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Podcast August 3, 2021

'Absolutely Unacceptable' COVID-19 Vaccination Rates in Developing Countries | The Development Podcast

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because a large part of the world remains unvaccinated and this is a danger for all of us," so warns Mamta Murthi, the World Bank's Vice President for Human Development.

  And what's being done to help?  In the latest edition of The Development Podcast, we're examining these questions and more.  

From Addis Ababa, Dr. Ahmed Ogwell, Deputy Director of the Africa Centers for Disease Control, details how the COVID-19 pandemic has unfolded across the African continent, and the steps being taken to increase vaccination rates.

Back in Washington, Murthi joins Raka Banerjee and Paul Blake to talk about global trends and the support that the World Bank Group is giving to countries and partners in the race to vaccinate the world against the coronavirus.

 

Transcript

Raka Banerjee: Hello, and welcome to The Development Podcast coming to you from the World Bank Group in the United States and around the world. I'm Raka Banerjee alongside Paul Blake.

Paul Blake: Today, the race to vaccinate the world against COVID-19. We're examining why many low-income countries are struggling to vaccinate their populations and what's being done to help.

Mamta Murthi (Clip): The situation that we see right now is absolutely unacceptable because a large part of the world remains unvaccinated, and this is a danger for all of us.

Paul Blake: And from Addis Ababa, the steps being taken to accelerate vaccination rates across the African continent.

Ahmed Ogwell (Clip): What we want are vaccines now. We don't want vaccines in 2022, 2023. And those vaccines that would be made available now have already been bought up. It means that even though we have the money, we can't be able to buy because there's nothing to buy.

Paul Blake: All that and more over the next few minutes, but first let's take a look at some data.

Paul Blake: All right, Raka. So you've been digging into the data and when it comes to COVID-19 vaccination rates around the world, what are you finding?

Raka Banerjee: So I was looking at data that's available from the Our World in Data website, which is updated daily based on the latest official statistics from governments and health ministries around the world. And what has become painfully clear is that the main story when it comes to vaccines is inequality.

Paul Blake: And what are some of those sort of major discrepancies?

Raka Banerjee: So worldwide, almost 4 billion vaccine doses have been administered globally. And 27.6% of the world's population has received at least one dose of a vaccine at this point. So that sounds pretty good. But then if you break it down by country income groups, 1.1% Of people living in low income countries have received even one dose of a vaccine.

Paul Blake: And 1.1% Is a very low number. Can you break it down and further?

Raka Banerjee: So that's in terms of percentage of population, but then if you look at the breakdown when it comes to the percentage of doses to date, and this is as of July 28th, 84% of all doses that have been administered so far have all gone to people in high and upper middle-income countries. And in comparison, looking at the percentage of doses that have been administered in low-income countries, it's a shockingly low 0.3%.

Paul Blake: I mean, that's a huge difference. Do things look any better if you start to compare across regions?

Raka Banerjee: Honestly, not really. So in terms of doses administered per every 100 people, Europe and North America come in at 84 and 82 doses respectively, and keep in mind that most of the vaccines are two dose regimens, right?

Paul Blake: Right.

Raka Banerjee: And then right from there, it drops really starkly. So South America has administered only 59 doses per 100 people, Asia 54, and then across Africa the rate is fewer than five doses for every 100 people.

Paul Blake: And is it a question of problems with production or with making the vaccines? Or is this an issue with doses being sort of held in surplus and not being made available to people who need them in other locations? And I guess if it's about that second point, like excess doses, where are they and why aren't they being released?

Raka Banerjee: So a big part of the problem is that many wealthy countries actually pre-ordered far more vaccine doses than they even needed to vaccinate their populations. Looking at data coming from Duke University, just for example, the US paid for enough vaccines for twice its population, the UK paid for enough for four times its population, and Canada for five times its population. So even though the world will have created 11 billion total doses by the end of this year, almost 9.9 billion of those doses have already been promised to higher and upper middle-income countries.

