Why Delayed Developing Nation Covid Vax Risks Prolonging Pandemic

Disparities in vaccination could depress demand and disrupt supply chains, extending the pandemic by a year or more. 

Until there is evidence that the entire world is making progress against Covid, caution will dominate the global economy. JL

Saeed Shah and colleagues report in the Wall Street Journal:

In the race to vaccinate against Covid-19, developing countries are running behind as mutations of the virus make it harder to catch up, (which) could spell another year of humanitarian and economic misery. Failure to inoculate all countries could cost advanced economies $2.6 trillion, far more than the cost of supplying global vaccines. Supply disruptions and low demand for exports (could persist) long after populations are inoculated if economies don’t recover quickly. 130 countries are yet to administer a single dose. The disparity could slow the global economic recovery and prolong the pandemic, by creating pockets of infection that could become breeding grounds for mutations.

In the race to vaccinate the world against Covid-19, developing countries are running dangerously behind as mutations of the virus make it harder to catch up—a situation that could spell at least another year of humanitarian and economic misery for poor nations.

The U.S. has now administered vaccine doses to about 12% of its population, while Europe has reached about 5%. But in South America, just 1.8% of the population had been given a vaccine by this week, while Asia reached 1.5% and Africa 0.1%, according to Our World in Data, a project based at Oxford University.

Almost 130 countries are yet to administer a single dose, the World Health Organization said recently. Just two countries in sub-Saharan Africa—the Seychelles and Mauritius—have started vaccinating a substantial proportion of front-line workers, though others are likely to roll out shots in the coming days.

The critically short supply of vaccines for poorer nations risks being curtailed further by the emergence of new variants of the virus, including in South Africa and Brazil, that appear to make some of the vaccines that have been secured less effective. Large parts of Africa and some countries in Latin America and Asia are unlikely to cover most of their populations before 2023 or 2024, experts say.

COUNTRY	PEOPLE WITH AT LEAST ONE DOSE	SHARE OF POPULATION GIVEN AT LEAST ONE DOSE▼
World	109,051,901	1.4%
Israel	4,250,643	49.1%
Seychelles	41,839	42.5%
United Kingdom	17,247,442	25.4%
Jersey	22,696	22.5%
Guernsey	12,045	18.0%
Bahrain	271,749	16.0%
Chile	2,818,147	14.7%
United States	42,809,595	12.8%
Serbia	805,000	11.8%
Malta	42,231	9.6%
United Arab Emirates	836,568	8.5%
Morocco	2,447,716	6.6%
Turkey	5,503,094	6.5%
Switzerland	474,437	5.5%
Denmark	299,335	5.2%
Norway	278,379	5.1%
Finland	276,280	5.0%
Slovakia	255,972	4.7%
Estonia	61,316	4.6%
Poland	1,743,841	4.6%
Iceland	15,644	4.6%
Greece	465,842	4.5%
Lithuania	121,113	4.5%
Hungary	427,309	4.4%
Slovenia	91,678	4.4%
Cyprus	37,570	4.3%
Singapore	250,000	4.3%
Romania	788,508	4.1%
Portugal	413,482	4.1%
Ireland	197,609	4.0%
Sweden	398,092	3.9%
Germany	3,179,290	3.8%
Spain	1,764,985	3.8%
France	2,540,702	3.8%
European Union	16,458,254	3.7%
Italy	2,112,371	3.5%
Luxembourg	21,853	3.5%
Belgium	397,679	3.4%
Austria	288,601	3.2%
Barbados	9,115	3.2%
Czech Republic	336,453	3.1%
Oman	138,723	2.7%
Brazil	5,756,361	2.7%
Canada	972,407	2.6%
Croatia	87,169	2.1%
Andorra	1,291	1.7%
Russia	2,200,000	1.5%
Latvia	27,540	1.5%
Bangladesh	2,082,877	1.3%
Bulgaria	81,433	1.2%
Costa Rica	54,395	1.1%
Argentina	445,614	1.0%
Mexico	1,210,886	0.9%
Azerbaijan	65,000	0.6%
Peru	161,113	0.5%
Indonesia	1,224,091	0.5%
Albania	2,438	0.1%
Guyana	668	0.1%
Colombia	33,140	0.1%
Ecuador	6,228	0.0%
Cambodia	3,236	0.0%
Mauritius	207	0.0%
Pakistan	52,768	0.0%
South Africa	10,414	0.0%
Iran	10,000	0.0%
Japan	5,039	0.0%

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Feb. 21, at 9:00 a.m.

Source: Our World in Data

All that means it could be years before life returns to normal in poorer countries, which saw more than 100 million people fall back into extreme poverty last year and which lack resources to unleash government spending as much as rich countries have. Some emerging-market countries that were able to mount domestic stimulus last year are running out of resources to continue.

