The global introduction of newly approved coronavirus vaccines has been marked by delays, shortages and bureaucratic errors as it has become clear that many governments will miss their targets for mass inoculation.
The burst of optimism that arrived with approvals of new vaccines – encouraged by unrealistic expectations raised by politicians – is colliding with the reality of the challenge of vaccinating a large part of the world’s population.
The vast scale of the effort by pharmaceutical companies to produce and package doses is already seeing strains through shortages of “fill and finish” materials such as the glass vials used for the vaccine.
Other chokepoints involve the capacity of regulatory authorities to approve packaged batches of vaccine, the effectiveness of national systems for vaccination, and local requirements for advising, monitoring and then logging the data of recipients, most of which is more time-consuming than giving the injection.
So how are individual countries doing?
The US’s rollout of its vaccine programme has struggled, echoing the country’s chaotic response to the pandemic under Donald Trump.
Out of about 17.5m doses of the Pfizer/BioNTech and Moderna vaccines that have been delivered around the country, only 4.2m have been administered, mainly comprising the first of two doses.
That is far behind where the US planned to be at the end of 2020, when it had been hoped 20 million people would have been vaccinated. Reports have emerged of vaccines going bad due to poor organisation, lack of healthcare professionals to administer them or, in one case, sabotage.
The biggest issue in the delays appears to be the fact that federal officials left delivery logistics to local health officials and hospitals, even as they were struggling to deal with the impact of a pandemic that has killed more than 350,000 Americans.
However, Dr Anthony Fauci, the country’s top infectious disease expert, said on Sunday he had seen “some little glimmer of hope” after 1.5m doses were administered in the previous 72 hours, a marked increase.
Hailed as a success story for the initial speed of its vaccination campaign, Israeli media reported last week that the pace of the vaccination campaign means it is running low on purchased doses and may have to pause unless a new supply is negotiated.
While Israel’s vaccination campaign – which has relied on the Pfizer/BioNTech vaccine that needs to be stored at ultra-cold temperatures – has been among the fastest in the world, its health minister, Yuli Edelstein, said his ministry may stop administering first doses for a short period, telling Channel 12 “there will be no shortage of the second dose”.
A disconnect between different regulatory approval regimes for vaccines is also causing its own issues, not least a shortage of supplies in some countries. While the UK quickly approved the Pfizer/BioNTech vaccine for emergency use in the UK and has since approved a second, the European Medicines Agency adopted a slower regulatory process and with Pfizer/BioNTech so far the only vaccine permitted within the bloc it has led to more demand from EU countries than the company can yet deliver.
It has warned there will be gaps in the supply of its vaccines until other vaccines are rolled out, with Uğur Şahin, the BioNTech chief executive, telling Germany’s Spiegel: “At the moment it doesn’t look good – a hole is appearing because there’s a lack of other approved vaccines and we have to fill the gap with our own vaccine.”
The European commission said on Monday it was in discussions with Pfizer and BioNTech about the possibility of ordering more doses of their vaccine, in addition to the 300m shots already covered under an existing contract. It was not clear whether this would compete with a German deal for more doses of the same vaccine.
Underlining the problem of vaccine supply, Germany and Denmark are also looking into the possibility of delaying administering a second dose of the vaccine to make scarce supplies go further, after a similar move by Britain last week.
Within the EU, France has had its own specific issues that have meant its vaccination programme has progressed at a glacial pace so far.
With one of the world’s most vaccine-sceptical populations, France had by the weekend only managed to inoculate 516 people compared with the UK’s 1 million, despite having 500,000 doses of the Pfizer/BioNTech vaccine.
Critics have also pointed to the 200,000 people who have been immunised in Germany during a similar timeframe after the EU-wide rollout began a week ago. The figure in France rose to several thousand on Monday, according to the health minister, Olivier Véran.
With a “hypercritical” public attitude towards vaccines – a survey at the weekend showed six out of 10 people intended to refuse one – France had settled on a slow and bureaucratic process, including a mandatory consultation with a doctor several days before receiving a jab. The president, Emmanuel Macron, has demanded a quicker rollout.
One assumed advantage in national vaccination programmes is the presence of a well-developed manufacturing capacity, although that has not necessarily been the case in the US.
While Indian regulators have only just approved the country’s first two Covid vaccines for restricted emergency use, one developed by AstraZeneca and Oxford University, and the other conceived locally by Bharat Biotech, India is home to the Serum Institute of India, the world’s largest manufacturer of vaccines that will eventually provide doses for the Covax scheme to supply the developing world.
For now, however, India’s emergency use authorisation means the vaccines will only be manufactured and made available in India, which with about 10m Covid-19 infections is one of the world’s worst-affected countries behind the US. Brazil is in talks to secure doses from India before a possible export ban.
The country plans to inoculate 300 million frontline workers, elderly and vulnerable people out of its population of 1.35 billion by August and has a stockpile of more than 50m doses. India also has considerable experience in running mass vaccination campaigns.
China, where Covid-19 originated, has (like Russia) pursued a typically aggressive approach to vaccine development and inoculation that has raised eyebrows in the west over claims of a lack of transparency in testing data.
Four and a half million Chinese received doses of Chinese made vaccines under trial even before the approval last week of a vaccine produced by the state-owned Sinopharm company, with Beijing alone setting up 220 pop-up vaccination sites and delivering more than 73,000 shots in the first two days of 2021.
The country aims to vaccinate 50 million people by February’s lunar new year in an attempt to control the spread of the virus when large parts of the population travel.
Other countries including Egypt, which has approved Sinopharm’s vaccine for emergency use, and Pakistan have said they will use the Sinopharm vaccine as part of their response.
South Africa, like other African nations, has found itself struggling to procure vaccines despite the global Covax initiative designed to ensure equitable supply of cheap vaccines to poorer countries.
Although Pfizer and AstraZeneca have said they plan to supply doses, the US’s Moderna has no supplies for Africa, and the AstraZeneca vaccine may not be available before next year in South Africa, the continent’s worst-hit country with 1.09m confirmed infections and 29,175 deaths.
South Africa will get enough shots for 10% of its population of 60 million people through the Covax initiative, but with concern about the new South African variant of the virus mounting, that is a drop in the ocean.
African countries will also face problems such as a shortage of ultra-cold storage for the Pfizer vaccine and logistical issues for distribution. Experts have said the absence of effective vaccination in the developing world could leave reservoirs of disease, including new mutations, that will continue to threaten global outbreaks.