A White House plan to donate hundreds of millions of doses of Covid-19 vaccines has been hampered in many developing countries by a lack of infrastructure to handle storage and distribution, leaving poorer nations far behind the developed world in vaccination rates.
After a delayed start—the U.S. missed its first donation target—the Biden administration has been ramping up overseas donations, shipping around 137 million doses, most of them Moderna Inc. and Johnson & Johnson. It expects to send 500 million doses of a shot developed by Pfizer Inc. and BioNTech SE by the end of June 2022, the largest donation total of any country.
At a summit on the sidelines of the United Nations General Assembly on Wednesday, President Biden is expected to urge leaders from around the world to help low- and lower-middle income nations vaccinate at least 70% of their populations by September next year, according to a draft of targets reviewed by The Wall Street Journal. Currently, less than 10% of people in those countries are fully vaccinated. In Africa, that rate stands at 3.6%.
But efforts to distribute even the current level of donations have hit snags in many poor countries that range from inadequate infrastructure and governmental resources to a lack of national planning for a major vaccine rollout, according to officials in those countries and public health specialists working on the issue. These problems, they say, have in some cases been exacerbated by confusing communication from the U.S. on when and what quantities of vaccines would arrive.
Many public-health experts are now urging the Biden administration to take a more hands-on role in providing that logistical and planning support, as well as funding to help pay vaccinators and buy needed equipment.
Complicating matters, the two-shot regimen of Pfizer-BioNTech, which comprises some 80% of the shots the U.S. has pledged for donation so far, requires storage at minus 70 degrees Celsius until up to a month before use. It also needs to be diluted with a saline solution before injection, requiring more equipment and training for healthcare workers than other vaccines.
“The response is just orders of magnitude smaller than it really needs to be,” said Ritu Sharma, vice president at CARE USA, which is supporting the Covid-19 response in some 60 developing countries. “If you are going to donate vaccines, you need to do it accompanied with the support that is needed to deliver the vaccines.”
With vaccination rates so low in many poor countries, some health specialists warn that more lives could be lost to Covid-19 in 2022 than 2021. At least 2.81 million people have died this year, up from 1.88 million deaths counted in 2020.
U.S. officials say the government has been seeking to provide infrastructure support, including $8.6 million in cold-chain storage containers provided by the Defense Department to 16 countries.
But they acknowledge that some countries won’t have the ultracold freezers or other infrastructure in place this year to receive the Pfizer shots. Only around a quarter of the 100 low- and middle-income nations that are eligible for the donated Pfizer shots have received any so far, though many got vaccines from Moderna or J&J instead.
“As more doses begin to flow, we are getting more fidelity on where resources are needed,” said Jeremy Konyndyk, executive director of the U.S. Agency for International Development Covid-19 Task Force and a senior adviser to the USAID administrator. “Anytime you roll out a new vaccine, it is a lift.”
Mr. Biden is expected to call on wealthy nations to raise a total of $10 billion this year and next to help poor countries overcome some of the barriers the U.S. donations have run into, including getting the necessary equipment for a broad vaccine rollout.
Covax, the international program backed by the World Health Organization and tasked with supplying vaccines to the world’s poorest nations, built its campaign around a shot developed by the University of Oxford and AstraZeneca Inc. and other vaccines that are easier to handle. Many of those vaccines got stuck in India when the government there banned exports amid a surge in Covid-19 cases. Others have yet to receive regulatory approval or faced production issues.
“It’s the challenge of a lifetime,” said Mutahi Kagwe, Kenya’s health minister, who said his country was prepared to handle the Pfizer vaccine. “We’ve never had to go out and vaccinate an entire population.”
In the first six months of 2021, Unicef, which is in charge of procurement for Covax, had delivered just 43 ultracold freezers to five low- and middle-income countries. In July, the agency ordered around 400 extra freezers from China. A Unicef spokesman said around 80% of countries that have asked for ultracold freezers should receive them by the end of September.
Mr. Konyndyk at USAID said the administration plans to allocate more funding toward supporting vaccine infrastructure in other countries and has so far given priority to shipments to those that have the capacity to administer Pfizer doses.
“We’re starting with the ones that are the most ready up front,” he said.
During recent calls, academics and NGO representatives bombarded officials from USAID and the National Security Council with questions and criticism about the U.S. involvement in vaccine distribution overseas, participants said.
“The current global response is without a leader,” said Carlos del Rio, a professor of global health at Emory University, who was on one of the recent calls.
The vaccine donation drive has faced other hindrances. Some governments, including in India, balked at giving Pfizer and other drug companies the full indemnification the companies sought from claims for potential vaccine side effects. U.S. and international officials struggled to get clear data on the freezers and fridges that were in place.
“One of the things that’s been learned is donating and sharing vaccines isn’t as easy as just putting them on a plane and telling somebody where to pick them up,” said Gayle Smith, who coordinates the U.S. global Covid-19 response at the State Department.
A donation of Moderna vaccines to Nigeria was initially meant to be one million doses, but later grew to four million doses, according to an African official familiar with the program. The exact timing of the arrival of the vaccines was communicated only a few days in advance, the official said, adding that he is now worried that some of the vaccines donated by the U.S. to African countries could go to waste.
In Liberia, Mosoka Fallah, who runs a local NGO advocating for better vaccine access, said a promised delivery of Pfizer vaccines has been repeatedly delayed, even though the country has an ultracold freezer installed by the National Institutes of Health for a 2015 trial of an Ebola vaccine.
Liberia has received 494,400 doses of Covid-19 vaccines from Covax, including 302,400 doses of the J&J shot donated by the U.S. It has been able to handle the vaccines it has received so far. But Mr. Fallah said without extra support, the rapid arrival of many doses could cause problems: “The system will be overpacked.”
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