The developed world isn’t just hoarding COVID vaccines. It’s hoarding the best COVID vaccines. And that has spurred some developing countries to make do with Russian and Chinese shots that aren’t as thoroughly tested or as effective as the leading jabs.
This uneven distribution of the best vaccine underscores a huge and growing equity problem as the world scrambles to contain the SARS-CoV-2 virus. Vaccine inequity isn’t just about quantity of shots—it’s about quality, too.
If you live in North America or Western Europe, you’ve probably got fairly easy access to the most effective and trustworthy of the roughly dozen major COVID vaccines. If you live in Latin America, Africa, or South Asia—the so-called “Global South”—you’re probably in a very long line for a limited supply of vaccines. And there’s a good chance the only vaccine available to you is Russia’s Sputnik V or China’s Sinopharm or Sinovac jabs.
There are some signs the Russian and Chinese vaccines work just fine. But then, there are more signs that they don’t. Some countries are eagerly snapping up all the Russian and Chinese vaccines they can. Others have rejected the jabs.
A lack of reliable, accessible data only exacerbates the confusion. We really don’t know how well Sputnik V, Sinopharm, and Sinovac work.
“At worst, these vaccines do not provide the protection they are expected to, particularly against increasingly prevalent variants,” Shaun Truelove, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told The Daily Beast.
In the United States, everyone over the age of 12 is eligible for shots, and U.S. states have millions more doses than they have eligible residents.
Better yet for Americans, the only vaccines the U.S. Food and Drug Administration approved for emergency use in the United States are also the best and most thoroughly tested jabs from Massachusetts-based Moderna, New York-based Pfizer, and Johnson & Johnson in New Jersey.
Extensive data from large-scale trials and multiple independent studies indicate that the two-dose vaccines from Moderna and Pfizer are around 95-percent effective at preventing symptomatic illness. Data shows that the single-dose Johnson & Johnson vaccine is around 70-percent effective against symptomatic illness. All three vaccines are nearly 100-percent effective at preventing severe illness that could require hospitalization and result in death.
The European Medicines Agency has signed off on the Moderna, Pfizer and Johnson & Johnson vaccines as well as a two-dose shot from AstraZeneca, headquartered in Cambridge in the United Kingdom. The European Union has ordered 2.6 billion doses; 238 million have already been delivered—enough to vaccinate around a third of the EU’s roughly 450 million people.
The United Kingdom, which left the EU in January 2020, has approved the Moderna, Pfizer, and AstraZeneca vaccines. The U.K. has ordered hundreds of millions of doses for its 67 million people. As of mid-May, the country is close to two-thirds vaccinated.
Compare the high vaccination rates in the United States and Europe—especially the U.K.—with the global average. Eighty-four percent of doses administered globally by mid-March were in rich countries, according to an analysis by The New York Times. Less than 1 percent of doses were in poor countries.
The vaccines available in the United States and Europe are, broadly speaking, plentiful and effective. And the regulatory structures around them are very thorough.
In April, the FDA and U.S. Centers for Disease Control and Prevention briefly pulled the Johnson & Johnson vaccine after a couple dozen people, out of seven million Americans who’d received the vaccine, suffered potentially serious blood clots. After 11 days of study, the agencies resumed distribution of the vaccine—albeit with a warning about the very unlikely possibility of clotting.
The FDA, meanwhile, has declined to approve the AstraZeneca vaccine, owing to some irregularities in the large-scale trials of the jab. Some of the vials the company shipped for the trials last year accidentally contained only a half-dose of the then-experimental vaccine, thus corrupting the trial’s data.
European regulators approved the AstraZeneca vaccine, only to reconsider last month when a small number of people who’d gotten the shot came down with blood clots—the same extremely rare problem that’s associated with the Johnson & Johnson jab. The European Medicines Agency ultimately endorsed the AstraZeneca vaccine a second time, stressing that the protection the vaccine offers outweighs any risk of complications.
Now compare the thoroughness, openness and extreme caution that U.S. and European regulators have demonstrated with the rushed, secretive and seemingly reckless approach of their Russian and Chinese counterparts.
With urging from the Chinese government, China’s pharmaceutical industry developed COVID vaccines at a mad sprint. State-owned pharma Sinopharm and private firm Sinovac, both based in Beijing, quickly developed two-dose vaccines using traditional “inactivated-virus” technology, which essentially injects dead virus in a person in order to stimulate their immune system.
China approved its first inactivated-virus vaccine way back in June. Russia was hot on China’s heels. The government-run Gamaleya Institute in Moscow modified two common adenoviruses to produce the two-dose Sputnik V vaccine. Mass-production started in August.
