchasing. And there is growing evidence that this idealistic initiative of international solidarity will not be enough for the developing world to achieve the goal of herd immunity in the foreseeable future, even as richer countries expect to reach that goal this year.
Canada pre-purchased millions of doses of seven different vaccine types, and Health Canada has approved four so far for the various provincial and territorial rollouts. All the drugs are fully effective in preventing serious illness and death, though some may do more than others to stop any symptomatic illness at all (which is where the efficacy rates cited below come in).
- Also known as: Comirnaty
- Approved on: Dec. 9, 2020
- Efficacy rate: 95 per cent with both doses in patients 16 and older, and 100 per cent in 12- to 15-year-olds
- Traits: Must be stored at -70 C, requiring specialized ultracold freezers. It is a new type of mRNA-based vaccine that gives the body a sample of the virus’s DNA to teach immune systems how to fight it. Health Canada has authorized it for use in people as young as 12.
- Also known as: SpikeVax
- Approved on: Dec. 23, 2020
- Efficacy rate: 94 per cent with both doses in patients 18 and older, and 100 per cent in 12- to 17-year-olds
- Traits: Like Pfizer’s vaccine, this one is mRNA-based, but it can be stored at -20 C. It’s approved for use in Canada for ages 12 and up.
- Also known as: Vaxzevria
- Approved on: Feb. 26, 2021
- Efficacy rate: 62 per cent two weeks after the second dose
- Traits: This comes in two versions approved for Canadian use, the kind made in Europe and the same drug made by a different process in India (where it is called Covishield). The National Advisory Committee on Immunization’s latest guidance is that its okay for people 30 and older to get it if they can’t or don’t want to wait for an mRNA vaccine, but to guard against the risk of a rare blood-clotting disorder, all provinces have stopped giving first doses of AstraZeneca.
- Also known as: Janssen
- Approved on: March 5, 2021
- Efficacy rate: 66 per cent two weeks after the single dose
- Traits: Unlike the other vaccines, this one comes in a single injection. NACI says it should be offered to Canadians 30 and older, but Health Canada paused distribution of the drug for now as it investigates inspection concerns at a Maryland facility where the active ingredient was made.
How many vaccine doses do I get?
All vaccines except Johnson & Johnson’s require two doses, though even for double-dose drugs, research suggests the first shots may give fairly strong protection. This has led health agencies to focus on getting first shots to as many people as possible, then delaying boosters by up to four months. To see how many doses your province or territory has administered so far, check our vaccine tracker for the latest numbers.
While wealthy countries have donated millions of dollars to COVAX, some of those same countries – including Canada – have then bypassed the global program to strike their own bilateral deals with COVAX suppliers.
In recent days, Canada and Britain have announced deals to purchase AstraZeneca vaccines from the Serum Institute of India – the biggest single supplier to COVAX and the main supplier for African countries such as Kenya, Ghana, Zambia, Nigeria and many others.
Canada is buying two million doses from the Serum Institute, while Britain is obtaining 10 million. The European Union is also reportedly considering possible purchases from the same source.
Critics say these deals will weaken COVAX by reducing the supply of vaccines available for the program to purchase, while also creating pressure for prices to rise.
Patricia Skinner, a spokeswoman for the Global Affairs Department, said Canada has received assurances from the Indian manufacturer that the Canadian deal “will not have an impact” on its other agreements, including COVAX.
But the World Health Organization’s director-general, Tedros Adhanom Ghebreyesus, has made it clear that he disapproved of the bilateral deals, although he did not explicitly mention Canada or Britain.
“We need to accelerate the supply and distribution of vaccines, and we cannot do that if some countries continue to approach manufacturers who are producing vaccines that COVAX is counting on,” Dr. Tedros told a media briefing last Friday, the same day Prime Minister Justin Trudeau announced the deal with the Serum Institute.
“These actions undermine COVAX and deprive health workers and vulnerable people around the world of life-saving vaccines,” Dr. Tedros said.
Kate Elder, senior vaccines policy adviser at Médecins sans Frontières (Doctors Without Borders), said the deals by Canada and Britain are unhelpful to COVAX and a contradiction of the WHO’s principles.
“At any point in time, there’s a finite supply, a constrained landscape,” she told The Globe and Mail in an interview. “If you take from one source, you’re taking away from someone else, that’s just the reality. It does undermine COVAX.”
Canada had earlier sparked controversy by deciding to buy vaccines from the COVAX program – making it one of the few wealthy countries to exercise provisions to do so. Under an updated plan announced this week, Canada will receive 1.6 million AstraZeneca doses from the program within the next three months.
U.S. President Joe Biden has said that he expects the United States to have enough vaccines for its entire adult population by the end of May. This makes it increasingly likely that healthy young Americans will be vaccinated before high-risk groups in many poorer countries – an example of the “tremendous inequity” in global vaccine distribution, Ms. Elder said.
Under the COVAX program, lower-income countries are scheduled to receive enough vaccines for 20 per cent of their population. “There’s no way to get rid of COVID with 20-per-cent vaccination – we need at least 60 per cent,” said John Nkengasong, director of the Africa Centres for Disease Control and Prevention, in a recent interview with the Mail & Guardian, a South African newspaper.
He warned of a segregated world where the wealthier countries will vaccinate their populations and then use travel bans to block visitors from lower-income countries.
“Europe is trying to vaccinate 80 per cent,” he noted. “The United States is trying to vaccinate everybody. They will finish vaccinating, impose travel restrictions, and then Africa becomes ‘the continent of COVID.’ ”
Over the past week, COVAX shipments have begun to arrive in a growing number of African countries. The program is scheduled to deliver 237 million vaccine doses by the end of May – but this will cover less than 3 per cent of the population in the recipient countries.
At a briefing this week, top COVAX officials acknowledged that the program is hindered by delays, including the need for regulatory approvals and the demand from manufacturers such as Pfizer for indemnification agreements so that they are not held legally liable for adverse events.
“It’s the complexity of not only getting prequalification, but approvals and shipping, and so some of the timelines have slipped,” said Seth Berkley, chief executive of the global vaccine alliance GAVI and a senior partner in COVAX.
“Pfizer has required countries to do some additional work on the deliveries and some of the indemnification and liability issues and that has taken more time, and that’s one of the reasons there has been a delay.”
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