Intended for healthcare professionals


Covid-19: WHO warns against “vaccine nationalism” or face further virus mutations

BMJ 2021; 372 doi: (Published 01 February 2021) Cite this as: BMJ 2021;372:n292

Linked Opinion

We need an equitable and coordinated global approach to covid-19 vaccination

  1. Lynn Eaton
  1. London, UK

World Health Organization officials have voiced concerns at “vaccine nationalism” which could increase the risk of the coronavirus mutating further, after a week long row over a shortfall in EU supplies of covid-19 vaccines.

Bruce Aylward, senior adviser to WHO’s director general, said, “Anything that restricts the ability to get these products out will affect our ability to control this disease and prevent variants emerging. The world is going to have to collaborate to get out of this,” he said.

Vaccines alone were not the solution, however, said WHO technical lead Maria Van Kerkhove. Test and trace measures, social distancing, mask wearing, and personal protective equipment will still be essential to control the virus, she said.

Meanwhile, WHO director general Tedros Adhanom Ghebreyesus called on countries that had vaccines left over after vaccinating their own priority health staff and at-risk groups to share them with others under the Covax programme. “Health and care workers have been on the frontlines of the covid-19 pandemic but are often under-protected and overexposed. They need vaccines now,” said Tedros.

At the WHO press conference on 29 January, a nurse from Pakistan and a midwife from Uganda pleaded for vaccine supplies. “They are right at the end of the queue,” said Michael Ryan, WHO executive director. “They see people at the top of the queue fighting about where they are in the line. It looks like fighting over the cake—when they don’t even have access to the crumbs,” he said, commenting on the vaccine row in Europe. “We all need to ask ourselves, ‘would I have the vaccine if I thought it meant a health worker in the south wouldn’t get that vaccine today?’ We all need to examine our own consciences, then tell our leaders what we want them to do.”

The confrontation between Brussels and London over vaccine supplies triggered another Brexit row, as the EU tried to block movement of EU produced vaccines from Ireland to Northern Ireland. Only after frantic and furious negotiations did the EU back down.

On 30 January AstraZeneca tried to diffuse the row by promising to increase its vaccine deliveries to the EU by 9 million by March, said European Commission chief Ursula von der Leyen. This will bring the total vaccines from the company to 40 million, half of what was expected. The EU has a deal with AstraZeneca for 300 million doses altogether. The aim was still to vaccinate 70% of adults in the EU by the end of summer.

The crisis began as vaccine production levels fell in the EU, undermining expected supplies. Pfizer hit problems at its plant in Belgium, affecting supplies in Spain, while AstraZeneca, a UK-Swedish company, signalled it was having problems meeting planned deliveries from its plants in the Netherlands and Belgium.

However, AstraZeneca was already producing vaccines from its two UK based plants to meet its contracted target with the UK government. And it was this manufacturing supply line that the EU wanted its 27 member states to access. If not, the EU would permit its member states to restrict the supply of any of their vaccines to the UK.

While details of the UK government contract with AstraZeneca are confidential, it would appear to have a clause that protects the supply of vaccines that are pre-ordered under contract for the NHS from being diverted elsewhere. Although portrayed as a “ban” in some quarters, a spokesperson from the Department of Health and Social Care (DHSC) insisted this was not a ban on exports by UK based manufacturers. “Drugs that have been manufactured and intended for markets abroad are not subject to export restrictions,” he said.

The UK has, however, had regulations in place since October 2019 that ban “parallel exporting.” These restrict wholesalers from stockpiling or exporting drugs for financial gain which were originally destined for the UK market. More than 100 named drugs held in the UK are on this list.1

“We have restricted the exporting and hoarding of drugs that have been placed on the market in the UK for UK patients to ensure the uninterrupted supply for the NHS,” the DHSC spokesperson said.

AstraZeneca chief executive Pascal Soriot said, “The contract with the UK was signed first and the UK, of course, said ‘you supply us first,’ and this is fair enough. This vaccine was developed with the UK government, Oxford, and with us as well. As soon as we have reached a sufficient number of vaccinations in the UK, we will be able to use that site to help Europe.”

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