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The global line for coronavirus vaccines stretches back to 2023

There’s a wild scrambleat the front of the line for COVID-19 vaccines, with the EU discussing export bans and legal action to ensure its supply speeds up in the coming months.

The flipside: The back of the line likely stretches to 2023 and beyond. Almost no low-income countries have managed to begin distribution in earnest, and total vaccinations in all of continental sub-Saharan Africa currently number in the dozens.

Driving the news: The EU is expected to approve a third vaccine tomorrow, from AstraZeneca. But European leaders are furious that initial supplies will be far lower than anticipated.

  • The EU is now pressuring the Anglo-Swedish firm to supply it with doses produced in the U.K. — which had a deal in place earlier — to make up for the shortfall.
  • The EU has managed to vaccinate just 2% of its collective population to date, vs. 11% in the U.K. Shortages have forced Madrid to pause distribution, and Paris is set to follow suit.
  • Brussels is considering export bans on doses produced in the EU, including the Pfizer/BioNTech vaccine.

The state of play: The fact that rich countries are not only buying up most of the supply of approved vaccines but also struggling to roll them out efficiently bodes ill for the countries left waiting further behind.

  • Some are paying a premium in smaller-scale bilateral deals, often for vaccines from China and Russia.
  • The Economist Intelligence Unit (EIU) projects that vaccines will only be widely available in the world's wealthiest countries this year, while many others (Brazil, India, Egypt) will reach widespread vaccination next year, and most low-income countries will wait until 2023 or beyond.

What they're saying: "What we are seeing now globally is not what we had hoped for," says Matshidiso Moeti, regional director for WHO Africa.

  • "It would be deeply unjust if the most vulnerable Africans were forced to wait for vaccines while lower-risk subgroups in wealthier countries are made safe," she said.
  • Barry Bloom, a professor of public health at Harvard, puts it more bluntly: "Right now, it is the law of the jungle."

African health authorities are hoping vaccine distribution will begin across the continent in March, initially with the roughly 3 million doses needed to cover medical workers.

  • The urgency is only growing as case counts rise on the continent and new variants spread. “The second wave is here with vengeance and our systems are overwhelmed,” said John Nkengasong, director of the African CDC.
  • The global COVAX initiative hopes to cover 20% of the population of every country by the end of 2021, and the African Union is attempting to supplement that with additional orders.
  • If all of those pieces fall into place, the WHO says 30–35% of Africans could be vaccinated by the end of the year.
Data: Our World in Data; Chart: Axios Visuals

What to watch: "In order to be successful, we need to achieve a 60% target within two years. If we do not do that, COVID becomes endemic on the continent," Nkengasong told reporters on Wednesday.

  • The other side: NIAID director Anthony Fauci has set a target of 70–85% in the U.S. by this summer.
  • By the numbers: The U.S., EU, U.K. and Canada have purchased at least a combined 2.5 billion doses, enough to vaccinate all of their residents (with two doses where necessary) and still have around 1 billion left over.

The big picture: The outlook in wealthy countries depends in part on what happens in poorer ones, as new variants of the virus originating anywhere in the world could ultimately cause fresh international outbreaks.

  • "We're in an arms race, except it's not an arms race, it's a race between vaccination and mutation," Israeli Prime Minister Benjamin Netanyahu said this week at the virtual Davos Agenda conference.

Israel, which has sprinted out ahead of the rest of the world in terms of vaccinations, is also on course to have millions of excess doses.

  • The government plans to cover Israel’s citizens and then “see what we can do for our immediate neighbors,” the health minister told the FT.
  • Israel has been criticized for declining to provide vaccines to Palestinians living in the occupied territories, even as it has vaccinated Jewish settlers there.

Countries on the periphery of the EU are also hoping to access leftover doses.

  • Ukraine, for example, has thus far only managed to sign a relatively small deal for a Chinese vaccine of questionable efficacy.
  • The country is otherwise dependent on COVAX and whatever arrangements it can reach with European producers and governments.
  • The EIU puts Ukraine among the countries likely to be waiting until 2023 for widespread coverage, along with parts of South Asia, Central and South America, and nearly all of sub-Saharan Africa.

Canada has secured more doses relative to its population than any other country, and it's pledged to donate those it doesn’t need to COVAX.

  • But Prime Minister Justin Trudeau — even as he emphasizes "equitable distribution" — has declined to say whether any donations will be made before Canada has vaccinated its entire population.

Meanwhile, President Biden has raised the hopes of global health experts and the WHO by revising Donald Trump’s decision to reject COVAX.

  • Bloom calls that a "major new factor," though Biden has yet to make any specific commitments in terms of doses or funding.
  • He hopes world leaders will see the current squabble in Europe as an indication that a centralized, equitable structure is needed for global distribution. But, he adds, "I'm not optimistic."

Go deeper: Israel's COVID crisis deepens even as the vaccination rate climbs

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