WITH an eighth of the world’s population, the rich countries – the US, Canada, UK and the EU – have received more than 50 per cent of the world’s vaccine doses. The US alone has received 147 million vaccine jabs (see Table 1). This is more than 14 times what the entire continent of Africa – with four times the population of the US – has received. And if we do not count the vaccine doses that Morocco, truly an outlier in Africa, has received, the US has received 60 times the vaccine doses that Africa has! No wonder Taddeus Ghebreyesus, the WHO’s director-general, called the distribution of vaccines in the world “grotesque”. Let us not call reserving the bulk of vaccines for a handful of rich ex-colonial or settler-colonial states ‘vaccine nationalism’. Let us call it what it is: vaccine apartheid at a global level.

Table 1: Number of Vaccine Doses Injected

Countries                      Population (Millions)        Vaccine Doses (millions)                        Vaccinate Doses/100
US+Canada                             368.7                                 153.1                                                     41.5
UK                                               68                                    34.5                                                     50.8
EU                                              445                                   72.2                                                     16.2
Rest of Europe                           237                                   16.6                                                       7.0
Latin America                          654.1                                   45.7                                                       7.0
China                                       1440                                    115                                                       8.0
India                                        1380                                    63.1                                                       4.6
Asia-India-China                      1820                                   66.8                                                        3.7
Africa                                        1340                                  10.3                                                        0.8
Total                                      4592.8                                 500.2                                                      10.9

(Figures from OurWorldinData https://ourworldindata.org/covid-vaccinations up to March 30, 2021)

The figures in Table 2 provide the number of vaccine doses produced till March 29 (AirFinity website) by major vaccine manufacturers. If we ignore the insignificant production of Bharat Biotech, Johnson & Johnson and CanSino to date, we see that more than 90 per cent of the current vaccines produced have come from Pfizer, AstraZeneca, Sinovac, Moderna and Sinopharm. Sputnik V is yet to manufacture large quantities, even though it has lined up many companies willing to manufacture the vaccine.

How much of the vaccine manufactured in the rich countries has gone to the rest of the world? The brutal answer is that the rich countries have supplied almost entirely to themselves. Moderna’s production has been entirely for the US. Pfizer has supplied the US from its US facilities, and the EU and the UK from its European plants. It has also supplied vaccines to Israel and the Gulf monarchies, but that is a small fraction of its total production.

The rich countries have had some squabbles with each other – the UK and the EU over AstraZeneca supplies, for example. (Perhaps this is why they have had no time for the rest of the world.) If we match the number of doses they have manufactured (see Table 2), with the number of doses used in their own countries, we get an estimate of how much they have supplied to other countries.

Where have these other countries – pretty much the rest of the world – got their vaccines from? It appears that the only sources of vaccines are those produced in China and India, with Russia providing smaller amounts. This is substantiated by various press sources which recount how countries in Latin America, Eastern Europe and Southeast Asia are receiving supplies from China, India or Russia.

Table 2: No of Vaccine Doses Produced
Companies                Doses (Millions)                    Fraction of Total (%)
Pfizer                            192.3                                            26.8%
AstraZeneca                 187.3                                            26.1%
Sinovac                        157.1                                             21.9%
Moderna                        85.0                                             11.8%
Sinopharm                     71.4                                             10.0%
Sputnik                          14.7                                               2.0%
Bharat Biotech                5.6                                                0.8%
Johnson & Johnson        2.0                                                0.3%
CanSino                          2.0                                                 0.3%
Total                            717.4                                              100.0%

(Airfinity website https://www.airfinity.com/data-studio with figures up to March 29, 2021)

How much of Sinovac and Sinopharm’s supplies go to China, and how much to the rest of the world? If we remove the number of doses that China has used (see Table 1), it appears that about 50 per cent of Chinese production – of 230 million doses, about 115 million doses are used in China and the same amount is going to the rest of the world. Similarly, based on the figures released by the India’s ministry of external affairs website (as of April 4, 2021) 64.5 million doses of the Serum Institute's Covishield vaccine – licensed from AstraZeneca – have been exported to other countries. This includes bilateral grants, commercial exports and exports to the WHO’s Covax platform. Again, looking at the total number of doses used in India’s vaccination drive – 87 million as of April 6 – 90 per cent of which is probably Covishield, the doses exported from India are roughly of the same order as doses delivered in India. China and India are the only two major countries that have been willing to export vaccines while also vaccinating their own people.

