On the Road to Global Vaccinations, the Last Mile Remains the Hardest


By Robert Grant, Executive Director of International Affairs

As business delivers on the promise to manufacture safe and effective COVID-19 vaccines for everyone, challenges persist on getting shots to everyone who needs one.

Business is delivering on the promise to manufacture safe and effective COVID-19 vaccines for the whole world.

2021 was a historic year for vaccine production, and the momentum continues. Last year saw the production of 10 billion does of COVID-19 vaccines, and production in 2022 should exceed 20 billion. These milestones lead Deputy Director-General of the World Trade Organization, Anabel Gonzalez, to note how “never has the world seen such a rapid development of a viable vaccine.”

Unfortunately, even as manufacturers produce billions of doses, the public health systems in some nations struggle to ensure these vaccines reach all patients. As of March, over 65% of global population has received at least one dose, and this number is growing every day, but some patients are harder to reach.

So, what are the challenges, and what steps can we take to make sure everyone who needs a shot can get one?

There are enough shots for everyone, but logistical huddles remain. 

The World Health Organization states, there are enough vaccines being produced to distribute to anyone who needs them. However, infrastructure, organizational, personnel, and other resources don’t always exist to deliver medicines the last mile to patients. Even as vaccination rates across Asia and Latin America have caught up with U.S. and Europe, large swathes of the world’s population remain unvaccinated—particularly regions in Africa. As Seth Berkley, CEO of the Gavi vaccine alliance puts it, “the challenges range from shortages of supplies like syringes or health care workers to utilize them, issues with the ‘cold chain’ needed to transport and store vaccine doses, vaccine hesitancy, or inadequate logistical planning.”

Undelivered doses expire and are destroyed.

Some African health officials requested a pause on vaccine deliveries until there is greater capacity for distribution and administration. Unreliable distribution causes unused doses to expire before they can reach a patient. In Nigeria, officials were forced to destroy nearly one million vaccines because inoculators didn’t have enough cotton swabs for safe administration, and spotty power supplies jeopardized proper refrigeration. Likewise, South Sudan received a batch of 191,000 vaccines, but only two weeks before their expiration date, forcing the government to destroy a third of them.

Hesitancy remains a major issue.

Vaccine hesitancy is a recognized problem in high- and middle-income nations. But as deliveries reach more communities across the globe, resistance to getting vaccinated is a major issue in poorer nations too. Also, due to some nations’ hoarding of vaccine supplies, African countries were late to receive supplies, which, on top of widespread misinformation, only increased hesitancy.

Political scapegoating won’t fix these problems. 

Some governments and media are distracted from practical solutions to achieving global vaccinations with issues unrelated to getting shots into arms. For example, they claim, without evidence, that weakening or suspending intellectual property rights for vaccine producers would somehow hasten the production and delivery of doses. On the contrary, the discovery of COVID-19 vaccines in record time was the product of decades of research and investment, strong private-public partnerships, and licensing technology—all of which require clear and enforceable rules for intellectual property.

The United States has a leading role in helping the world overcome these last-mile challenges. 

The U.S. has a long and proud tradition of leading the global response to global health challenges. The business community supports a greater global leadership role for America to bring the pandemic to an end. This requires focusing on real, practical matters.

The Biden Administration’s recently announced plan is on the right track, and industry and Congress should continue to support such efforts. Making these investments now will save trillions later, by hastening the end of the pandemic and the impending risk of new COVID variants.

The U.S. can provide support for public education to fight vaccine hesitancy, aid in training healthcare workers, increase the cold chain capacity, and bolster medical supplies. Additionally, the U.S. Government could consider appointing a senior official in the White House to organize and oversee international efforts to combat COVID-19.

Private investments are driving regional vaccine production. 

Finally, now that attention is turning to preparations for the next pandemic, some argue that greater regional vaccine production should be established, especially in Africa. Continental partnerships announced by Moderna and BioNTech, and Johnson & Johnsons’ partnerships with Aspen, are significant developments in this regard. To be effective, such efforts must be sustainable and capable of addressing the next challenge, not just the last one. Private investment is the key, and putting in place the legal and economic conditions to support such investment will be essential in the long term.

In all of the above, continuing partnerships between governments and businesses will be necessary to overcome this pandemic and prepare effectively for the next. Focusing on real and practical challenges and solutions is the only responsible path ahead.

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