Messy deployment in the US and overseas

The worldwide deployment of coronavirus vaccines were never going to be easy. But it quickly turned into frustration at home and nationalist acrimony abroad as countries around the world face a maelstrom of logistical and political challenges.

The 50 states of the United States report shortages like america fragmented administrative and health systems struggle to distribute even the limited stocks of vaccines that have been produced.

Europe has fallen into its own awful struggle for supplies. And there are few signs that the world’s poorest countries will soon have access, maybe not before 2023.

Some in Africa, South America and Asia have turned to China and Russia, which are using vaccine diplomacy to strengthen their influence in these parts of the world, some experts say.

In the United States, “the deployment is slow and awkward and very frustrating for our population,” said Dr. Tom Kenyon, former director of the Center for Global Health at CDC.

Washington should be in the best position to vaccinate its citizens, having ordered 1.2 billion doses while working hand in hand with the pharmaceutical giants. Yet the United States lags behind Israel, the United Arab Emirates, the United Kingdom and Bahrain in terms of shots per capita.

Its stakes are broadly twofold: manufacturing and distribution.

As in Europe, the US supply has been strangled as drugmakers struggle to meet growing demand, which is sometimes too promising before having to reduce their orders.

“They probably haven’t done a very good job of communicating well, managing expectations and being transparent,” said Maria Elena Bottazzi, associate dean of the National School of Tropical Medicine, part of Baylor College of Medicine in Houston. .

But what particularly worries the United States, experts say, is that its healthcare system is not centralized and that President Donald Trump’s administration has failed to develop a national vaccine deployment plan. suitable for filling the void.

After inheriting what some experts describe as one of the best pandemic preparedness plans in the world, Trump proceeded to sack his senior biosafety adviser, allowed his global health unit to be disbanded, and downplayed it. importance of the coronavirus during the crucial first weeks of the outbreak last year.

The result today is a chaotic rush when it comes to vaccines, so this criticism goes, where states, counties and hospitals have been left to fend for themselves.

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“We have a very divided approach,” said Kenyon, who is now health officer at Project HOPE, an international global health and humanitarian organization. “We actually have states competing for the vaccine. This is by no means optimal.”

These concerns must, however, be placed in context. Under Trump’s watch, the vaccines arrived faster and were more effective than many anticipated. And the encouraging data keep arriving.

But at the moment, that doesn’t do much to calm officials, experts and citizens exasperated by the vaccine distribution, which is only made worse by new variants and the hesitation of some to be vaccinated.

People line up at a designated Covid-19 vaccination center in Dubai’s financial hub district.Giuseppe Cacace / AFP – Getty Images

Last week, President Joe Biden announced measures reorganize the federal deployment strategy. Time will tell if this will make a difference.

“When it comes to coordination during a public health emergency, you see where our system has collapsed,” said Justin Ortiz, associate professor in the University of Maryland School of Medicine, referring to the record. of the Trump administration. “The idea that the previous federal government could wash its hands of this and rely on each state to create its own systems is a dereliction of duty.”

In Europe, the situation is just as tense.

A quagmire of bureaucratic wrangling appears to have hampered the deployment of the European Union, which has been glacially slow and dysfunctional. Doctors in Madrid and Paris had to suspend vaccinations because stocks are almost exhausted.

In the middle of it all the EU and AstraZeneca disagree after the Anglo-Swedish pharmaceutical giant said it would have to cut deliveries due to a manufacturing glitch. The EU insisted that the drugmaker keep its word.

Margaret Keenan, 90, is the first person in Britain to receive the Pfizer / BioNTech Covid-19 vaccine on December 8.Reuters dossier

To a drastic measure, the EU is now seeking to block exports of any vaccine from companies that did not first honor the order from Europe. EU officials have also suggested that vaccines destined for the UK be redirected to fill the gap on the continent.

A dispute over logistics now risks metastasizing into a real diplomatic crisis.

“We reject the logic of first come, first served,” EU Health Commissioner Stella Kyriakides told a press conference on Wednesday. “It can work in a butcher’s shop but not in contracts and not in our advance purchase agreements.”

Even in the UK, there are concerns about its own ostensibly successful rollout, namely its decision to allow up to 12 weeks between the first and second dose.

The decision came as the country grappled with the world’s deadliest Covid-19 epidemic. Strongly defended by expert government advisers, the delay is much longer than the drug manufacturers recommend, divide the scientific community.

Syringes discarded at Clalit Health Services in the northern Israeli Arab town of Umm al Fahm earlier this month.Jack Guez / AFP – Getty Images File

But nowhere is the situation worse than in the developing world.

For all the tragedies in the West, the delays will be measured in weeks and months. But Africa, parts of South Africa and Central Asia are unlikely to see widespread immunization coverage until 2023, according to an article published last week by the Economist Intelligence Unit, a research group in London. .

In addition to trying to put his own house in order, Biden joined a program run by the World Health Organization called COVAX, which raised $ 2 billion to buy vaccines for poor countries.

Seeing the United States engage in a selfless effort Trump shunned has been welcomed by public health experts. But in reality, what COVAX needs is not just more money and kind words, but doses in hand and the ability to distribute them.

“US funds are welcome, but COVAX’s problems go beyond money,” said Mukesh Kapila, who was an adviser to the former WHO director-general.

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