Global herd immunity remains out of reach because of inequitable vaccine distribution – 99% of people in poor countries are unvaccinated

A COVID-19 field hospital in Santo Andre, Brazil. The pandemic has killed over 503,000 people in Brazil; just 11% of the population is fully vaccinated.
Mario Tama/Getty Images

Maria De Jesus, American University School of International ServiceIn the race between infection and injection, injection has lost.

Public health experts estimate that approximately 70% of the world’s 7.9 billion people must be fully vaccinated to end the COVID-19 pandemic. As of June 21, 2021, 10.04% of the global population had been fully vaccinated, nearly all of them in rich countries.

Only 0.9% of people in low-income countries have received at least one dose.

I am a scholar of global health who specializes in health care inequities. Using a data set on vaccine distribution compiled by the Global Health Innovation Center’s Launch and Scale Speedometer at Duke University in the United States, I analyzed what the global vaccine access gap means for the world.

A global health crisis

Supply is not the main reason some countries are able to vaccinate their populations while others experience severe disease outbreaks – distribution is.

Many rich countries pursued a strategy of overbuying COVID-19 vaccine doses in advance. My analyses demonstrate that the U.S., for example, has procured 1.2 billion COVID-19 vaccine doses, or 3.7 doses per person. Canada has ordered 381 million doses; every Canadian could be vaccinated five times over with the two doses needed.

Overall, countries representing just one-seventh of the world’s population had reserved more than half of all vaccines available by June 2021. That has made it very difficult for the remaining countries to procure doses, either directly or through COVAX, the global initiative created to enable low- to middle-income countries equitable access to COVID-19 vaccines.

Benin, for example, has obtained about 203,000 doses of China’s Sinovac vaccine – enough to fully vaccinate 1% of its population. Honduras, relying mainly on AstraZeneca, has procured approximately 1.4 million doses. That will fully vaccinate 7% of its population. In these “vaccine deserts,” even front-line health workers aren’t yet inoculated.

Haiti has received about 461,500 COVID-19 vaccine doses by donations and is grappling with a serious outbreak.

Even COVAX’s goal – for lower-income countries to “receive enough doses to vaccinate up to 20% of their population” – would not get COVID-19 transmission under control in those places.

The cost of not cooperating

Last year, researchers at Northeastern University modeled two vaccine rollout strategies. Their numerical simulations found that 61% of deaths worldwide would have been averted if countries cooperated to implement an equitable global vaccine distribution plan, compared with only 33% if high-income countries got the vaccines first.

Put briefly, when countries cooperate, COVID-19 deaths drop by approximately in half.

Vaccine access is inequitable within countries, too – especially in countries where severe inequality already exists.

In Latin America, for example, a disproportionate number of the tiny minority of people who’ve been vaccinated are elites: political leaders, business tycoons and those with the means to travel abroad to get vaccinated. This entrenches wider health and social inequities.

The result, for now, is two separate and unequal societies in which only the wealthy are protected from a devastating disease that continues to ravage those who are not able to access the vaccine.

A repeat of AIDS missteps?

This is a familiar story from the HIV era.

In the 1990s, the development of effective antiretroviral drugs for HIV/AIDS saved millions of lives in high-income countries. However, about 90% of the global poor who were living with HIV had no access to these lifesaving drugs.

Concerned about undercutting their markets in high-income countries, the pharmaceutical companies that produced antiretrovirals, such as Burroughs Wellcome, adopted internationally consistent prices. Azidothymidine, the first drug to fight HIV, cost about US$8,000 a year – over $19,000 in today’s dollars.

That effectively placed effective HIV/AIDS drugs out of reach for people in poor nations – including countries in sub-Saharan Africa, the epidemic’s epicenter. By the year 2000, 22 million people in sub-Saharan Africa were living with HIV, and AIDS was the region’s leading cause of death.

The crisis over inequitable access to AIDS treatment began dominating international news headlines, and the rich world’s obligation to respond became too great to ignore.

“History will surely judge us harshly if we do not respond with all the energy and resources that we can bring to bear in the fight against HIV/AIDS,” said South African President Nelson Mandela in 2004.

