Euractiv writes: Argentina has complained to Russia about delays in delivering second doses of its Sputnik V coronavirus vaccine in a letter warning of breach of contract repercussions, the government in Buenos Aires said Thursday (22 July).
Euractiv writes: More than half of all European adults are now fully vaccinated, the EU said on Thursday (22 July), as countries across Europe and Asia battled fresh outbreaks blamed on the fast-spreading Delta variant.
The US and Europe are offering low- and middle-income countries crumbs, so that they can protect their billionaires, their pharmaceutical lobbies, and their campaign contributions. This has created an opening for China and Russia – and both are rushing into the breach.
Minority communities and developing-country populations may approach health services cautiously – and with good reason, given the medical profession’s history of inhumanity. But, by blaming low COVID-19 vaccination rates on vaccine hesitancy, the profession is effectively using this history to victimize the same communities again.
© World Bank / Curt Carnemark
This blog is from a series on digital safeguards and enablers for COVID-19 vaccine delivery.
As COVID-19 vaccine rollout advances globally, countries must address issues around vaccine hesitancy and the spread of misinformation. Inaccurate information about COVID-19 has caused people, especially, women and marginalized communities around the world to be wary of COVID-19 vaccines. This can be a key barrier to vaccine uptake and prolong the effects of the pandemic.
As women are often responsible for most household healthcare decisions — including for children, parents, and extended family members — their vaccine hesitancy can have significant ripple effects and it is essential to build their trust during a vaccine rollout..
Vaccine hesitancy is endemic worldwide. In June 2020, a survey of nearly 13,500 participants in 19 countries showed that only 72 percent of the participants were likely or somewhat likely to take a vaccine, with wide inter-country variances. In a GeoPoll study in Côte D’Ivoire, DR Congo, Kenya, Mozambique, Nigeria, and South Africa, only 42 percent of respondents would “definitely” get the vaccine as soon as possible. Whilst not universal, there is a trend of higher vaccine hesitancy amongst women including in Africa and Latin America, as well as the UK and the US. This is a key health equity issue: vaccine hesitancy is higher in traditionally disadvantaged communities. A study in Chandigarh, India, showed that scheduled castes or scheduled tribes had 3.48 times greater odds of vaccine hesitancy compared to others. Those most hesitant are unfortunately also the hardest hit.
The cost of ignoring vaccine hesitancy is high, and it leaves a vacuum for misinformation. In 2015, two Ebola vaccine trials in Ghana had to be stopped, due to media accusations that researchers were infecting participants with Ebola. Rumors that polio vaccines could be contaminated with anti-fertility agents, HIV, and carcinogens led to a boycott of a polio vaccination campaign in 2003 in Nigeria. This boycott led to a five-fold increase in polio incidence and contributed to outbreaks across the continent.
So, how can digital technologies help?
First, research suggests that peer networks and trusted sources are effective in spreading important health information compared to mass media campaigns. Digital technologies are critical to social connectedness, and can help galvanize family, group, or community-level conversations to combat hesitancy. Stakeholders can utilize digital and in-person platforms that engage social and community networks. For example, Nigeria’s National Primary Healthcare Development Agency uses online media campaigns as well as regular advocacy sessions with community, religious and political leaders. And the World Health Organization has launched a WhatsApp-based HealthAlert service in various languages for outreach, building on the successful program of MomConnect in South Africa.
Digital technologies can also provide opportunities for smaller groups to engage in robust conversations to help clarify the science and facts about the vaccine development and distribution process in a safe yet trusted environment. Social media networks — now actively cracking down on vaccine misinformation — can also provide real-time public data to understand community attitudes and behaviors, which can then inform communication strategies around immunization.
Second, while some evidence suggests that people in countries with greater internet access are significantly more likely to be skeptical due to the easier spread of disinformation online, research also shows the effectiveness of using digital technologies to combat this. In Zimbabwe during COVID-19, WhatsApp newsletter messaging from a trusted civil society organization may have substantively large effects not only on individuals’ knowledge but also ultimately on related behavior. Co-developing inclusive communications campaigns with local community networks and organizations can help. Specific messaging targeting women with disabilities, from ethnic and religious minorities, rural and other marginalized communities, developed in local languages, is most useful. Digital platforms such as U-report hosted by UNICEF can serve as a tool to encourage dialogue, share information, and develop joint solutions to community-level vaccine skepticism. Earlier studies also show that being exposed to denial arguments without a rebuttal can have a negative effect on trust and support of vaccination, however putting forward the facts in a discussion have positive effects on attitudes.
Third, healthcare professionals globally have called for more diverse populations in vaccine trials, and for better understanding the effects on marginalized populations. Digital technologies can help operationalize a vaccine safety monitoring system — smartphone apps such as V-SAFE in the US and the DIVOC platform in India enable a mobile-first population to report adverse events and conduct post-vaccine follow-up reporting with ease, providing more representative data on populations that may not have been fully included in clinical trials.
Finally, demographically disaggregated vaccination data and monitoring systems matter. Demographic markers based on the country can also help to ensure that the vaccine rollout is equitable. Data should at least be disaggregated by sex and age and shared transparently with the public and within high-risk communities. Data management and monitoring systems must comply with regulations and standards for collecting, sharing, storing, and securing patient data to build trust.
Unfortunately, these digital outreach efforts may not be accessible to many — nearly 40% of the world still does not have access to reliable broadband connectivity, and the elderly, women, and low-income communities are amongst the most vulnerable and suffer the greatest. Identifying and proactively addressing gaps in public confidence and developing targeted efforts is key to building trust and, ultimately, to ensuring an inclusive recovery from this pandemic.
