Covax scrambles to make up vaccine shortfall due to Indian export halt

The international scheme many countries are relying on to get Covid-19 vaccines is scrambling to secure more doses after its biggest supplier said it would be unable to provide any more shots until the end of the year.

The World Health Organization-backed Covax programme was originally depending on the Serum Institute of India, the world’s largest vaccine maker, for well over a third of the 2.2bn doses it hoped to distribute this year, according to the scheme’s most recent data, published last month

Serum had supplied about 30m of the 70m vaccine doses received by Covax before the company’s announcement this week that it was unlikely to resume shipments, halted since March, until the end of 2021. That leaves a big shortfall for Africa and other regions highly dependent on the programme.

“We are in a situation where the vaccine market is extremely limited and the virus is raging,” said John Nkengasong, director of the Africa Centres for Disease Control and Prevention.

Covax has done further supply deals recently with other companies including Moderna. It also announced a 200m dose agreement with Johnson & Johnson on Friday. These may have lessened the scheme’s dependence on Serum, although many of the new doses will not be available until 2022 either.

A G20 health summit co-hosted by the European Commission and Italy in Rome on Friday will unveil plans to build up future vaccine manufacturing capacity on the continent. But the problem is much more immediate.

Gavi, the international vaccines alliance also backing the Covax scheme, said it was considering a “number of options” to make up the jab shortfall to 92 lower income countries, many of them in Africa, most dependent on Serum Institute supplies. Covax was making “good progress” towards a goal to build a wider portfolio of between 10 and 12 different vaccines, it said. “[Covax] urges all governments with doses to share them.”

Under the Serum supply deal announced in February, the Indian manufacturer was due to provide Covax with 1.1bn doses of two vaccines, one developed by Oxford/AstraZeneca and one by Novavax, and to supply the vast majority this year. According to the most recent vaccine supply forecast issued by Gavi on April 7, doses from Serum would make up about 40 per cent of the 2.16bn shots Covax hoped to distribute in 2021.

The Serum suspension has underscored how poor countries are losing out in the battle for vaccine stocks that currently fall well short of global demand. It puts in jeopardy a call by the Africa CDC for governments to immunise at least 30 per cent of their populations this year and at least 60 per cent by the end of 2022.

“Everybody realises that Africa is lagging behind when it comes to vaccine access,” said Amadou Sall, director of Institut Pasteur in Dakar, Senegal. “We are too dependent on India.”

Covax decided to use the Serum Institute as a main supplier because of its massive production capacity, ability to deliver at low cost, and license to manufacture AstraZeneca’s vaccine, which was one of the first Covid-19 shots approved by the WHO for emergency use, Gavi said.

Harsh Pant, a director at New Delhi’s Observer Research Foundation, said it was unlikely that India would ease export restrictions any time soon. Prime Minister Narendra Modi’s government is facing intense criticism for not having enough vaccines as the country grapples with a severe wave of Covid-19 cases.

“There is no way a democratic government under these circumstances would not take domestic political sensitivities into account, for them it would be a dead end,” Pant said. “I don’t think India would be in a position to come back to its original role as an exporter of vaccines. Perhaps it will dent India’s image but no country comes out of this crisis unscathed.”

Africa has received only a tiny number of doses to date compared with its estimated 1.2bn population. African countries had received deliveries of just over 40m doses by mid-May, of which 17.5m came from Covax, 14m were purchased by governments and 10m were donated, according to a vaccine tracker compiled by the Tony Blair Institute.

Aspen Pharmacare, a drugs maker based in South Africa, has said it will be able to fill and finish 300m doses of the one-shot J&J vaccine this year, although it has struggled with supply problems from the US.

 “It is very clear that until [Africa] builds capacity [including] real intellectual knowhow of what we call the upstream drug substance manufacture, they will always be dependent as second class citizens of the world for vaccines,” said Patrick Soon-Shiong, a South African-American medical practitioner and billionaire entrepreneur pushing for vaccine manufacturing on the continent.