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Covid-19 vaccine shortages: what is the cause and what are the implications?

BMJ 2021; 372 doi: (Published 19 March 2021) Cite this as: BMJ 2021;372:n781

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Vexed issue of vaccine shortage - Call for a COVID Vaccine Global Super Tsar

Dear Editor

I read with trepidation your news item on COVID-19 vaccine shortage (1). I strongly disagree with this statement in your news item that the delay “is solely dependent on India, and it has nothing to do with the Serum Institute of India" and the Telegraph news “Five million UK-bound AstraZeneca vaccine doses being held up ‘by Indian government’. The issue is not as simple as it sounds and much more complicated in the interlinked global network of vaccine manufacturing and vaccine politics. We have highlighted (2,3) the issues faced by this particular vaccine in Europe in the past through the British Medical Journal rapid response pages. When this saga is about to subside, there have been problems on another front. On 17th of March Government's Vaccines Task Force notified (4) local vaccination providers that there will be a significant reduction in weekly supply available from manufacturers beginning in the week commencing 29 March, meaning volumes for first doses will be significantly constrained. They now currently predict this will continue for a four-week period, as a result of reductions in national inbound vaccines supply. This is likely to have some impact on one of the most successful vaccination programmes in history against COVID19.

The BBC is reporting that the unexpected reduction in the UK's Covid vaccine supply in April is partly due to a delay in a delivery from India of five million Oxford-AstraZeneca doses (5). The reasons for this appear to be due to the actions taken thousands of miles away in the United States of America. Adar Poonawalla, the chief executive officer of the Serum Institute of India which is licensed to produce hundreds of millions of Covid-19 vaccines from AstraZeneca and Novavax, told (6) a World Bank panel recently that a US law blocking the export of certain key items, including bags and filters, is likely cause of serious bottlenecks. Those supply disruption concerns have arisen after the Biden administration announced plans to use the Defence Production Act (DPA) to boost supplies needed to make Pfizer’s vaccines. A senior colleague from the World Health organisation added, “There is a shortage of materials, of products that you need for the manufacturing of vaccines,” “This is where again you need global agreement and coordination not to do export bans.”

One wonders in the face of a global pandemic is this the right approach to be taken by the richest democracy which has the motto “In God we trust”. The act was passed in September 1950 at the start of the Korean War, the DPA Act was modelled on the War Powers Acts of 1941 and 1942, which gave President Franklin D. Roosevelt sweeping authority to control the domestic economy during World War II (7). Over a year ago questions were raised in the European Parliament (8) on the adverse impact of this act including “Does it [European Parliament] plan to take new measures to guarantee that there will be sufficient medical equipment in the EU, apart from the measures previously taken? The act was designed to fight the enemies of the state. However, during the pandemic there is a common enemy threatening the lives and livelihood of us all – the global citizens. If vaccine supplies are hit it will hurt less well-off countries the most as they stand to benefit from COVAX programme (9).

As we are in an extraordinary situation where vaccine nationalism is raising its ugly head, we need a global initiative and a global Statesman to lead this initiative to help countries and national leaders to raise above their differences and self-interests. The UK as the current lead for G7 nations has a big role to play in ensuring uninterrupted production and supply of the vaccine across the globe. There have been calls for vaccine equity (10) and people’s vaccine “available to all, everywhere, free of charge” (11). Elected leaders of democracies must put the interest of their citizens first. In the USA this will be the opportunity for the new Biden administration to show that they are making a slight move from “America first” to “Americans first”. They must ensure that Americans have enough vaccines but at the same time guarantying vaccine flow is uninterrupted in the rest of the world by making slight changes to the DPA to exempt key vaccine components from the export ban.

I call for a COVID Vaccine Global Super Tsar who can lead and coordinate a global effort to ensure that key vaccine components are not prevented from leaving the developed world using laws that have been enacted to fight the enemy when the country is threatened by invasion. I can think of no other Statesman to lead this noble effort other than the former President of the United States of America Mr. Barrack Obama, who will be able to negotiate with the Biden administration and address the vaccine scarcity created by the DPA. Science and evidence show that no one is safe unless we are all safe. Hence it is in the interest of everyone to ensure uninterrupted production, distribution, and administration of the COVID vaccine to billions of our brethren across the globe. It is my fond hope that the Vaccine super Tsar will be able to achieve this in the interest of humanity and mankind.


1 Torjesen I. Covid-19 vaccine shortages: what is the cause and what are the implications? BMJ 2021;372:n781

2 Cubitt E, Badrinath P. COVID VACCINE: Cautious approach with (potential) catastrophic consequences? The tale of two allies: EU and UK. [BMJ] 6th March 2021. [accessed 19th March 2021]; Available from:

3 Cubitt E, Badrinath P. Shifting sands of the Oxford AstraZeneca vaccine - Is politics silencing the science? [BMJ] 16th March [accessed 19th March 2021]; Available from:

4 NHS. COVID-19 vaccination deployment next steps on uptake and supply. [Internet] 17th March [accessed 19th March 2021]; Available from:

5 Covid vaccine: UK supply hit by India delivery delay [Internet] 18th March [accessed 19th March 2021]; Available from:

6 Adar Poonawalla, WHO warn of delays as US prioritises Pfizer [Internet] 6th March 2021 [accessed 19th March]; Available from:

7 What Is the Defense Production Act? [Internet] 26th January [accessed 19th March 2021]; Available from:

8 European Parliament. Parliamentary questions - Subject: Coronavirus pandemic and the US Defence Production Act. [Internet] 24th March 2020. [accessed 19th March 2021]; Available from:

9 THE COVAX FACILITY: INTERIM DISTRIBUTION. [internet] 3rd February 2021. [accessed 19th March 2021]. Available from
10 Covid-19: A call for global vaccine equity [BMJ] 17th March 2021[accessed 19th March 2021]; Available from:

11 The People’s vaccine. [Internet] [accessed 19th March 2021]; Available from:

Dr Padmanabhan Badrinath, Consultant in Public Health Medicine, Director, Public Health Specialist COVID19 Centre Suffolk County Council & Associate Clinical Lecturer, University of Cambridge. Directorate of Public Health, Endeavour House, Suffolk County Council, Ipswich, IP1 2BX.

Disclaimer: The views expressed here are the personal view of the author and in no way represent the views of his employer, Suffolk County Council.

Conflict of interest: The author is a British citizen of Indian origin and holder of the Overseas Citizen of India document.

Competing interests: The author is a British citizen of Indian origin and holder of the Overseas Citizen of India document. The views expressed here are the personal view of the author and in no way represent the views of his employer, Suffolk County Council.

19 March 2021
Padmanabhan Badrinath
Consultant in Public Health Medicine & Associate Clinical Lecturer
Suffolk County Council & University of Cambridge
Endeavour House, Suffolk County Council, Ipswich IP1 2BX