Paul Blake: And so what's happening now in countries where the vaccine supply exceeds the demand for the vaccine?

Raka Banerjee: Well, some countries have started to donate some of their excess supply, but it's hard to find data on exactly what's happening. Last month, the G7 agreed to donate 1 billion COVID-19 doses to poorer countries, so that's a start. But given that the World Health Organization has stated that vaccinating most of the world's population will take 11 billion doses, a lot of people have felt that this contribution was not nearly as substantial enough to make the difference that we need to actually stop the pandemic.

Paul Blake: And you mentioned that it was hard to find data around excess doses. Do you have any thoughts about why that is? Why it's hard to find data? Is it a matter of the research not being done? Is it a matter of sort of transparency? What's behind that?

Raka Banerjee: Well the thing is when it comes to data, it's so important to have transparency so that people can hold governments to account. And since much of this information is not publicly available, it's really hard to advocate for the equitable distribution that is really needed to make sure that people in poorer countries aren't just being left to fend for themselves.

Paul Blake: All right. So one last question. Is vaccine production a factor here? And is there any good news on that front in terms of getting shots into arms?

Raka Banerjee: So many of the major vaccine manufacturers have ramped up production. So for example, Pfizer and BioNTech are planning to produce 3 billion doses by the end of the year. And a third of those are intended to go directly to COVAX or low and middle-income countries.

Paul Blake: All right. Well, thanks so much for sharing all this background and context. Really appreciate it.

Raka Banerjee: My pleasure. Thanks, Paul.

Raka Banerjee: This is The Development Podcast from the World Bank Group.

Paul Blake: Now, March 2020 may feel like it was a different era, but it was just about 17 months ago that the World Health Organization declared COVID-19 a global pandemic. With developing countries bracing for the virus to arrive on their shores, one region that was of particular concern was Africa. Many countries across the continent have long suffered from fragile health systems that were already stretched by outbreaks in years past.

Raka Banerjee: To understand how African countries were pulling together and preparing for the pandemic. We spoke last year to the Africa Centers for Disease Control's Deputy Director, Dr. Ahmed Ogwell.

Ahmed Ogwell (Clip from March 2020): The mood I would say is one of uncertainty because this thing is new, what images available online, and the media is not very encouraging. And of course there's quite some anxiety what that mean if it came onto the continent.

Paul Blake: Well, that was March 2020. Let's fast forward to today. Just what has the virus meant for the continent? What about vaccination efforts and what challenges are on the horizon

Raka Banerjee: To get answers to these questions and more, we had the opportunity to talk once again with Dr. Ahmed Ogwell. He joined us down the line from Addis Ababa.

Paul Blake: Well, thank you so much for joining us. When we last spoke, which was in early March of 2020, before I think much of the world realized just how serious this pandemic was going to be, we asked you how serious the pandemic seemed at the time to you and what those kinds of early signs look like to you in your kind of professional opinion relative to previous outbreaks of diseases. And let's just, real quick before we jump into some questions, take a listen to that clip.

Ahmed Ogwell (Clip from March 2020): This one is looking a lot more serious than the earlier ones. If you look at COVID-19, it's transmissibility is quite high. It's easy to transmit from person to person. And then the level of illness that it causes particularly to the older folk is quite much higher than what SARS and MERS has shown us to be able to do.

Paul Blake: So that was a really prescient answer there from early March 2020. How has the African continent fared since then?

Ahmed Ogwell: There are three things that I think stand out for us on the continent, and thank you very much for having me on the show.

Paul Blake: My pleasure.

