Adopting coronavirus vaccines worldwide would never be easy. But there was quick domestic frustration and nationalistic sharpness abroad as countries around the world dealt with a vortex of logistical and political challenges.
All 50 US states are reporting bottlenecks as America’s fragmented administrative and health systems struggle to distribute even the limited supplies of vaccine that have been produced.
Europe has gotten into its own ugly struggle for supplies. And there is little evidence that the world’s poorest countries will have access anytime soon, maybe not until 2023.
Some in Africa, South America and Asia have turned to China and Russia, who are using vaccine diplomacy to increase their influence in these parts of the world, some experts say.
In the US, “the rollout is slow and cumbersome and very frustrating for our population,” said Dr. Tom Kenyon, former director of the CDC Center for Global Health.
Washington should be in the best position to immunize its citizens as it has ordered 1.2 billion doses while working hand-in-hand with pharmaceutical giants. Still, the US lags behind Israel, the United Arab Emirates, the United Kingdom and Bahrain in per capita shots.
There are broadly two problems: manufacturing and distribution.
As in Europe, American supply has been throttled as drug makers struggle to keep up with increasing demand, which is sometimes too promising before orders have to be scaled back.
“You probably haven’t done a very good job of communicating properly, managing expectations, and being transparent,” said Maria Elena Bottazzi, assistant dean at the National School of Tropical Medicine, which is part of Baylor College of Medicine in Houston.
However, experts say the US is particularly concerned that its healthcare system is not centralized and that President Donald Trump’s administration has not put in place an appropriate national vaccine rollout plan to fill the void.
After inheriting what some experts call one of the best pandemic prep plans in the world, Trump fired his top biosecurity advisor, disbanded his global health unit, and downplayed the coronavirus in the crucial early weeks of the outbreak last year .
The result is a messy mess today when it comes to vaccines. This criticism goes where states, counties and hospitals have left it to themselves to inspire it.
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“We have a very divided approach,” said Kenyon, who is now the chief health officer at Project HOPE, an international global health and humanitarian organization. “We actually have states that are competing with each other to get the vaccine. That is by no means optimal.”
However, these concerns should be seen in context. Under Trump’s watch, vaccines arrived faster and were more effective than many expected. And the encouraging data continues to arrive.
But for now, that does little to reassure officials, experts and citizens who are angry about vaccine distribution. This is only compounded by new varieties and the reluctance of some to get vaccinated.
This week President Joe Biden announced measures to revise the federal rollout strategy. Time will tell if this will change things.
“When it comes to coordination during a public health emergency, you can see where our system fell apart,” said Justin Ortiz, associate professor on the University of Maryland Medical School, referring to Trump administration records . “The idea that the previous federal government can wash its hands and rely on each state to create its own systems is a breach of duty.”
The situation is also tense in Europe.
A quagmire of bureaucratic struggles seems to have hampered the rollout of the European Union, which was icy slow and dysfunctional. Doctors in Madrid and Paris had to pause vaccinations because stocks were almost dry.
In the midst of all this, the E.U. and AstraZeneca are in dispute after the Anglo-Swedish pharmaceutical company announced it would have to cut deliveries due to a manufacturing problem. The EU. insisted that the drug maker keep its word.
In a drastic step, the E.U. is now trying to block the export of vaccines from companies that did not fulfill the European order first. European Union officials have also proposed redirecting vaccines in the UK to make up for the deficit on the continent.
A dispute over logistics could now lead to a full-blown diplomatic crisis.
“We reject the logic of first come, first served,” said E.U. Health Commissioner Stella Kyriakides said at a press conference on Wednesday. “That might work in a butcher shop, but not in contracts and not in our extended sales contracts.”
Even in the UK, there are concerns about the supposedly successful rollout, namely the decision to allow up to 12 weeks between the first and second dose.
The decision was made as the country faced the world’s deadliest Covid-19 outbreak. The delay, vigorously defended by the government’s technical advisors, is far longer than recommended by drug manufacturers and divides the scientific community.
But nowhere is the picture worse than in the developing world.
In all dramas in the West, the delays are measured in weeks and months. However, in Africa, parts of South Africa and Central Asia, full vaccine coverage will most likely not come until 2023, according to an article by the Economist Intelligence Unit, a research group in London, this week.
In addition to trying to put his own house in order, Biden has joined a World Health Organization-led program called COVAX, which has raised $ 2 billion to buy vaccines for poor countries.
It has been welcomed by public health experts that the US is dealing with an altruistic effort that Trump has shunned. In reality, however, COVAX not only needs more money and kind words, it also needs cans in hand and the ability to dispense them.
“The American funds are welcome, but COVAX’s problems go beyond money,” said Mukesh Kapila, advisor to the former WHO director general.