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Dear Editors

I am curious about some assertions in this article by Jane Feinmann.

1. It is suggested that there is a surplus of vaccine supplies on the ground in the US and UK (amongst many other "wealthy" countries), in which many short dated vaccines could have been used to vaccinate willing arms in other countries.

It is hard to determine demand on vaccine supplies, despite official estimates of expected uptake prior to vaccine rollout. Many factors and events ultimately determine the actual vaccination of those eligible for these products; as experience has shown, perception of urgency during a bad wave of cases, media outcries of vaccine side-effects or celebrities dying from COVID-19 itself, weather and natural disasters, all played a part in influencing how many vaccines are actually used in each region at a given time; and lost opportunities due to lack of vaccines is politically unforgiveable.

Hence it should not be unexpected that supplies are not all used up and there is some wastage.

Given that the cold chain of storage for certain vaccines, like Pfizer, is extremely demanding (ref 1), it would be fairly unrealistic and frankly dangerous to expect the collection of unused vaccine from vaccination hubs into some big lot of unused medical products to be sent to less wealthy countries and think there will be no significant deterioration in quality and quantity of usable vaccine at a time when cross-border logistical support is tenuous at best in this pandemic.

And this assumes that the relevant authorities in the recipient countries are happy to distribute these hand-me-down short-dated medical products with no certainty of a regular supply for the second dose as well as dealing with vaccine hesitancy in a population already suspicious of these 'donated seconds'.

Which ties into the next issue:

2. "In March 2021, for instance, Malawi, with one of the lowest vaccination rates in the world, publicly burnt almost 20000 doses of the AstraZeneca vaccine marked with an expiry date of 13 April, as these would require second doses from the same batch to be administered after the expiry date.

We are destroying these stocks publicly in order to stay accountable to Malawians, the health minister Khumbize Chiponda was reported as saying as she personally placed the red plastic bags of AstraZeneca vials into an incinerator in the capital, Lilongwe.7 "

I am not certain that the Financial Times reference (ref 2) had implied anything about AstraZeneca (AZ) vaccine requiring "second doses from the same batch to be administered after the expiry date". I presumed the actual logic was not that AZ vaccine required second dose which comes from the same batch as the first (as the sentence appears to apply). Possibly the authorities could not give 10 000 people full vaccination of 2 doses, since if they were to use the 20 000 vaccine to fully vaccinate these people, the second dose would have to be give after the expiry dates.

I would point out if this is the logic of the Malawian health authorities, then it can be also considered a flaw view since AZ vaccine given as a first dose offers some form of protection over the unvaccinated individual (albeit not as much as those fully vaccinated with 2 doses of AZ) thus at least 20 000 vulnerable persons could have been given their first dose and the Malawians have about another 3 months to seek and negotiate enough supply for the second dose elsewhere.

Granted there is some validity when these donations are viewed as giving leftovers to the needy as described by Ayoade Alakija, co-chair of the Africa Unions Vaccine Delivery Alliance, I am concerned that nationalistic pride resulting in refusal to accept gestures interpreted as cast-offs ultimately compromises the health of their own population by these governments who have neither the finances nor the clout to secure any substantial deals from major vaccine manufacturers by themselves at this stage of the pandemic.

Certainly the refusal to be pragmatic or heed WHO's proposal to keep expired doses (pending viability analysis of these products beyond their use-by dates) will cost more lives than saving them.

3. This article also enclosed a colourful figure appearing to suggest surplus vaccine supplies by many wealthy countries, but curiously it also includes vaccines that were not yet even approved for use in any countries in the world as far as I can tell, including Sanofi-GSK and Novavax, both still awaiting completion of Phase III, so if there is an attempt to portray surplus of vaccine, it needs to be clear that this surplus includes vaccine that is still not released for use.

Furthermore the surplus assumes that the complete course of vaccination (in most cases 2 doses) is all that is needed for the entire population of the countries listed in the figure, except that there is increasing evidence for a need for booster dose from at least 6 months after the 2 doses of mRNA vaccine (despite WHO's pleas for the booster shots not to be given (ref 3), "to help vaccines reach poorer nations facing shortages".

Frankly while the WHO's stance is understandable, the economic impact of another wave of COVID-19 pandemic upon the US, UK and other privileged countries will be so debilitating (after the disasters of the first 18 months), coupled with the controversial handling of the donated short-dated vaccines by the needy, as to make the decision to look after "number one" an easy one.

Attempts at shaming the wealthy nations or stirring up guilty consciences (from past exploitation) will be dampened by changing geopolitical reputation and prestige in addition to posturing by new spheres of influence. It should not be surprising to many developing nations that traditional sources of "foreign aid" may dry up and they will have to rely on financial support from other development initiatives to address the health and economic impact of the pandemic, possibly at the cost of their independence.

References1. https://www.pfizer.com/news/hot-topics/covid_19_vaccine_u_s_distribution...2. Mancini DP, Cotterill J, Schipani A. Covid-19 vaccines burnt as shelf-life complicates global rollout. Financial Times 2021 Jun 1.3. https://www.bmj.com/content/374/bmj.n1962

Go here to read the rest:
The so-called vaccine "surplus" is not chess-pieces easily moved around the world and accepted with gratitude - The BMJ