If the Covid-19 vaccine rollout continues at its current pace, the majority of people in many Pacific Islands won’t be vaccinated until 2023, an international NGO is warning.
The dire prediction comes from the International Federation of Red Cross and Red Crescent Societies (IFRC), which has been warning against distribution inequality since a Covid-19 vaccine was created last year.
Dr Abhishek Rimal, Asia Pacific emergency health coordinator for the organisation, says data in March showed 74 per cent of Covid vaccines already produced have been sold to the top 10 high-income countries.
“There is growing recognition of fair and equitable distribution of the vaccine, but that’s yet to translate into reality,” says Rimal.
“The investment is not coming on that and most of the doses are still going to the high-income countries.”
This inequality of distribution and high demand for vaccines is outstripping supply and causing an adverse ripple effect in the Pacific.
“We do believe that 15 to 20 per cent of the population might get the vaccine this year or early part of 2022, but if we are talking about the majority of the population being vaccinated in the Pacific it’s 2023 to 2024 or beyond,” says Rimal.
To reach herd immunity it was initially estimated by scientists that 70 to 75 per cent of the population needed to be vaccinated.
However, health officials around the world — including New Zealand's Director-General of Health, Dr Ashley Bloomfield — now say 90 per cent of the population needs to be vaccinated against the virus for herd immunity to be reached.
Fine Tu'itupou-Arnold, the Secretary General of Cook Islands Red Cross, says this could easily be achieved in smaller nations like the Cook Islands once vaccines arrive.
With a population of 17,000, the entire adult population of the Cook Islands could receive their first vaccine within five days.
“If everything, all the resources, all the vaccinators are catered for, then I think we can do it,” she says.
Getting the vaccines on the tarmac in the Pacific is one major challenge, while vaccinating 90 per cent of most Pacific populations is another.
Vaccination rollouts across the region in 2021 are increasingly looking like an impossibility, with many Pacific nations relying on Covax, which will only supply vaccines for 20 per cent of their population this year.
Keeping Covid-19 from their shores has added to the vaccine access challenge, with many Pacific countries being bumped down the priority list for Covax, which is rushing to supply vaccines to countries struggling with outbreaks.
“We have a limited number of doses of Covid-19 vaccines to give a country,” says Rimal.
“The country suffering the most, the Covid vaccine goes there. But even though Covid is not in the Pacific, they’re still suffering from the dying livelihood, the dying tourism industry.”
New Zealand has offered to help out its Pacific neighbours, pledging $75 million to help supply Covid vaccines to Samoa, Tonga and Tuvalu, Tokelau, Niue and Cook Islands.
Australia has also pledged to help Melanesia with its vaccine rollout.
Money and support for the Covid vaccine rollout has been welcomed by the region, however there is no set date for when they will arrive, and global shortages are pushing delivery dates back even further.
Bilateral deals with wealthier countries and pharmaceutical companies are also helping to fuel the vaccine shortage.
“Initially when the whole Covax facility was set up and everyone rallied their energy behind it because it was a fair and equitable distribution of the vaccine," says Rimal.
“But once the vaccine was available the approval from different regulatory authorities there was some back channeling, there were some bilateral deals…that put Covax on the back foot.”
Rimal says the deals and issues earlier this year around investment into Covax means the two billion vaccines the organisation hoped to distribute in 2021 might not happen.
“At this stage they are slightly struggling because of these back channeling or bilateral deals that different countries have.
“We have on one hand fair and equitable distribution of vaccines and on another vaccine nationalism.”
Are patent waivers on Covid vaccines the way forward?
One hope for ending vaccine nationalism and increasing the supply of Covid vaccines is to waive patents on the vaccines.
A waiver of patents has been backed by Amnesty International and dozens more NGOs and charities across the world.
“I think the issues the waiver is trying to address is the core issue that demand is just outstripping supply,” says Lisa Woods, Amnesty International's campaign director for New Zealand.
“We need to be addressing that manufacturing issue and the answer to this is getting pharmaceutical companies to share knowledge about the creation of the vaccine so that we can scale up production across the globe.”
Last week, the US put its support behind a temporary move to lift patent protections for Covid vaccines. It was a move supported by the New Zealand Government.
India and South Africa have also put proposals through to the World Trade Organization to have patents waived.
However, EU leaders argue waiving the patents wouldn’t achieve an increase of production of vaccines.
Victoria University of Wellington's Jessica Lai, who specialises in intellectual property and patents, says a patent waiver is unlikely to increase supply because of how complicated it is to make vaccines en masse.
“Mass manufacturing vaccines is a very capital-intensive undertaking. It involves a lot of physical materials, manufacturing spaces and people with the right knowledge and skills,” she says.
“Mass manufacture of vaccines is typically harder than mass manufacture of normal medicines. There’s a lot of know-how involved.”
Lai says patent disclosures are often missing a lot of information which could include “know-how or the little steps and tricks to get something to work”.
An example of this, Lai says, is the Pfizer vaccine, which is manufactured through a 50,000-step process which isn’t fully outlined in the patent.
This would make re-creation of the vaccine difficult for many labs and take time and resources they may not have.
Lai says governments pushing for the waiver could run the risk in the future of pharmaceutical companies working on vaccines in secrecy to protect their exclusivity if they can’t get protection for their inventions with patents.
Lai believes pharmaceutical companies should license their intellectual property and charge a licensing fee to manufacturers.
“The licencees should be able to manufacture relatively quickly.”
Woods says Amnesty International knows the patent waiver is not the only answer to the vaccine shortage but still believes it is an “integral part” of it.
“Sharing the IP is going to be crucial. There are other multilateral initiatives that are happening such as the Covid technology access pool, Covax, countries donating vaccines.
“All of these types of things are really important, so the waiver is not overtaking any of these or substituting anything else.”
While nations like those in the Pacific wait for vaccines to arrive, new variants of the virus are emerging such as the one found in India.
These new and concerning variants could put the current vaccines at risk making the need for more vaccines and equitable distribution vital, says Woods.