Will COVID Split the World in Two? Part 2

Last updated on April 11, 2021

Monier Bouazar, the head of COVAX logistics in Copenhagen, sprints up the metal steps of a staircase on a March morning. The 39-year-old has a dimpled chin and a subtle sense of humor. “Three to four months” – that’s how long he had to prepare for the start of the first deliveries. He says he hasn’t slept much in the past year. “I don’t really count the number of hours. For me personally, it’s not just a job.”

He is standing above the world’s largest humanitarian warehouse. The 20,000-square-meter (215,000-square-foot) storage complex contains tens of thousands of pallets holding goods for the world’s poorest people. Robot cranes drive the crates from one corner to the other: medication, soccer balls, school notebooks, products for water purification, special food for starving children and, as of recently, syringes for use in vaccinations.

Forklifts hum amid the cranes. Aid leaves the Copenhagen logistics center when a catastrophe happens somewhere in the world, like a war, an earthquake – or a pandemic.

By the end of 2020, Bouazar had ensured that half a billion syringes were distributed to UNICEF’s four warehouses in Copenhagen, Dubai, Panama and Shanghai. Now, with COVAX up and running, thousands of vaccines need to reach their destination every day, ideally at the same time or a shortly after the syringes used for injections arrive.

The pandemic complicates Bouazar’s task. There are few or no flights because of the travel restrictions. The global flight schedule has been thinned out and none of the dozen-and-a-half airlines that have pledged to help UNICEF, for example, fly to East Timor or the Pacific Islands. Vaccines and syringes headed to war-torn Yemen, for instance, must be transported via Nairobi, where Bouazar charters a flight carrying nothing more than a few thousand vials and syringes. This logistical tour de force is a financial disaster. But Bouazar says that “no doses should be lying around, no matter how small.”

Bouazar hopes to ship more vaccine in the second half of the year. “If we have bigger shipments, you could find charter solutions.” If not, he will continue sending lots of small packages on big, empty planes.

There’s one idea that might make Bouazar’s job easier, one that is currently being heatedly debated among politicians and activists: suspending intellectual property rights for vaccines in a manner limited to the duration of the pandemic.

India and South Africa have filed a request with the World Trade Organization to suspend patents on COVID-19 vaccines and drugs, supported by 100 countries. Other companies would then also be able to produce the vaccines.

This happened during the AIDS pandemic, when 2 million people were dying of AIDS every year in southern Africa at the turn of the millennium. At the time, Indian generic drug companies broke international patent law and saved millions of lives with affordable drugs.

The big pharmaceutical companies argue that, unlike then, there is currently a lack of raw materials and expertise and that the request is in vain.

It’s true that there can be no innovation without a return on investment, but it’s also true that few people have thought about how to give the global South the tools necessary to fight the pandemic. Not even the initiators of COVAX.

The biggest criticism of the initiative remains that it turns financially weaker countries into supplicants and doesn’t empower them in any way to help themselves.

Malawi: Fragile Hope

On March 5, the first 360,000 doses were unloaded onto the tarmac at the airport in Lilongwe, the capital of Malawi, from an Emirates aircraft. Malawi’s health minister pointed to the white cardboard boxes with the COVAX stickers and said: “That is hope. Hope for the children, hope for the health authorities, hope for us all.”

Most of the approximately 20 million inhabitants of Malawi live as farmers. The country made it through the first wave of the virus better than many expected. But the second hit hard. Hospitals were overloaded, there were oxygen shortages and a soccer stadium and presidential residence were turned into emergency hospitals.

Twelve days after the first doses arrived, vaccination expert Steve Macheso is standing in a turquoise UNICEF T-shirt in a warehouse in Lilongwe. Ten cold storage rooms stand next to one another. The remains of the COVAX shipment are in the rearmost one, in the eastern end of the warehouse. Refrigeration units rumble inside. Two of the trucks that will transport the vaccines to the country’s hospitals and health centers are parked outside.

AstraZeneca’s vaccine only needs to be refrigerated to 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit), which makes it attractive to many countries, but for a poor country like Malawi, even that can be a problem. Some parts of the country have only spotty electricity and there is, for example, a shortage of spare parts for thermometers. Now, during the rainy season, roads often turn into mud. The day before, a car carrying vaccine was stuck in the mud for six hours. Doses of vaccine have gone bad before.