Sputnik V, developed by the highly respected Gamaleya Institute, has shown its efficacy in clinical trials. Ramping up its production has been slow. Russia’s production capacity of vaccines is not on the scale of Indian and Chinese manufacturers. Though many Indian and South Korean companies are willing to manufacture Sputnik V, they have yet to start, or even receive the necessary regulatory clearances. Only one South Korean company – Hankook Korus Pharm – has started production of Sputnik V. Five Indian companies – Hetero, Gland Pharma, Stellis Biopharma and Virchow Biotech, PanaceaBiotech – have inked deals with the Russian Direct Investment Fund (RDIF), for setting up a combined production capacity of 850 million doses.

Though India has not halted exports of vaccines from India, it has prioritised its own supplies in view of a sharp increase in the numbers infected. Its supplies to other countries appear to have slowed down. The Serum Institute of India, the largest vaccine manufacturer in the world, has a large supply of vaccines in stock, since it began stepping up production even before the Oxford-AstraZeneca vaccine finished its clinical trials. It can produce 100 million Covishield doses per month, and has said that it can ramp it up even to 200 million doses per month. So why is the Serum Institute not able to increase its production? Similarly, why has Biologic E, which has a collaboration to produce 600 million doses of Johnson & Johnson’s single jab vaccine recently approved by the US drug regulator, not able to begin production?

This is where the global media – read the dominant western media – fails to inform the people about the real bottlenecks in ramping up production around the world. The fundamental block to a quick ramping up of global vaccine production is that the rich countries – the US, EU and the UK – have been refusing not only to export finished vaccines but also the export of supplies of intermediate products and raw materials required for vaccine production in other countries.

The US is using a 1950 Korean War vintage Defence Production Act to curb exports of vaccines, as well as raw materials and other inputs vital for vaccine production elsewhere. The Serum Institute of India, with a capacity to manufacture 100-200 million doses of Covishield a month, is currently manufacturing only 60 million. In a letter to government authorities in India in early March, Prakash Kumar Singh of the  Serum Institute wrote that by invoking the Defence Production Act, the US is making it difficult to import necessary products like cell culture media, other raw materials, single-use tubing assemblies and some speciality chemicals to India. The US restrictions will not only harm Serum Institute's Covishield vaccine production but also affect its efforts to produce another one billion doses of Novavax vaccine. Adar Poonawalla, the chief executive of the Serum Institute of India, said, “The Novavax vaccine, (of) which we’re a major manufacturer, needs these items from the US… We are talking about having free global access to vaccines but if we can’t get the raw materials out of the US – that’s going to be a serious limiting factor.”

Similarly, Mahima Datla of Biologic E, which is committed to making 600 million doses per year of Johnson & Johnson’s single-dose vaccine, voiced her concern about the US embargo on vital intermediate products and supplies. In an interview with Financial Times, she said that materials that are a vital part of vaccine production are made only by a limited number of companies and they are under the US embargo. Unless the global supply chain is viewed in its entirety, and not with the me-first approach of the US and the rich countries, we will not be able to control the epidemic.

The Indian government, which has been quite willing to be the Quad’s Covid-19 vaccine supplier, as we saw in the Spirit of Quad declaration, seems to have backed off from any public engagement with the US government on this count. We have no public response of the government on the plea of the Indian big generic manufacturers of how to facilitate much needed supplies for vaccine manufacture. Instead, the government of India has slowed down its export of vaccines to other countries. 

The other part of the ugly picture of vaccine apartheid is the vicious campaign mounted against Chinese and Russian vaccines. It is bad enough that the US and its allies are not willing to share the vaccine they produce with the rest of the world. But an anti-China and anti-Russia campaign means they are willing to deprive the global population of any vaccine – even if this means the risk of new variants emerging and the permanent threat of Covid-19 to everyone, including their own population.

Covishield, Novavax and Johnson & Johnson vaccines are vital to the WHO’s Covax platform, the only hope for large parts of the world to get Covid-19 vaccines. The Covax facility is being run by GAVI and CEPI with the WHO and UNICEF. It has yet to clear either the Chinese or the Russian vaccines. Contrary to the Trump administration’s campaign of the WHO being under Chinese influence, the Bill and Melinda Gates Foundations are the major funders of the GAVI and CEPI initiative, as well as that of the WHO. The EU regulator has also been dragging its foot in giving Sputnik V a green signal, even though many companies in the EU are signing up for production deals of the vaccine. Hopefully, both Indian and EU regulators will soon give it a green signal, and perhaps so also WHO’s Covax platform.

We have written earlier in these columns about the WTO rules and the rich countries’ unwillingness to temporarily suspend intellectual property right rules so that all the vaccine producers can re-engineer their facilities very quickly for producing Covid-19 vaccines. In the books of the rich countries, the tens of billions of dollars of vaccine market for big pharma far outweighs the benefits of saving millions of lives. It is a matter of dollars over lives every time, whether it was the AIDS epidemic earlier or it is the Covid-19 pandemic now.