A 9-year-old girl in Johannesburg, South Africa, prays before taking her twice-daily HIV medications in 2002.
Per-Anders Pettersson/Getty Images

Pharmaceutical companies began donating antiretrovirals to countries in need and allowing local businesses to manufacture generic versions, providing bulk, low-cost access for highly affected poor countries. New global institutions like the Global Fund to Fight AIDS, Tuberculosis, and Malaria were created to finance health programs in poor countries.

Pressured by grassroots activism, the United States and other high-income countries also spent billions of dollars to research, develop and distribute affordable HIV treatments worldwide.

A dose of global cooperation

It took over a decade after the development of antiretrovirals, and millions of unnecessary deaths, for rich countries to make those lifesaving medicines universally available.

Fifteen months into the current pandemic, wealthy, highly vaccinated countries are starting to assume some responsibility for boosting global vaccination rates.

Leaders of the United States, Canada, United Kingdom, European Union and Japan recently pledged to donate a total of 1 billion COVID-19 vaccine doses to poorer countries.

It is not yet clear how their plan to “vaccinate the world” by the end of 2022 will be implemented and whether recipient countries will receive enough doses to fully vaccinate enough people to control viral spread. And the late 2022 goal will not save people in the developing world who are dying of COVID-19 in record numbers now, from Brazil to India.

The HIV/AIDS epidemic shows that ending the coronavirus pandemic will require, first, prioritizing access to COVID-19 vaccines on the global political agenda. Then wealthy nations will need to work with other countries to build their vaccine manufacturing infrastructure, scaling up production worldwide.

Finally, poorer countries need more money to fund their public health systems and purchase vaccines. Wealthy countries and groups like the G-7 can provide that funding.

These actions benefit rich countries, too. As long as the world has unvaccinated populations, COVID-19 will continue to spread and mutate. Additional variants will emerge.

As a May 2021 UNICEF statement put it: “In our interdependent world no one is safe until everyone is safe.”

[The Conversation’s most important politics headlines, in our Politics Weekly newsletter.]

Maria De Jesus, Associate Professor and Research Fellow at the Center on Health, Risk, and Society, American University School of International Service

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The best hope for fairly distributing COVID-19 vaccines globally is at risk of failing. Here’s how to save it

Deborah Gleeson, La Trobe UniversityCOVAX, the global initiative to coordinate the distribution of COVID-19 vaccines in an equitable way, is crucial for bringing the pandemic under control.

But COVAX’s aim of delivering 2 billion doses to participating countries by the end of 2021 — including 92 low-income countries that can’t afford to buy vaccines directly from manufacturers — is threatened by chronic under-investment, vaccine nationalism and export restrictions.

COVAX is not intended only for low-income countries: Canada has so far received 316,800 doses through the scheme. As such, it represents an important “insurance policy” for Australia, potentially enabling access to a wider portfolio of vaccines than we could secure through negotiations with suppliers.

The vulnerability of our vaccine procurement strategy has become clearer over the last few weeks, with supply blockages limiting vaccine imports from Europe and now the government’s warning about the AstraZeneca vaccine and its links to a rare blood-clotting disorder.

Saving COVAX will require more than donations (of both funds and vaccines), as well as the removal of export bans. Countries must collaborate to urgently remove the legal and technical barriers preventing more widespread vaccine manufacturing in order to increase the global supply of vaccines for COVAX to distribute.

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Yes, export bans on vaccines are a problem, but why is the supply of vaccines so limited in the first place?

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How does COVAX work?

COVAX is led by the Coalition for Epidemic Preparedness Innovations (CEPI); Gavi, the Vaccine Alliance (a public-private partnership that aims to increase vaccination in low-income countries); and the World Health Organization.

It aims to deliver doses to all of the participating countries that have requested them in the first half of 2021, and 2 billion vaccines in total by the end of 2021.

COVAX is complex, but essentially it works by investing in a portfolio of promising vaccines and then distributing them according to a formula to both “self-financing countries” and “funded countries”.

Self-financing countries are those which have contributed funds to COVAX, such as Australia. They are able to buy the vaccines at cheaper prices negotiated by COVAX and will initially receive enough to vaccinate 20% of their populations. In the longer term, these countries may receive enough doses to vaccinate up to half of their populations, depending on how much they contribute.

Funded countries include 92 low-income countries that can’t afford to buy their own vaccines. They will also receive enough to vaccinate 20% of their populations, provided COVAX is able to meet its goals. This is nowhere near enough to achieve herd immunity, but will at least allow health workers and the most vulnerable groups to be vaccinated.

