WHO should call the shots, but it hasn’t

May 18, 2022

by Maricar R. Piedad

The World Health Assembly, the decision-making body of the World Health Organization (WHO), is set to have its annual meeting next week. It will be the 75th in WHO’s existence and the third one under one of the world’s worst pandemics. What exactly will be the agenda when WHO action is stalling?

It has been more than two years since WHO declared COVID-19 as a pandemic and a little bit over a year since the global vaccination program was started. Currently, at least 4.68 billion people, or about 59.4% of the world population have been fully vaccinated, still far from the WHO target of 70% of the global population to achieve herd immunity against the coronavirus.

Last year, the main issue for the slow uptake of the vaccination program was allegedly the lack of available supply of doses compared to the estimated demand. But 11.2 billion doses were produced, which is only 800 million doses short compared to the estimated 12 billion doses needed to vaccinate 70% of global population. If these produced vaccines were distributed efficiently and fairly, the number of fully vaccinated individuals could have been higher than reported.

Vaccine hoarding

COVAX, the global vaccine public-private initiative being managed by WHO together with GAVI The Vaccine Alliance and the Coalition for Economic Preparedness Innovations (CEPI), aims to achieve global vaccine equity through distributing vaccine doses to countries that have no capacity and resources to secure their own. Through COVAX, rich countries and big institutions led by the Bill Gates Foundation can pool their funds and doses to be donated to poorer countries and regions. COVAX committed a 20% vaccine coverage for the countries, but so far only 1.4 billion doses for 144 recipient countries have been shipped.

The failing of COVAX and WHO in facilitating the equitable distribution of available vaccine doses has contributed largely to the slow progress of achieving global herd immunity. Yet, a bigger issue that WHO failed to address was vaccine hoarding by High Income Countries (HICs) and some Upper Middle Income Countries (UMICs), which resulted in a lack of available doses for Lower Middle Income Countries (LMICs) and Low Income Countries (LICs).

Through COVAX’s Advanced Market Commitment last year, several rich governments secured more than the amount of doses their countries need. Some purchased double or even quadruple of what their respective populations need.

Vaccine manufacture is controlled by Big Pharma, the world’s largest transnational pharmaceutical companies that are headquartered in the HICs. The Big Pharma can easily secure the supply to meet the global demand, but they apparently increased their donation to the COVAX facility only when vaccine doses were nearing expiration.

Vaccine wastage

In the Philippines, it was reported that around 27 million doses will be expiring this July if not administered quickly. The Philippine government, since its COVID response has been slow, is lobbying vaccine manufacturers to replace the purchased doses. COVAX, which is the source of 3 million of these expiring doses, has committed to give the replacements. If this potential vaccine wastage is not acted upon appropriately, this can result in Php40 billion gone to waste.

This is not the first instance of vaccine wastage globally. Last year some vaccine doses donated to African nations expired and were not used. For a region with very low vaccination coverage – only 17% of Africa’s total population is fully vaccinated – this is a huge loss to the campaign of achieving herd immunity. In Nigeria where less than 2% of the population are fully vaccinated, at least 1 million AstraZeneca vaccines expired and were not used.

Weak healthcare and education

Vaccine wastage, apart from being due to vaccine inequity, is also due to the poor countries’ poor healthcare capacity. Many LMICs and LICs have no sufficient health capacity to facilitate fast vaccination deployment. Even before the pandemic, these countries were already struggling with their health system and the facilitation of mass immunization programs was an added burden to their already weak health capacity.

For instance, in the Democratic Republic of Congo (DRC), most of the COVAX-given 1.7 million AstraZeneca doses were impossible to use before their expiry date due to the lack of facility to administer these doses within the limited period.

In the Philippines, the severe gap between health capacities among regions has caused an uneven progress in the national vaccine deployment. Regions that are generally well-off and highly urbanized have made progress, while poorer local government units are still struggling in achieving local herd immunity.

In African nations, the lack of logistical capacity for vaccine maintenance and storage also resulted in a very low vaccination rate among their population. These nations have no sufficient infrastructure and facilities to meet the requirements for optimal storage of several vaccine brands.

