Delivering doses to countries with vaccine shortages is critical, but only a first step; the next challenge is getting these doses from airports into arms. Bottlenecks reported by AMC92 countries include erratic and unpredictable deliveries, short shelf life for vaccines delivered close to expiry dates, lack of vaccinators and support workers (particularly to address supply surges), limited data systems to track doses and potential adverse events, and challenges in vaccine acceptance and misinformation (Source: COVAX alliance partners).
Countries need advance notice of deliveries, a predictable supply schedule, and plenty of time to distribute and administer doses before expiration. Manufacturers and delivering entities, such as COVAX, should provide specific forecasted dose delivery schedules with expiry dates, so countries can plan for prioritization and effective rollout of vaccines.
Countries also need adequate complementary supplies such as syringes to turn doses into vaccinations. Shortages of syringes are anticipated due to increased vaccine production and high demand, disruptions to global supply chains, and bans on syringe exports (Source: UNICEF). Projections suggest that supplies are adequate for 2021 but that there will be a shortfall of between one and two billion syringes by the end of 2022 (Sources: PATH, Gates Foundation and UNICEF). This shortfall will be a significant bottleneck to global vaccination efforts without immediate action to increase manufacturing supply, prioritize syringes and other medical equipment in international shipping, and expanded use of alternative syringe types.
Additionally, priority must be given to strengthening countries’ last mile delivery and distribution capabilities. Large-scale vaccination requires significant cold chain capabilities, distribution plans, a vaccinator workforce, data infrastructure, and public education and communication. COVID GAP is engaging directly with leaders of vaccine programs in LMICs and at regional levels to develop a stronger evidence base of the needs and challenges on the ground in these areas and the swiftest path to overcoming them.
Closing the vaccination gap will require increased financial and operational support. These resources can come from more concerted multilateral and bilateral efforts, such as our proposed US Emergency Plan for Global COVID-19 Relief. An agreed-upon cost estimate would also help drive further commitments and accountability.
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