Australia has committed A$123.2 million to enable it to purchase 25 million vaccines for domestic use.

It has also committed A$80 million specifically earmarked for providing vaccines for low-income countries. This money will be drawn from existing aid funding, however, and won’t go very far in terms of assistance.

How is the program going so far?

COVAX made its first delivery of vaccines to Ghana on February 24. By April 11, it had shipped approximately 38.5 million doses to 106 countries and territories.

The first shipment of COVID-19 vaccines distributed by COVAX arriving in Ghana.
Francis Kokoroko/UNICEF/AP

While these figures might look promising at first glance, this is a long way behind COVAX’s aim to deliver 100 million doses by the end of March.

And they don’t stand up well in the context of global vaccine roll-outs. So far, only 0.2% of the 700 million vaccine doses administered globally have been given in low-income countries, whereas 87% have been received by people in high-income and upper middle-income countries.

Tedros Adhanom Ghebreyesus, director-general of the WHO, pointed out last week that only one in 500 people in low-income countries have so far received a vaccine — a situation he described as a “shocking imbalance”.

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Why is COVAX struggling to deliver?

COVAX needs more funding, to the tune of US$3.2 billion even to meet its modest goals for 2021. But the supply of vaccines is an even bigger problem.

Rich countries like Australia have undermined COVAX by negotiating deals for vaccines directly with pharmaceutical companies, rather than waiting for COVAX to allocate them fairly. By last November, high-income countries making up just 14% of the world’s population had negotiated pre-market agreements covering 51% of the global supply.

Adding to COVAX’s problems, the flow of vaccine deliveries has mostly dried up in the last week.

Some 90 million doses of the AstraZeneca vaccine manufactured in India that were to be delivered to 64 countries in March and April have been delayed as a surge in COVID-19 cases prompted the Indian government to restrict exports.

Boxes of AstraZeneca COVID-19 vaccines manufactured by the Serum Institute of India and provided through the COVAX global initiative arrive at the airport in Mogadishu, Somalia.
Farah Abdi Warsameh/AP

What needs to happen?

WHO has called on rich countries to immediately share 10 million doses to prop up COVAX in the first half of 2021.

But so far, no country has committed to do this. Donations that come after countries have fully vaccinated their own populations will be too late. And where bilateral donations have been made outside of the COVAX program (mainly by China and Russia), they have largely been driven by security, strategic or political considerations, rather than donated to the countries where they are most needed.

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Removing export restrictions would help. But as long as demand exceeds supply and the countries where vaccines are manufactured face large outbreaks, we are likely to continue to see these types of barriers.

What is needed most are more sustainable approaches to dramatically boost the global supply of vaccines and ensure there’s enough to go around.

This first requires removing the intellectual property protections that allow vaccine developers to hold exclusive rights to control who can make and sell them.

India and South Africa have put forth a proposal at the World Trade Organization to waive intellectual property rights for COVID-19 medical products during the pandemic, which has been supported by more than 100 low- and middle-income countries. However, several high-income countries, including Australia, have blocked it.

Secondly, governments need to support mechanisms for sharing intellectual property, such as the WHO’s COVID-19 Technology Access Pool (C-TAP).

This was set up nearly a year ago, but no vaccine developer has contributed to it yet. Governments need to make sharing intellectual property and contributing to the pool a condition of public funding for the development of COVID-19 products.

Finally, governments need to help low- and middle-income countries to produce their own vaccines. This means investing money to build up manufacturing capacities in these countries and facilitating technology transfers from companies based in high-income countries.

For COVAX to supply enough vaccines for even 20% of the world’s population, rich countries will need to step up. And fast.

Deborah Gleeson, Associate Professor in Public Health, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

China’s COVID vaccines are already being distributed. But how do they work, and where are they up to in trials?

Adam Taylor, Griffith University

Chinese authorities have already approved multiple COVID vaccines for emergency use in the country, and nearly a million Chinese have already been vaccinated with one candidate.

Several local governments are already placing orders for domestically developed vaccines, though the Chinese government hasn’t confirmed how many people it’s aiming to vaccinate as part of emergency approval.

The first international shipments of the vaccine, by private Chinese company Sinovac, have also already arrived in Indonesia this week in preparation for a mass vaccination campaign ahead of expected local approval.