The disparity could also slow the global economic recovery more broadly and prolong the pandemic, by creating pockets of unchecked infection that could become breeding grounds for mutations of the virus, experts say.

The International Monetary Fund expects the pandemic’s economic damage to be deeper and more persistent in the developing world, especially in countries that are heavily reliant on tourism or oil exports. The WHO is urging wealthy countries to share their vaccines once they have inoculated their most vulnerable populations.

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A recent study by the U.S.-based National Bureau for Economic Research concluded that a failure to inoculate all countries equitably could wind up costing advanced economies up to $2.6 trillion—far more than the cost of supplying global vaccine coverage. It said that developed economies could see supply disruptions and low demand for exports long after their populations are fully inoculated if developing economies don’t recover as quickly.

“Our point is that all economies are connected to each other through trade relationships,” said Selva Demiralp, one of the study’s authors and a professor of economics at Koç University in Turkey.

The best many developing countries can hope for is to cover health workers, the elderly and those with underlying illnesses by the end of the year, through a WHO-supported initiative known as Covax, which has yet to send a single dose. Covax says it is on track to reach 27% of the population in 92 eligible countries by the end of 2021, mostly in the second half of the year.

Covax’s relatively modest goals are heavily dependent on the vaccine developed by Oxford University and AstraZeneca PLC, the cheapest and most abundantly available. Questions over its efficacy emerged after a small human trial in South Africa found that it didn’t prevent mild and moderate Covid-19 from a new variant circulating there.

The WHO and other vaccine experts say that it will likely still prevent severe illness, but South Africa, the country worst hit in Africa by the pandemic, has suspended administration of the vaccine. The mutation has been found in at least 40 countries and is believed to be dominant in nearby nations such as Zambia and Mozambique.

“Prospects for vaccine access in lower-income countries were already bleak,” said Andrea Taylor, from the Global Health Innovation Center at Duke University. “We will not be able to fill critical supply gaps without the Oxford-AstraZeneca vaccine in the short-term, certainly not in the first half of 2021.”

AstraZeneca says it is updating its inoculation to target the variant, but the new vaccine will only be ready in the fall.

While even wealthy countries are seeing delays in vaccine delivery, they have at least secured supply. Many aim to vaccinate most of their adult population by the end of summer, although the spread of variants could delay those timetables.

Developed markets have scooped up 57% of known vaccine purchases, despite having only 18% of global population, according to a UBS tally.

Canada has bought nearly six times the vaccine doses it needs, the U.K. and U.S. more than four times, and the European Union over three times, including options for additional purchases, according to Duke University data.

Rich-world governments also expect to have to buy new vaccines that will act more effectively against the variants.

That leaves some difficult math for poorer countries. Global production of Covid-19 vaccines in 2021 will be 6 billion to 7 billion doses, estimates Seth Berkley, chief executive of GAVI, the vaccine alliance and another partner in Covax. With most vaccines requiring two doses, that means less than half the earth’s population can be covered this year.

Low-income nations, which didn’t have the resources to compete in the frenzied buy-up of vaccines before they passed trials, have purchased less than 9% of confirmed vaccine purchases, Duke data shows. The International Rescue Committee expects some countries only to reach about 3-5% coverage this year.

Some countries, like Nepal, have asked their citizens for donations to fund vaccine purchases. Members of the African Union have clubbed together to increase their buying power. Pakistan and others have offered their populations for trials, in return for preferential access to vaccines.

Developing nations have also reached out to Russia, China and India, which are using their production to grow diplomatic clout with favored countries. Some of those supplies have arrived slowly, though the pace could soon accelerate significantly.

Meanwhile, the human and economic cost is building. 

In Mozambique, the new strain from South Africa pushed daily Covid-19 cases to five times the peak of the first wave of infections. In the capital, Dr. Lucia Chambal at Maputo Central Hospital has watched colleagues die or be hospitalized in recent weeks, while caring for Covid-19 patients in tents erected outside the hospital as isolation wards citywide filled up.

“We can see that there are countries that have already covered their healthcare workers and their old people and we haven’t even started,” said Dr. Chambal.

Support from financial institutions like the IMF and World Bank, and expansive monetary policy in the U.S. and Europe, kept many poor-countries afloat as revenues dried up in 2020. In recent weeks, though, some governments, including Ethiopia and Chad, have started to buckle under the pileup of debt and said they would seek relief from creditors.

Standard & Poor’s forecasts that by the end of 2021, general government debt for the largest 60 emerging markets it rates will be 15.5% above 2019 levels. Some highly indebted developing economies are starting to find it more difficult to borrow to support the pandemic response, the IMF said in January.

In South Africa, support measures for individuals and companies are due to expire in the coming months, even though experts warn that without large-scale vaccinations, the country should prepare for new waves of infections as winter looms in the Southern Hemisphere and international tourism is unlikely to pick up soon.