Ahmed Ogwell: The three things. One is that when knowledge is shared with the public, they tend to respond largely in positive ways. And that is-

Ahmed Ogwell: ... largely in positive ways. And that is why, in the beginning of the pandemic, we saw low numbers in Africa, not just because there was leadership from many levels, the Africa Union, the Africa CDC, the member states, but also because the public listened to evidence and science and they responded. Second, is that when the chips are really down, that Africa is on its own and we've struggled to handle things that will have been a lot easier if there was more solidarity globally. Third, is the spread of the virus does not really respect modeling. It does not respond to discussions amongst the professionals and politicians. It does what it does, and that's how the variants have ripped across the world. We knew variants were coming, but we were not entirely prepared globally speaking. We were not entirely prepared for the large number of variants. And of course, Delta variant just waking up and becoming the real problem really during the whole pandemic so far.

Raka Banerjee: When we spoke last, you had said that one of your main concerns at that time was that across the continent of Africa, health systems are not the strongest, that they might be overwhelmed. Where those fears realized to any extent, or can you give us an update on that?

Ahmed Ogwell: Africa is very diverse and there are parts of Africa that the systems were not completely overrun, but heavily stretched. It really is heavily dependent on how much prevention and the community engagement our country does because that then reflects on not the overall numbers of cases, and then the numbers of those that really need hospitalization. And those that need hospitalization are the ones that would put a huge strain on the health system. And the knock-on effects include other areas, malaria, TB, childhood illnesses, will then get affected because the staff are quite stretched.

Ahmed Ogwell: But sitting back and looking out to the whole continent as one block, we are very pleased that we, our systems on the continent have not been overrun. Although we are getting low numbers, we are getting slightly more people dying, and this is not a situation that we will have liked. We know why. Three main things come out of that. One, is that we have few health facilities that can be able to handle really serious illnesses. Second, is all the equipment and consumables needed, particularly oxygen concentrators, oxygen machines themselves, ICU facilities, those are few on the continent. And finally, it is because our health workers are also few. And so they are stretched in between looking after relatively more individuals who need that care, but our health systems have not been overrun. And it is something that we are trying to keep that way in the next month as we roll out a vaccination on the continent.

Paul Blake: And that's the very next point I want to go to. You're the expert here certainly much more than me, but I would assume another factor would be the relatively low vaccination rate across African countries and across much of the developing world, but many African countries have very low vaccination rates right now. And I'm wondering what, in your view, is causing those vaccination rates to fall so far behind other countries around the world, and in particularly more developed countries and what needs to be done?

Ahmed Ogwell: There are a few things, factors, that are contributing to the very low vaccination rates. In fact, as of today, we are at about 1.65% fully vaccinated, which is extremely far when you consider our target of 60% of the population on the continent.

Raka Banerjee: [crosstalk 00:13:35] I'm sorry. That's across the whole continent? 1.65% across across the African continent?

Ahmed Ogwell: Correct, fully vaccinated.

Paul Blake: We're-

Raka Banerjee: [crosstalk 00:13:43] Fully vaccinated.

Paul Blake: And fully vaccinated, yeah. And just for anyone who's listening in the future, we're recording this on July 28th, in late July. So data as of July 28.

Ahmed Ogwell: That's correct. So a few factors are contributing to the low vaccination. One, is that there are a few entities that are actually manufacturing COVID-19 vaccines. And particularly those that have achieved emergency use authorization. There are few that are doing that. While, at the same time, the whole world wants the vaccines. So access is heavily limited by the rate of supply of the vaccines. Second, is that the relativity well to do countries bought up the vast majority of the vaccines that are to be made available during this year, because what we want are vaccines now. We don't want vaccines in 2022, 2023. And those vaccines that could be made available now have already been bought up. And in that way, it means that even though we have the money, we can't be able to buy because there's nothing to buy. And we are negotiating very hard with the manufacturers to see if we can be able to get some of these items earlier.

Ahmed Ogwell: So this second. Third, is vaccine nationalism. Even those that we had agreements with to supply, governments have gone into the very unhelpful policy path of keeping everything that is being manufactured within their borders. And this is, in our view, a very negative path to take because it actually continues to keep the whole world at risk because if you don't cover equitably, then the variants will pop up. And those variants, as Delta has shown us, does escape the current vaccines that we have, and that means another. We may need booster doses in the future.

