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COVID-19 Vaccines and the Vulnerability of Small Nations

More than 10 billion doses of COVID-19 vaccines have been preordered. That’s more than one dose for every person living in the world today. But it doesn’t mean that there will be enough for e everyone. COVID-19 vaccines are unevenly distributed, so most of the vaccine production through 2021 will be going to a few rich countries, and poorer countries won’t see widespread vaccination for the next few years.

The nature of the vaccines

The currently available vaccine, developed by Pfizer, requires two doses several weeks apart. Moderna’s vaccine also requires two doses, and AstraZeneca’s may need follow-up with a half dose. Nations will therefore need roughly twice the number of doses as they have residents.

Canada has preordered nine doses for every person in their country. The United States has four doses per resident. Japan and the United Kingdom have also already preordered more doses than needed to vaccinate their populations. Counting the EU, which has also preordered many doses, the countries which are fully covered make up about 14% of the world’s population.

One reason for the over-ordering is that countries with the resources hedged their bets, preordering more than one vaccine in case their first choice was not approved.

Another cause is the fact that the first approved vaccine, the Pfizer version, has very strict temperature requirements. It must be shipped at -94 degrees Fahrenheit, and can be refrigerated for just five days. Some vaccination facilities, especially in big cities, can keep the vaccine at the required temperature for storage.

In many places, however, the vaccine will be kept on dry ice and distributed as fast as possible. It is possible that some doses will be lost because they cannot be stored.

Population issues

Since 975 doses is the minimum order, vaccination hubs must have at least 975 people ready to receive the vaccine within a few days of its arrival. (Pfizer’s vials are turning out to have 6 or even 7 doses rather than the five anticipated, so the number of people who need to be ready to receive the vaccine will in fact be larger than anticipated.

The vaccine must be distributed according to plans filed with the CDC. Puerto Rico’s plan, like those of most states, begins with distribution of the vaccine to healthcare workers.

In rural areas, a healthcare facility might have only 20 or 30 workers. The next nearest facility might be many miles away. With the high numbers of people needing treatment for COVID-19 on top of the ordinary healthcare needs of the community, it could be difficult for healthcare workers to travel to the vaccination hub while still providing care for their patients.

While every state and territory is working out the logistics, these realities about population and geography add to the possibility of losing some doses of the vaccine.

There have already been some concerns about delivery schedules.

Global agreements

The preordering of vaccines made it possible for pharmaceutical companies to develop the vaccines. Preorders funded the work. However, that doesn’t necessarily mean that the rich countries which provided the funds should receive all the vaccinations.

The World Health Organization has organized a plan to distribute the vaccine equitably around the world. More than 150 nations, representing about 64% of the world’s population, have signed on. The United States has not.

The plan is for all the nations to pool their resources so the pharmaceutical companies will have the funds they need to produce the vaccines. Then the vaccines will be distributed to the highest risk populations in every nation in the world first.

The WHO points out that vaccinating some countries and leaving others unvaccinated will not end the spread of the virus, since international travel will allow the virus to spread in the future. Uneven distribution of immunization could also lead to economic effects in wealthy countries. In 2020, supply chains for many ordinary household goods were disrupted. For example, a yeast shortage was caused in part by a shutdown by a packaging company in India which was the only supplier of packaging for major yeast suppliers in the United States. Manufacturers found that this kind of problem was unpredictable and hard to solve or to work around.

For this reason, hoarding the vaccines could backfire.

Puerto Rico

As a territory of the United States, Puerto Rico is scheduled to have plenty of vaccine available. If Puerto Rico were an independent nation, it would be in a different position.

Puerto Rico’s neighbor, the Dominican Republic, is waiting for the vaccine from AstraZeneca, still in the works. The AstraZeneca vaccine will not have special requirements for storage and it will be much less expensive than the Pfizer vaccine. AstraZeneca’s vaccine could cost as little as $2.50 per dose, which is about one tenth the cost of the Moderna vaccine. It can be refrigerated, so it will use the standard cold chain process.

The Dominican Republic expects that with its preorders from AstraZeneca, help from Covax, and a contract with another company currently working on a vaccine, it will have 14 million doses available for its population of 10 million people. This is the official word from Public Health Minister Plutarco Arias. They expect to be able to immunize 7 million people.

However, the AstraZeneca vaccine may be much less effective than the Pfizer and Moderna drugs: as low as 62% rather than 95% effective. AstraZeneca has also made an arrangement with a vaccination manufacturer in India to speed up production. It is considered the most realistic option for developing countries.

Nations like the Dominican Republic will also face logistical issues, though, and they may have limited resources to deal with those challenges.

Cuba is working on its own vaccine. Reliefweb estimates that Haiti will be prepared to vaccinate 10% of their population. Grenada hopes to begin receiving vaccines for medical workers through Covax at about the time the United States expects to have all residents vaccinated.

Due to its relationship with the U.S., Puerto Rico is not expected to contend with the delays its sovereign, independent neighbors are facing.

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