China is developing at least five COVID vaccines from four producers. These vaccines, which have progressed through development very rapidly, are largely based on traditional vaccine manufacturing techniques such as inactivating the virus.

These methods provide some benefits to the vaccines over others. For example, some of the Chinese-developed vaccines can be stored in regular fridges, making distribution much easier. This is in contrast to Pfizer’s jab, which must be kept at around -70℃.

Too early to tell if they’re safe and effective in the long term

The results of clinical trials of vaccines developed by Chinese-based companies have for the most part been published in leading international journals. These journals are independently reviewed by members of the global scientific community who provide open and critical analysis before acceptance of the work. They’re also some of the most trusted medical research journals in the world, a testament to the quality of the science being carried out in China.

The emergency approval for use of a number of the vaccines developed in China has come exceptionally early in the clinical trial process. This is likely to have raised concerns that the correct due diligence for safety isn’t being followed. These are, however, exceptional times. It should also be noted the vaccine developed by Pfizer, and granted emergency approval in the United Kingdom, hasn’t yet received full regulatory approval with phase 3 clinical trials set to conclude soon.

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The early rollout of these vaccines into the general population should really be viewed as an unofficial extension of phase 3 clinical trials, rather than an ultimate seal of approval. People who have been vaccinated should continue to be monitored for adverse events and lasting immune responses. Any subsequent reports of serious adverse events due to vaccination will halt use of that vaccine, but could also erode confidence in vaccination and vaccine uptake internationally.

So who are the companies developing these vaccines in China, and what do we know about them?

Sinovac

Sinovac Life Sciences is a private Chinese company that focuses on research, development and manufacturing of human and animal vaccines. It has developed and commercialised six vaccines for human use, and one for animals.

The company’s COVID vaccine, called CoronaVac, is an inactivated vaccine. It has recently been shipped to Indonesia.

It’s manufactured by growing the COVID virus in laboratories and treating it with a chemical that inactivates it. The chemical locks the virus in a state where it’s unable to replicate, but its structure is maintained, allowing the body to recognise it as foreign and mount an immune response.

It’s also delivered with an adjuvant, an immune stimulant that’s given to improve the protective response.

Having shown a substantial immune response and minimal safety concerns (mostly mild pain at the injection site) in phase 1 and 2 clinical trials, CoronaVac is now in phase 3 clinical trials.

The phase 3 trials have recruited tens of thousands of participants to test vaccine efficacy and safety, and are taking place in Brazil, Indonesia and Turkey.

Brazilian officials claimed in October that the vaccine is safe, amid phase 3 trials.

However, the death of a phase 3 trial participant in October led Brazilian authorities to temporarily halt the Sinovac trial. Although details of the death were unclear, the trial was quickly resumed with the Brazilian institute involved in the trial confirming the participant’s death was unrelated to the vaccine. The outcome of phase 3 trials may be released in a matter of days.

Despite not knowing the results of phase 3 trials, a condition typically required to receive regulatory approval, CoronaVac has been approved for emergency use in China to vaccinate high-risk groups since July 2020.

This emergency approval is likely to have followed positive data from the vaccine’s phase 1 and 2 trials.

Sinopharm

Sinopharm is a state-owned Chinese company that researches, develops and distributes vaccines and other pharmaceuticals. It has produced a number of drugs that’ve been approved by the US Food and Drug Administration, and by EU authorities.

The two COVID-19 vaccines being developed by Sinopharm are both inactivated vaccines. Both follow a similar inactivation process as the Sinovac vaccine, and also use adjuvants to stimulate an immune response.

Both have undergone phase 1 and 2 clinical trials with encouraging results. They produced an effective immune response in participants and reported adverse reactions, including pain at the injection site and fever, were mild and quickly resolved. Certain doses generated SARS-CoV-2 specific antibodies in all phase 1 and 2 trial participants.

Both vaccines are currently in phase 3 trials. Again, despite incomplete clinical trials, both are reported to have been distributed for use by Chinese government officials and health-care workers.

What’s more, the United Arab Emirates, a site of ongoing phase 3 trials, granted emergency use for one of Sinopharm’s vaccines in September, following testing in 31,000 participants.

Despite this unusual early use of the vaccines, phase 3 testing is still required to determine if it’s safe and effective in the long run.