Ahmed Ogwell: And then finally, is the whole area of vaccine hesitancy. This has contributed to some parts of Africa, not the most, but some parts of Africa. Although they have the vaccines, the uptake has been a bit low and slow, and we are working with our communications colleagues to ensure that we are doing good community engagement so that that hesitancy can drop and uptake can be able to increase.

Raka Banerjee: Do you worry about African countries being left further behind going forward? And what do you see as some of the consequences of that?

Ahmed Ogwell: Yes, we are very concerned that the slow pace may leave Africa behind. And the consequences of that, we're already seeing them. When we are told that you can't go to certain public places in certain countries, unless you show a vaccine evidence that you've been vaccinated. And yet, we don't have the vaccines to be able to vaccinate. So this is already an immediate consequence. It means I will not be able to take a holiday, for example, in certain parts of the world because it will be difficult to be able to move around without vaccination.

Ahmed Ogwell: Apart from that is the risk and the very, very high risk that if we do not vaccinate enough and bring the pandemic under control, the new variants we will pop up. And finally, is the risk of our health systems getting overwhelmed if we allow for the numbers to increase. And this is something that really, really keeps us awake at Africa CDC are trying to support our countries to keep the numbers low. If the numbers go high, we know that our health systems will be in real trouble. And in that situation, we will end up with a very, very messy situation, which we are working very hard to avoid.

Paul Blake: Dr. Ahmed Ogwell, thank you so much for taking the time this morning.

Raka Banerjee: Thank you so much.

Ahmed Ogwell: Pleasure.

Raka Banerjee: Such a pleasure.

Ahmed Ogwell: Thank you.

Raka Banerjee: Amid the confusion and devastation of the pandemic, one thing is clear. Vaccines are our most effective tool to stop the outbreak, save lives, and return to normalcy.

Paul Blake: While the Herculean work of scientists to develop safe and effective vaccines so quickly was a massive success. The distribution of vaccines, especially to the developing world, has been rocky and uneven.

Raka Banerjee: Why is this the case and what is being done to boost vaccination rates among the poorest and most vulnerable? We spoke to Mamta Murthi, the World Bank's Vice President for Human Development, who joins us down the line from her home in the Washington DC area. So today, about a year and a half into the pandemic, wealthy countries have the vast majority of the world's supply of COVID-19 vaccines. And in contrast, low-income countries are struggling to even obtain doses for their most at-risk citizens. How can we close this divide in vaccine rollout between rich and poor countries?

Mamta Murthi: So thanks Raka, that's a great question. The situation that we see right now is absolutely unacceptable. Because a large part of the world remains unvaccinated. And this is a danger for all of us. I can see at least four things that need to happen. First of all, we need to increase the supply of vaccines in the short term, there simply aren't enough vaccines for everyone. The second thing is that the vaccines that do exist have been pre-purchased and pre-committed to countries that have more than enough to vaccinate their populations. So we need to release these doses from surplus countries and give them to countries that don't have enough doses. The third thing that needs to happen is that countries need to gear up and be ready to vaccinate people. And there's a bit of chicken and egg here. Countries will be ready if they know they're going to receive vaccines. And finally, the fourth thing is we need greater transparency around how many doses can be manufactured, who are these committed to, where are the surplus doses, so that we can have reallocation towards countries that need those doses.

Paul Blake: And, Mamta, what is the World Bank doing to help in all this?