To address the problem UNICEF, has acquired a fleet of motorcycles. “We are also looking into boats right now,” says Macheso.

It’s already clear in some countries that not everyone has the same opportunities. City dwellers are vaccinated before rural inhabitants. The elite before the slum dwellers. There are also countries like Syria, where militias are in charge in places where the government isn’t. Others prioritize the military over health workers.

UNICEF tries to quietly influence distribution, but it’s up to the countries to decide what they want to do with their share of the vaccines. COVAX’s jurisdiction ends at the airport. In truth, though, UNICEF workers, including 40-year-old Macheso, often accompany the vaccine further.

On his way to a health center in Njanja in central Malawi, his Landcruiser passes cornfields, markets and villages. Macheso knows that vaccinating the health workers is the easy part. The harder part comes after: in getting the jabs to the rest of the population. “That’s where we expect some resistance,” Macheso says as he tries to access the real-time system on his laptop that tells him how many people have already been vaccinated. A moment later he says: “Data has been entered by just under half of the districts. Some 4,377 people have been registered as vaccinated there.” He sounds happy.

But increasingly negative reports about the AstraZeneca vaccine have been circulating online recently. “We support the government in awareness campaigns. But looking at Europe gives me goosebumps,” Macheso says. That’s because Malawi committed to only one vaccine: AstraZeneca, which has spurred distrust after reports of deadly thromboses.

The biggest criticism of the initiative remains that it turns financially weaker countries into supplicants.

Macheso’s car turns into a narrow dirt road and stops in front of a low brick building. Health center employees sit on cement benches. Fourteen men and women are to be vaccinated. Five employees didn’t show up.

Lucy Kakowa, the team leader, tells those present about possible side effects, like headaches and fever. “We are happy to be vaccinated now,” she says, explaining that the health workers’ fears have also grown amid the second wave. Then the nurses roll up their sleeves and, as the rain pelts on the tin roof, a colleague in a blue coat readies the syringes.

“First, we vaccinate the people in the health system and social workers, then people with pre-existing conditions, then the elderly,” Kakowa explains. The week after next, she says, they will begin the awareness campaigns in the villages.

Malawi needs 7.6 million doses to fully vaccinate 20 percent of its population. They expect 900,000 more doses from COVAX soon, but Macheso doesn’t know exactly when they will arrive. There should be enough vaccine for the approximately 60,000 employees of the health sector, but, at this point, not much more.

Some experts are already warning that the populations in many poorer countries won’t be vaccinated until 2024. WHO chief Tedros recently asked richer countries to donate doses – 10 million vaccine doses for 20 countries that have yet to receive a single delivery from COVAX.

Germany has provided almost 1 billion euros for the COVAX initiative, and is thus one of the biggest donors. But Berlin doesn’t want to give up its own vaccine either, much like the European Union and the U.S. There, President Joe Biden has said, “If we have a surplus, we’re going to share it with the rest of the world. But we’re going to start off making sure Americans are taken care of first.”

Nevertheless, the vaccines, which are currently a scarce commodity, could soon pile up. Estimates suggest that between nine and 12 billion doses of vaccine could be available by the end of the year. Global herd immunity would then be within reach, but only if the doses can be distributed evenly across the globe.

This would mean that many Africans, Asians and Latin Americans would be vaccinated before many Italians, French or Germans. It would mean that countries would need to share – countries where citizens’ frustrations are already great and the pressure on those in power is growing. On top of that, Germany will elect a new parliament and chancellor in the fall.

The industrialized nations’ vaccination policy has consequences that extend beyond people’s health. Developing nations are once again learning who they can rely on and who they cannot.

At the start of this year, aid workers in Nepal lugged cooling boxes with vaccine to mountain villages in the Himalayas. India had sent its neighbor a million doses of vaccine early on. In early March, a modest delivery from COVAX followed. After that, the flow stopped. And on March 17, the government suspended its vaccination program.

Last week, there was once again reason for the Nepalese to celebrate. A shipment of 800,000 vaccine doses arrived at the airport in Kathmandu, a gift from a friend whom many suspect of having ulterior political motives. The gift didn’t come from COVAX, the EU or the U.S. It came from China.