Intended for healthcare professionals


Covid-19: Countries dump vaccines as demand slumps and sharing proves difficult

BMJ 2021; 374 doi: (Published 27 July 2021) Cite this as: BMJ 2021;374:n1893

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  1. Elisabeth Mahase
  1. The BMJ

The US, the UK, and the Netherlands face throwing away tens of thousands of covid-19 vaccine doses that are due to expire.

The US had already thrown out more than 180 000 vaccine doses by the end of March,1 and some states, including Iowa and Arkansas, have warned that they have thousands more doses set to expire soon. Meanwhile, vaccine administrators in the UK now report that they too are having to discard doses, as strict rules around dosing intervals and fewer people coming forward for their first dose have led to supply far exceeding demand.2

But the UK and the US, where vaccine coverage is high, are not the only countries experiencing these issues. The World Health Organization reports that 23 African countries have used fewer than half of the doses they have received so far, and about 1.25 million doses of the Oxford-AstraZeneca vaccine in 18 countries are set to expire at the end of August.3 Malawi and South Sudan have already destroyed around 20 000 and 59 000 vaccine doses, respectively.4

Why the waste?

Robert Ator, a retired colonel leading Arkansas’s covid-19 vaccine distribution drive, told the Stat news website, “We’re drowning in this stuff . . . It’s starting to get a bit silly.”5 However, repeated requests from state health departments to redistribute stock to other countries have reportedly been denied by the federal government owing to legal and logistical challenges.

The same issues are being faced elsewhere. A group of doctors in the Netherlands have been attempting to ship vaccine doses to other countries but have been blocked by a law that prevents any medicine delivered to doctors for their patients from being traded in.6

Vaccine hesitancy and logistical issues have slowed rollout, especially in countries such as Bulgaria and Romania, where vaccine doses have been sold to other countries despite low coverage at home. And in the UK health leaders have urged young adults to come forward for their vaccinations, as interest among this group seems to have waned.

Pippa Nightingale, chief nursing officer at Chelsea and Westminster NHS Foundation Trust, said recently, “Our vaccination centres are only really operating to about 30% of their capacity, because that’s the people that are turning up. We’ve got staff there, we’ve got vaccines there, but we are really struggling. That’s the picture across London; it’s also a picture across the country.”7

Countries that have tried to send vaccines nearing expiry to other countries have also found it difficult to find recipients able to take the stock and distribute it before the expiry date. In July, Israel had one million vaccine doses due to expire and attempted to send them to countries including Palestine and the UK, as part of deals that would see the countries send back the same number of doses later in the year. Both deals fell through, but Israel eventually agreed a swap for 700 000 doses with South Korea.8

Vaccine sharing is “short term solution”

At a press conference on 21 July WHO’s director general, Tedros Ghebreyesus, said, “Over 3.5 billion vaccines have been distributed globally, but more than 75% of those have gone to just 10 countries. Vaccine inequity is not only a moral failure, it is also epidemiologically and economically self-defeating.”

WHO has set a global target to vaccinate at least 10% of every country’s population by September, 40% by the end of 2021, and 70% by the middle of 2022. To achieve this, said Ghebreyesus, 11 billion doses were needed—and vaccine sharing, while helpful, was only a short term solution.

“We need to dramatically scale up the number of vaccines being produced,” he said. “This can be done by removing the barriers to scaling up manufacturing, including through technology transfer, freeing up supply chains, and IP [intellectual property] waivers.”

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