Mamta Murthi: So we're actually doing quite a lot. First of all, on the manufacturing side, IFC is supporting manufacturing of vaccines, medical equipment, and PPE. In fact, the largest investment in the history of IFC has been in Aspen pharmaceuticals in South Africa, which has just started rolling out Johnson and Johnson COVID-19 vaccines. The second thing we're doing is we're helping countries with financing and technical assistance so that they can buy and administer vaccines to their populations. We've already committed over four and a half billion dollars in over 50 countries to assist with the purchase and deployment. To give you some examples. There are already 50 million doses of COVID-19 vaccines that have been contracted using World Bank financing. World Bank financing will also allow countries in Africa to pay for 400 million doses that the African union has arranged. Another thing that we're doing, the third thing we're doing is we're helping countries with readiness, getting ready to administer and deploy vaccines. And the fourth and final thing we're doing is, along with many others, we're advocating for the release of surplus doses. In fact our president, president Malpass along with the heads of the IMF, WTO, and WHO, are jointly leading a task force, a COVID-19 war room if you like, to accelerate the delivery of vaccines and drugs and therapeutics to developing countries.

Paul Blake: So it sounds like it's a very complicated issue and there's a lot of factors at play, but two that seemed to stand out is that there's a lack of vaccine supply, and there's a lack of effective distribution. When you really dive into the data, what's the real issue behind the vaccine rollout? Which one is the most urgent, which one is causing the most problems?

Mamta Murthi: I would say it's both. It's a shortage of supply. Without a doubt. There aren't enough vaccines being produced, and the production is not equitably distributed. The second thing I would say is that countries still need to gear up for rolling out these mass vaccination campaigns. Just to underline the point, most developing countries are used to vaccinating their child population. The COVID-19 vaccine is a vaccine that will have to be administered at scale to a very large number of adults. Most developing countries vaccinate their children against childhood diseases, measles, mumps, rubella, that kind of thing. They're not used to vaccinating their adults. So there's a lot of preparation that is involved in such a large scale vaccination campaign. And so it's extremely important that countries are ready for this. As the World Bank we've been working with WHO, Gavi, UNICEF and others, on readiness assessments. If you like this as a cheat sheet, it's a list of things that countries have to think about in order to be ready for a large-scale vaccination campaign. And we've worked in over 140 countries to help governments complete these assessments. And these have identified specific gaps that countries need to work on in order to be ready for a large vaccination campaign. I think in terms of having a plan for vaccination, most countries are ready. And also having security systems, I think 80% of countries are ready. But in terms of training vaccinators, about one third of countries still need to do a lot more work, and over half of countries still need to work on stakeholder engagement and communication to address vaccine hesitancy.

Raka Banerjee: I think you had mentioned that the supply for 2021, a lot of it has already been pre-purchased by wealthier countries, and it seems like many of these rich countries already have more than enough vaccine to vaccinate their population, a couple of times over even. And I know that the World Bank has been encouraging countries to donate their excess doses, can you speak to the consequences if they don't?

Mamta Murthi: Well, if we're not able to vaccinate everybody in the world soon, we could be in a situation where the pandemic is prolonged. We're already one and a half years into the pandemic. This could go on for longer and it would affect the global economic recovery. We could be in a situation where the world is not recovering, so global economic growth could be lower. And this has consequences, there are fewer jobs, there's less income in the hands of people. And this affects the ability of people to live comfortably and take advantage of the opportunities that exist. We also run the danger of the emergence of mutations as the pandemic is prolonged and the virus circulates amongst newer populations. And this means that we are all at danger of being victim to a new mute mutation that actually escapes the immunity that is being provided by vaccines.

Raka Banerjee: In terms of looking at this more regionally, it seems that African countries are facing some of the greatest challenges in accessing and distributing COVID-19 vaccines. Their vaccination rates are shockingly low in Africa, relative to other parts of the world. What is the world bank doing to help in Africa specifically?

Mamta Murthi: So vaccination rates in Africa are extremely low, around 1% of the population has been vaccinated, compared to 40% of the population in high-income countries. As the World Bank, we are doing a lot. First of all, IFC is supporting manufacture of vaccines in Sub-Saharan Africa. The second thing we're doing is supporting African countries with financing to both purchase and deploy vaccines. I talked about over four and a half billion dollars that we have committed in over 50 countries. Well, half of these countries are in Africa.

