The global vaccine-sharing initiative Covax has so far delivered about one in five of the Oxford/AstraZeneca doses it estimated would arrive in countries by May, according to a Guardian analysis, starkly illustrating the cost of export bans, hoarding and supply shortages for a scheme that represents a key lifeline for many in the developing world.
The organisations that run Covax had predicted countries would receive fewer vaccines than expected after the Indian government restricted exports from its largest manufacturer in response to a catastrophic second wave there, but the figures reveal the shortfall to be severe, leaving many governments scrambling to secure doses elsewhere.
Large countries such as Indonesia and Brazil have so far received about one in 10 of the Oxford/AstraZeneca doses they were expecting by May, while Bangladesh, Mexico, Myanmar and Pakistan are among those that have not received any doses of the vaccine through the programme so far.
A handful of countries such as Moldova, Tuvalu, Nauru and Dominica have received the full amount they were allocated, but the vast majority of those in the scheme have so far received a third or less of what they were allocated.
In Africa, Rwanda has received just 32% of its allocation, the biggest percentage on the continent, ahead of countries including Nigeria, Kenya, Ethiopia and the Democratic Republic of the Congo, which have each received about 28% of the doses they are expecting.
Overall, as of Wednesday this week, the programme had delivered about 40.2m or 21.5% of the 187.2m doses it planned to distribute during or by the end of May. The analysis is based on data drawn from Airfinity, a life sciences analytics firm, and Unicef and Gavi, two of the organisations that are helping to run Covax.
The shortage is leading to panic in countries such as Bangladesh, where a source in the vaccine industry said supplies of Oxford/AstraZeneca doses would run out within a fortnight, with no prospect of an imminent resupply.
“We have already given first doses to 5.7 million people and we have to give them the second dose, but we don’t have any supply,” he said, asking not to be named because he was not authorised to speak to media. “How do we immunise those 5.7 million people?”
Covax is an unprecedented global collaboration that aims to use funds from charities and wealthier countries to bulk-purchase vaccines and distribute them equitably around the world, ensuring that at least 20% of the population of each country – focusing on health workers and the most vulnerable – are vaccinated by the end of the year.
But the scheme is at the mercy of national governments and the pharmaceutical industry, and both have undermined it since it was established last year. Wealthy governments especially signed up to Covax but also struck private deals directly with vaccine manufacturers offering to pay higher prices to secure access more quickly.
Vaccine producers such as Pfizer agreed to sell a relatively small amount of doses to Covax at a not-for-profit rate, but directed the bulk of their supply to more lucrative private contracts. Other manufacturers such as Moderna are yet to supply the program with a single dose.
Covax was nonetheless able to secure agreements for more than 1.53bn doses this year relying heavily on the Serum Institute of India, a Pune-based supplier that was licensed to produce the Oxford vaccine on a royalty-free basis in exchange for agreeing to produce it for developing countries.
But the institute has been slower than predicted to increase supply, citing US exports bans on key ingredients it needs to produce more doses. Alongside this, the resurgence of the virus in India has led the government there to drastically reduce the amount of vaccine it is permitting to be sent overseas.
Liam Sollis, the head of policy at Unicef UK, said the dramatic shortfall in Covax supplies so far emphasised the need for well-supplied countries to start donating some of their doses immediately.
“We need to ensure that current supply of manufactured doses that are available in the UK at the moment, a proportion of those are committed to be shared with Covax,” he said.
“A minimum of 5% should be committed at this stage and that should be a on a rolling basis, but that proportion should be scaling up over the course of the year as vaccination coverage increases in the UK, and that same commitment should be made by the G7 countries and all countries with significant supply at the moment.”
Some countries have not received the Oxford/AstraZeneca doses they were allocated because they may not have needed it. Qatar, for example, which has bought ample supply privately, or Canada, which was criticised for drawing on the Covax supply when it had already privately reserved the most doses per person of any country in the world.
South Africa, too, has stopped using the Oxford/AstraZeneca formulation owing to fears over a possible link to blood clots, though studies suggest the clotting risk is significantly greater from contracting Covid-19 than the vaccine.
But any advantage for other Covax countries from this potentially extra supply has been dwarfed by the overall vaccine shortage.
A Unicef spokesman told Reuters on Wednesday that it had found alternative supplies of the Oxford vaccine outside India and that it expected to receive 65m more doses by the end of May.
The Serum Institute of India says it plans to increase its vaccine production to 100m doses a month by the end of May but it is unclear how much of this supply will be permitted to go to Covax.