CanSino Biologics

This Chinese company has developed a COVID vaccine based on an adenovirus in partnership with the Chinese Academy of Military Medical Sciences. The adenovirus is unable to cause disease itself, but is used to deliver a coronavirus protein.

Phase 2 clinical trials reported the vaccine to be safe and induce significant immune responses in most participants.

This vaccine was also approved for limited use by the Chinese military in June, around the time of the conclusion of phase 2 trials.

Phase 3 clinical trials, which began in August, are ongoing in countries including Saudi Arabia.

Anhui Zhifei Longcom Biopharmaceutical

Chinese-based company, Anhui Zhifei Longcom, has developed a protein subunit COVID-19 vaccine. Subunit vaccines use a purified piece of the virus, a protein, to trigger an immune response. It has recently started phase 3 clinical trials. There hasn’t yet been any announcement or published report of the results of phase 1 and 2 trials.

Adam Taylor, Early Career Research Leader, Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Buying and distributing a COVID-19 vaccine will involve hard ethical and practical choices

http://www.shutterstock.com’

Barbara Allen, Te Herenga Waka — Victoria University of Wellington and Michael Macaulay, Te Herenga Waka — Victoria University of Wellington

The world was ablaze with hope following the announcement last week that a vaccine developed by Pfiser and BioNTech may be more than 90% effective in preventing COVID-19.

New Zealand politicians were quick to point out 1.5 million doses had already been pre-purchased through a legally binding agreement signed in late September to buy any vaccine to emerge from the multilateral COVAX facility.

Within the week, a second potentially effective vaccine emerged from US biotech firm Moderna. Health Minister Chris Hipkins would not say if New Zealand had negotiated for this option.

But assuming an approved vaccine is coming, attention then turns to logistics. Funding, procurement, storage and distribution all raise significant questions about values, decision-making and ethics.

We know there are multiple candidates for a COVID-19 vaccine, but there will be few “winners”, as many countries have already pre-contracted substantial amounts based on calculated risk assessments of which will emerge first. Even then, the challenges will be immense.

For example, assuming the Pfizer vaccine does become available as a safe option, it must be held in “ultra-cold storage” at -70 degrees Celsius. As has been observed already, “Distributing an effective COVID-19 vaccine to the global population will likely be the greatest logistical challenge since World War II.”

Who gets a vaccine first?

For New Zealand, as with all countries, the questions raised are complex: do we now spend a large amount of money to scale up a logistics, distribution and storage system for the Pfizer drug? Or should we wait for an alternative that is more effective, easier to transport and store, and possibly cheaper?

After all, the first available vaccine might not achieve the outcomes we want. But would it be fair (or feasible) to make the country wait?

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Furthermore, because enough doses to treat everyone will not be available immediately, it will be necessary to prioritise recipients. What are the country’s obligations here? Do we offer the vaccination first to the oldest, or the youngest, or the most vulnerable?

National health systems will have some idea about how to go about this, but wealthy countries have never faced an immediate requirement on this scale.

An ethical framework

Answering these questions means calling simultaneously on a number of different ethical perspectives:

• an ethic of justice to assess the fairness of a decision

• an ethic of consequentialism to look at outcomes

• the ethics of obligations to see who we may have made commitments to

• an ethic of care to look at individual cases, rather than relying on abstract logic.

Only when we combine these perspectives can we begin to make sense of priorities.

The vaccine marketplace is a kind of oligopoly, with a few extremely large firms deciding which vaccines get made, when and at what price. Pharmaceutical companies are reluctant to invest in producing new vaccines for the developing world because they have little prospect of earning an attractive return.

While global organisations such as vaccine alliance GAVI have been instrumental in getting vaccines to developing countries, given the geopolitics of procurement it could be a long time before an effective COVID-19 option reaches the poorest populations.

The moral dimension

All this points to the deeper ethical issue of inequality. Many agencies, including the World Health Organisation (WHO), have demonstrated that health outcomes are related to socio-economic, ethnic and gender inequalities. COVID-19 has only made these inequalities worse.

Only last week, for example, a UK study showed 57.7 more people per 100,000 have died in the poorest areas of northern England than in the rest of the country.

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This matches other research showing how the pandemic has disproportionately affected poorer families, including their being less likely to be able to work from home or adapt to home-schooling.

Limited or selective availability of a vaccine could exacerbate these problems. And while New Zealand may be in a relatively privileged position, this doesn’t mean there won’t be negative consequences for other countries.