Mamta Murthi: ... and in over 50 countries. Well, half of these countries are in Africa. The third thing we're doing is we are, our financing. We're working with the African Union so that our financing can be used to purchase 400 million doses that the African Union has managed to secure from Johnson & Johnson. And so this means that the World Bank's financing will support the vaccination of 400 million people in Sub-Saharan Africa. We're doing a lot, both on vaccination, but also beyond vaccination on strengthening health systems, helping Africa become more resilient to climate change and supporting jobs and economic transformation in Africa.

Paul Blake: I also understand there's a COVID-19 taskforce that the bank is teaming up with a number of other partners, the IMF, the WTO, the WHO. Can you tell us exactly what that is and what it hopes to accomplish?

Mamta Murthi: So the taskforce, as you mentioned, is joint with three other agencies. And the whole purpose is to track, coordinate and accelerate the delivery of vaccines and diagnostics and therapeutics to low-income countries. The challenge that everyone is facing is this lack of transparency around exactly what the supply is, what has been committed and when it will be delivered. So one of the first things the taskforce committed to do is to have a website and a country dashboard, which would identify specific gaps, initially in the delivery of vaccines, but over time, in the delivery of diagnostics and therapeutics. This would make it easy for everyone to see exactly where the shortages are, where the critical bottlenecks are. And the intention is to bring this to the attention of national authorities and other stakeholders so that the critical bottlenecks can be addressed. The second thing that the taskforce is doing is advocating for very ambitious targets when it comes to vaccination. It's advocating for vaccinating 40% of the population in developing countries by the end of this calendar year, and 60% by the middle of next calendar year. It's also advocating for donations of vaccines. It's actually called for a donation of a billion doses this calendar year, in order to meet this ambitious target of 40% of populations of developing countries to be vaccinated. The third thing it's doing is it's arguing for filling any financing gaps that are getting in the way of vaccinating people in developing countries, including financing gaps in the ACT accelerator. And finally, it's advocating for removing any supply constraints and export restrictions that may be getting in the way of delivery of vaccines, drugs, and therapeutics. It's a joint advocacy come data transparency effort, which is intended to really move the dialogue and accelerate the delivery of these critical tools to developing countries.

Raka Banerjee: You spoke about the transparency, and I've been hearing criticism about the lack of transparency that's there right now in terms of the vaccine contracts between governments, pharmaceutical companies, and the organizations that are part of the vaccine production and delivery. Can you just speak a little more to why transparency is so important in this process?

Mamta Murthi: So, greater transparency is absolutely essential for equitable access. Countries and manufacturers need to be transparent about what has been committed to whom by when. Because once there's clarity on this, then they can be clarity on how much supply is available for discussion, for negotiation, for redirection, towards the parts of the world that really needed. Without this clear picture, it's very hard to be certain that we can move supplies to developing countries and reach the target of 40% by the end of the calendar year. Similarly, complete transparency around the supply chain. Supply chains for vaccines are very complicated. Complete transparency around these supply chains will actually help identify where the critical bottleneck is, which is getting in the way of production and delivery of vaccines or drugs or therapeutics. And then bringing this to the attention of the relevant authorities can help with the bottleneck being removed. Without this transparency, I would say that it's actually very hard to get to this objective of equitable access. And as a part of walking the talk, as the World Bank, we've decided to be completely transparent about what we're doing. We have created a portal that anybody can access to see what our financing is going into. This is available by country.

Raka Banerjee: Thank you so much for being with us. Really appreciate your thoughts on all of this.

Mamta Murthi: Thanks for having me. It was great to talk.

Raka Banerjee: Okay, well that is it, for another episode of the Development Podcast.

Paul Blake: If you like our show, please recommend it to a friend, leave us a review, share it with your social networks. Do all of that.

Raka Banerjee: And if you like it, and even if you don't like the show, you can always email me, Paul and the rest of the team at thedevelopmentpodcast@worldbank.org

Paul Blake: Until next time. Goodbye.

Raka Banerjee: Bye.