This work is supported by the Digital Development Partnership, administered by the World Bank. For more information or how you can receive assistance with these topics, please contact Digital4Vaccines@worldbankgroup.org
- The G7 pledged to dramatically increase vaccine donations to developing countries.
- But serious challenges remain in terms of distributing the doses necessary to protect everyone.
“A big help, but we need more.”
An estimated 11 billion doses will be needed to vaccinate 70% of the global population and “approach” herd immunity – assuming that most vaccines require two doses. So far, however, only slightly more than one in five people worldwide are estimated to have had at least a single dose.
The experience to date of the COVAX vaccine initiative, which will distribute doses pledged by the G7 to developing countries, has illustrated the challenges involved. Even as the resourceful endeavour has used camel riders in Kenya to spread awareness and delivered doses via drones in Ghana, the initial COVAX effort has in many ways disappointed.
In Afghanistan, for example, about 18% of the doses allocated for the country by COVAX have reportedly been received, while the figure is 22% for Cameroon, and 20% for the Dominican Republic. El Salvador, meanwhile, has received all of its allocated doses.
A dearth of vaccine manufacturing capacity has been blamed for shortfalls. When COVAX’s supplier, the Serum Institute of India, was impacted by a devastating outbreak in that country and a subsequent vaccine export ban, there were no other options.
The prevailing approach among wealthy countries also made early hiccups inevitable. Rather than promptly committing funds to COVAX, many opted to first secure doses for domestic use. The US, for example, spent billions of dollars to lock up vaccines while refusing to take part in COVAX, before a change in administration led to a fresh commitment to the effort.
Making complex pharmaceutical products that require a high degree of safety and quality is not a simple process. Building up the sort of infrastructure needed to churn out COVID-19 vaccines as needed globally may therefore take several years.
The existing COVID-19 manufacturing landscape has been described as “remarkably opaque.” Estimates for production this year range from about 9.5 billion doses to 12 billion, and UNICEF has estimated that capacity will top 43 billion doses next year.
Once a vaccine is made, however, demanding logistics and storage requirements can make it difficult to deliver (issues can arise during production, too, as was the case with the 15 million possibly-contaminated doses of Johnson & Johnson’s COVID-19 vaccine that had to be thrown out in March when flaws at a US plant were revealed).
In addition to vaccines made specifically for distribution to disadvantaged regions, countries able to buy more than they’ve needed aim to donate their surplus. However, the issue can be politically sensitive, and the risk that surplus doses will expire before they can be used adds even more pressure to vaccine supply chains.
Another sensitive issue is patent protection. Public health researchers, humanitarian organizations and some countries have advocated waiving patent protection for vaccines to boost supply. Others are not so keen; Gavi, the Vaccine Alliance – the primary organization behind COVAX – has argued that there’s no evidence to suggest patent protection is hindering the production of vaccines.
- Without “sweeping reform” of COVAX’s distribution criteria, this analysis argues, there’s no assurance that pledged doses will make it to countries suffering disproportionately. (Peterson Institute for International Economics)
- It’s brilliant news that wealthy countries plan to donate vaccines to developing countries, according to this piece, but it also points to a weighty question: what is the “right price” to pay for surplus vaccines? (Center for Global Development)
- In Afghanistan it’s children who are paying the harshest price for vaccine inequality, according to this report, as confirmed cases hit a record high and schools remain closed even as wealthier nations celebrate a return to normal life. (The Diplomat)
- In some ways the ability of vaccines to end pandemics might also be weak in wealthy countries. This profile of a vaccine anthropologist ponders what an abundance of vaccines is really worth if not enough people are willing to take them. (New Yorker)
- As the G7 was meeting in the UK, the first COVID-19 vaccinations arrived in Bor – a town in South Sudan where people see more deaths from conflict than the virus, according to this analysis, and both mistrust in government and vaccine skepticism run high. (LSE)
- Reports have surfaced of cases spiking in countries using China’s Sinopharm COVID-19 vaccine, but this piece argues that it should continue to underpin the global response to the pandemic as long as vaccine demand outstrips supply. (The Conversation)
- The curious case of Tamil Nadu – in India, vaccine shortages and a lack of robust healthcare infrastructure is one reason for uneven coverage, according to this report, but another can be a high degree of vaccine hesitancy. (Observer Research Foundation)
Many countries are looking to the COVID-19 vaccines with the hope of overcoming the pandemic and beginning economic recovery. While the drug companies in the West operate as independent for-profit businesses, in China the government directs the research and development efforts of both state and privately owned companies, and uses them as a tool in its policy through official visits in the international theater, cooperation agreements, commitments to supply vaccines, and the provision of loans and other financial assistance. The vaccines developed in China are also among the most sought-after: a map of vaccine approvals in various countries illustrates China’s growing global economic and political influence.
Quantifying the economic damage caused by the COVID-19 pandemic and the worth of a cure can assist cost-benefit analyses of potential public-sector investment to alleviate the impact of the current pandemic. By reflecting forward-looking expectations, stock prices should indicate the economic value of progress being made towards vaccine development. This column estimates the value of a COVID-19 cure using the behaviour of stock prices and a novel vaccine progress indicator. The value of a cure is worth between 5% and 15% of wealth and rises substantially with uncertainty surrounding the frequency and duration of the pandemic. Understanding the fundamental biological and social determinants of future pandemics may be as important as resolving the immediate crisis.
- Deals between pharmaceutical companies and rich countries enlarge chasms of inequity.
- We will not recover from COVID-19 until we ensure vaccine access to all people, in all countries, without delay.
- The People’s Vaccine Alliance urges that vaccines are made available for all people, in all countries, free of charge.