This adds an international dimension to our national dilemma: we have a duty to protect our own citizens, but is there a way we can minimise harm to others at the same time?

Barbara Allen, Senior Lecturer in Public Management, Te Herenga Waka — Victoria University of Wellington and Michael Macaulay, Professor of Public Administration, Te Herenga Waka — Victoria University of Wellington

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Creating a COVID-19 vaccine is only the first step. It’ll take years to manufacture and distribute

Adam Kamradt-Scott, University of Sydney

The world is hoping a safe and effective COVID-19 vaccine will soon become available. So far, more than 160 candidate vaccines are in development.

Some 31 of these have entered human clinical trials. One of them is Russia’s “Sputnik V”, which was granted approval by the country’s health ministry last week. But the World Health Organisation (WHO) and a large number of international experts have urged Russia to conduct more testing to ensure the vaccine’s safety before using it.

But even if this candidate and others are proven to be safe and effective, developing the vaccine is just the first step.

Some of the biggest challenges in getting everyone vaccinated still lie ahead.

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Challenge 1: manufacturing the vaccine

The first major challenge after a vaccine is developed is to produce enough of it to start vaccination programs. One estimate puts global vaccine production capacity at up to 6.4 billion doses per year, though this is based on single-dose influenza vaccines.

But some of the COVID-19 vaccines currently in development require two or three injections. This means, if the same technology for COVID-19 vaccines is required as for influenza vaccines, global production is severely reduced.

It has been estimated that to achieve sufficient levels of immunity among the global population with a two-dose vaccine, we would need between 12 billion and 15 billion doses – roughly twice the world’s current total vaccine manufacturing capacity.

Shifting to exclusively manufacture a COVID-19 vaccine will also mean shortages of other vaccines such as those for preventable childhood diseases such as measles, mumps and rubella. So prioritising COVID-19 could cost many other lives.

Can we buy vaccines in advance?

Given these production constraints, governments have previously tended to sign advance purchase agreements with vaccine manufacturers to guarantee access. These commercial-in-confidence agreements are usually signed in secret, often with different prices being charged to different governments depending on whether they are the first customer or 30th and their ability to pay.

It also means countries that can afford to buy vaccine stocks in advance get first access, leaving poorer nations to miss out or be forced to wait years. This has happened on at least two previous occasions.

In 2007, Indonesia found it couldn’t purchase H5N1 influenza (bird flu) vaccines despite being one of the worst-affected countries at the time. This was because several other richer countries had already organised advanced purchase agreements, and led Indonesia to temporarily withhold sharing virus samples with the WHO in retaliation. And in 2009, rich nations bought up almost all the stock of H1N1 influenza vaccines, crowding out less-developed nations.

A ‘my country first’ policy means richer countries can secure supply of vaccines at the expense of poorer countries.
Morning Brew/Unsplash

Most of the world’s leaders, including Australia’s Prime Minister Scott Morrison, have stated that a successful COVID-19 vaccine should be shared equitably. In July, Australia was one of 165 countries to join the “COVAX” initiative launched by the WHO, global vaccine alliance GAVI, and the Coalition for Epidemic Preparedness Innovations. The initiative aims to deliver 2 billion doses of a COVID-19 vaccine by the end of 2021.

Countries representing 60% of the world’s population have signed up to this initiative, but not everyone has and we’ve already seen a number of instances in which governments have sought to gain priority access over others. The problem with this vaccine nationalism is that rather than being based on equity or need, it will create global supply problems with those countries that have special deals getting access to the vaccine first.

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How ‘vaccine nationalism’ could block vulnerable populations’ access to COVID-19 vaccines

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Challenge 2: distributing the vaccine

The second key challenge is distributing the COVID-19 vaccine. Most vaccines need to be transported in cold storage, which presents a problem for many parts of the world where electricity failure is a common feature of daily life.

The WHO has estimated up to 50% of vaccines are wasted every year, often because of inadequate temperature control in supply chains.

With the marked reduction in international passenger air travel, the movement of cargo has also slowed. This will need to be addressed with airlines ahead of any attempts to distribute the vaccine.

Beyond the initial transport from the manufacturer, getting the vaccine to rural and remote communities requires sophisticated logistical services, which many poorer countries lack.