Another weakness is the lack of public health education that has only led to vaccine hesitancy. In the Philippines, the Dengvaxia scandal that happened years before the COVID-19 pandemic has made several Filipinos afraid or stubborn on not having COVID-19 vaccine. A World Bank report shows that among several Southeast Asian countries, the Philippines has the lowest percentage of population willing to be vaccinated. Only 41% of respondents from the Philippines are willing, and this rate is only half of the shares in Indonesia, Malaysia and Vietnam.

Inequity and poverty

Latest reports show that only 11% of the total population in LICs and 48% in LMICs have been fully vaccinated, while the figures for HICs and UMICs are at 74% each. This severe gap between rich and poor countries highlights the vaccine inequity that WHO and COVAX have failed to manage within a year. If one-third of the world’s population remains unvaccinated, the COVID-19 virus will continue to mutate and that will prolong the global fight in eliminating the disease.

Increasing poverty rates among nations with a low vaccination rate should also be a major cause of concern. Countries such as Nigeria, DRC and Tanzania for a start already have high poverty incidences. The slow vaccination progress in these countries could lead to more economic decline and push more of their people to live longer in poverty. In the Philippines, the poverty incidence increased from 21.1% in the first semester of 2018 to 23.7% in the first semester of 2021 due to the pandemic. By magnitude, the number of Filipinos considered poor grew from 22.3 million to 26.1 million in the same period.

For 2021, countries which have higher vaccination rates have registered faster economic growth. Notwithstanding the persistent and severe poverty that a neoliberal world economic order has engendered among poor nations, this only shows that an efficient response to COVID, including a fast and efficient vaccination program, helps pick up the economy. But this has apparently only happened among rich countries.

Can it be done? The case of Cuba

The Cuban vaccination program is an example of an effective and efficient immunization program. Cuba, which is famous for investing in its own health and biotechnology systems, was able to develop its own COVID-19 vaccines that are apt for the needs of the country.

One specific example of appropriateness is doing away with the need for an advanced cold storage system for the vaccine doses since Cuba is a tropical country. Cuba’s vaccines are also cheaper due to the type of technology used. Currently, 88% of Cuba’s population is fully vaccinated, which is among the highest records worldwide.

All of Cuba’s locally produced vaccines are subunit protein vaccines that are generally cheaper to produce compared to other vaccine types and do not need extreme cold temperature for storage.

Cuba’s vaccines, Abdala and Soberana 02, could have been useful and helpful to low-income countries due to their cheap prices and low maintenance compared to Western brands. Once Cuba’s vaccines become available to other nations, they do not need to be burdened with spending huge amounts of money on building infrastructure to store vaccines. But WHO has not yet granted an Emergency Use Listing (EUL) approval to Cuba’s locally developed vaccines.

Cuba’s immunization program should also be thoroughly studied and reviewed by WHO and can be used to model LMICs and LICs vaccine deployment programs.

Cuba has already signified its willingness to share its locally made vaccines to other nations through transfer of technology and knowledge sharing. WHO should welcome this type of initiative and convince rich countries and the Big Pharma to help poor countries make their own vaccines. This will be more sustainable in the long run than for these countries to solely rely on importing vaccine doses. But it appears that all these moves go against the unbridled profitability of the Big Pharma.

But WHO has remained in its comfort zone

As the 75th World Health Assembly is approaching, WHO should be opening the discussion on more rigorous actions in achieving global herd immunity and vaccine equity. The conduct of last year’s vaccine deployment should be a lesson on the ineffectiveness and inefficiency of the COVAX mechanism that only benefited rich nations.

Since COVAX was only focusing on securing vaccine doses to sponsored countries, it did not put into consideration the already weak and poor health capacity of these nations. The COVAX should look into going beyond the delivery of vaccine supply and encourage governments to put more comprehensive programs in capacitating their health systems, in terms of strengthened workforce, construction of relevant and appropriate infrastructure and facility, and more directed health education to address the numerous issues that they have faced in their respective immunization programs.

It is taking longer than necessary for the underdeveloped world to fully recover from the damage and economic losses that poor COVID response and harsh lockdowns have caused. But it appears that one of the main stumbling blocks to their full recovery is WHO’s own complacency and staying in its comfort zone, in support of Big Pharma and rich nations.