The best Western vaccines use messenger-RNA tech that includes no actual virus, and instead delivers genetic information to a person’s immune system, teaching it how to fight the pathogen. It took time for developers to get the mRNA vaccines right. The FDA didn’t green-light a vaccine, Moderna’s mRNA jab, until December.
Despite beating mRNA vaccines to market by six months, and despite being in wide circulation across the developing world, the Chinese pharmas still haven’t released their large-scale trials data. Gamaleya has been cagey with its data, too, despite having a four-month head-start on Western pharmas.
In February, The Lancet, a leading U.K. medical journal, published an analysis of Gamaleya’s large-scale vaccine trials. The analysis, conducted by a team of Russian scientists, claimed the Sputnik V vaccine was more than 90-percent effective in preventing symptomatic COVID.
But other scientists are skeptical. Last week, The Lancet published a retort from a team led by Temple University biologist Enrico Bucci. The Temple team claimed it asked the Russian scientists who endorsed Sputnik V to share their data, and the Russians declined.
The Russians’ apparent reluctance to show their work has raised eyebrows. “There are important questions that have been raised about the completeness, accuracy and availability of data to be able to fully assess safety and efficacy,” Julie Swann, a systems engineering professor and vaccine-distribution expert at North Carolina State University, said of Sputnik V.
Bucci and his team and Swann are not alone in expressing their concern. The European Medicines Agency has been reviewing Sputnik V for several months and has yet to approve it. It may never. Brazilian regulators, who have a reputation for thoroughness, outright rejected the Russian vaccine.
The Chinese vaccine has its own problems. When Brazilian scientists ran their own trial of the Sinovac vaccine in January, they concluded it was just 50 percent effective.
Early this month, the World Health Organization belatedly endorsed the other Chinese vaccine—the one from Sinopharm. Around the same time, the Seychelles suffered a major COVID outbreak despite having vaccinated 60 percent of its population with Sinopharm. “Breakthrough” cases, where the virus infects a vaccinated person, were alarmingly widespread.
A couple weeks later, authorities in the United Arab Emirates and Bahrain urged local recipients of that Chinese jab to get three doses instead of the prescribed two in order to shore up the vaccine’s apparently low effectiveness.
All over the world, holes are appearing in the Sinopharm vaccine’s protections. “We are seeing breakthrough infections at a seemingly higher rate in countries that rely on these vaccines for the majority of the population,” Amesh Adalja, a public-health expert at the Johns Hopkins Center for Health Security, told The Daily Beast.
The warning signs are clear. It’s possible Russian scientists aren’t being totally honest about Sputnik V. And the Chinese vaccines might not work very well. Still, these jabs are in high demand as COVID continues to rage across much of the world and rich countries such as the United States hoard much of the best vaccine.
No fewer than 40 countries—many of them in the relatively poor Global South—are distributing the Chinese vaccines. Naturally, they include China itself. Beijing’s goal is to produce up to five billion doses this year in Chinese factories alone, around half for export.
Meanwhile, 50 countries, including many in Latin America, are giving out Sputnik V. India, which is still suffering through a devastating surge in COVID cases, has inked a deal for nearly 400 million doses of the Russian vaccine.
Big orders for Sinopharm, Sinovac, and Sputnik V jabs make sense when you consider the restrictions many Western countries have placed on their own locally-developed vaccines.
The U.S. government requires Moderna, Pfizer, and Johnson & Johnson’s American factories to fill huge domestic orders before exporting doses. The British government added clauses to its vaccine contracts that require firms to make up for shortages in the U.K. by diverting doses from other countries.
The more rich countries hoard the best vaccine, the more pressure poor countries will be under to take chances with the second-best vaccines.
“We should do what we can to make sure that sufficient vaccines are produced to cover people around the world,” Swann told The Daily Beast. “The best case is that we do this as quickly as possible with vaccines that have been demonstrated to be safe and effective.” But 18 months into the pandemic, with vaccines still in short supply across most of the world, we’re way past “best case.”
To be sure, even a less effective vaccine is better than no vaccine at all. But the sustained popularity of the Chinese and Russian vaccines speaks as much to countries’ desperation as it does the vaccines’ worth.
The world’s rich countries have developed some really effective and trustworthy vaccines. Until these countries share that vaccine wealth, poor countries have little choice but to make do with whatever vaccines they can get their hands on. Even if those vaccines aren’t very effective or trustworthy.
“The ethical issues,” Truelove said, “are absolutely daunting.”