Without substantial investment to strengthen international and national supply chains, it will be years before vaccines can reach everyone who needs them.

How is Australia placed?

In Australia, criticism has emerged the government hasn’t done enough to secure access to vaccines, with some reports also suggesting New Zealand has invested more in global vaccine initiatives.

But Federal Health Minister Greg Hunt said on Sunday that Australia is in “advanced negotiations with a range of different companies with regards to a vaccine,” one of which is reportedly the University of Oxford’s candidate.

While some might argue more needs to be done to secure a COVID-19 vaccine for Australians, it’s not necessarily the best move to enter into advanced purchase agreements. They are expensive, and there’s no guarantee the candidates Australia signs up for will be safe and effective.

Nevertheless, the government’s approach has been to avoid putting all its eggs in one basket, supporting multiple vaccine initiatives. It has also supported multilateral initiatives such as granting more than US$10 million to CEPI, one of the key organisations managing the COVAX initiative.

It’s also good to see the government is willing to support initiatives such as COVAX that aim to make the vaccine available to those countries with limited means to pay. While some may see this as excessive altruism, it’s in Australia’s broader interest, given borders are likely to remain closed until a vaccine has been made widely available. The quicker the world is vaccinated, the sooner we can reopen our borders.

What this means for the average Australian is that we should get ready for a long wait. Even if the Australian government signs an advanced purchase agreement to secure priority access to a safe and effective COVID vaccine, initial supplies are going to be extremely limited.

Priority groups like frontline health-care workers will get first access, followed by those who are more vulnerable to serious illness. If you’re otherwise fit and healthy, you should be prepared that it could take up to a few years after vaccines become available.

If they become available sooner, it will only be because countries have agreed to work together like never before. Let’s hope they can do it.

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Adam Kamradt-Scott, Associate professor, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Indonesia: Bible Distribution

Malaysian Christians Seek to End Restrictions on Malay Bibles

Federation calls for removal of ‘every impediment’ to importing and printing Scripture.

KUALA LUMPUR, Malaysia, April 6 (CDN) — Christian importers of Bibles that Malaysian officials detained are balking at conditions the government has imposed for their release, such as defacement of the sacred books with official stamps.

The Home Ministry stamped the words, “This Good News [Malay] Bible is for use by Christians only” on 5,100 Bibles without consulting the importer, the Bible Society of Malaysia (BSM), which initially refused to collect them as it had neither accepted nor agreed to the conditions. The Home Ministry applied the stamp a day after the government on March 15 issued a release order for the Bibles, which had been detained in Port Klang, 38 kilometers (24 miles) southwest of Kuala Lumpur, since March 20, 2009.

Another 30,000 Bibles detained since Jan. 12 on the island of Borneo remain in port after the Sarawak state Home Ministry told the local chapter of Gideons International that it could collect them if the organization would put the stamp on them. Gideons has thus far declined to do so, and a spokesman said yesterday (April 5) that officials had already defaced the books with the stamp.

The government issued letters of release to both organizations on March 15 under the condition that the books bear the stamp, “Reminder: This Good News [Malay] Bible is for use by Christians only. By order of the Home Minister,” and that the covers must carry a serial number, the official seal of the department and a date.

The Home Ministry’s stamping of the BSM Bibles without the organization’s permission came under fire from the Christian community. In a statement issued on March 17, Bishop Ng Moon Hing, chairman of the Christian Federation of Malaysia (CFM), described the Home Ministry’s action as desecration.

“[The] new conditions imposed on the release of the impounded Bibles … is wholly unacceptable to us,” he added.

Ng described the conditions imposed by the Home Ministry as tantamount to treating the Malay Bible as a “restricted item” and subjecting the word of God to the control of man. In response, Home Minister Hishammuddin Hussein has said the act of stamping and serialization was standard protocol.

 

Government Overtures

In the weeks following the March 15 release order, the government made several attempts to try to appease the Christian community through Idris Jala, a Christian from Sarawak state and a minister in the Prime Minister’s Department.

Idris issued the government’s first statement on March 22, explaining that officials had reduced earlier conditions imposed by the Home Ministry to require only the words, “For Christianity” to be stamped on the covers of the Bible in font type Arial, size 16, in bold.

Idris informed BSM that the Bibles could be collected in their present state or arrangements could be made to have stickers with the words “For Christianity” pasted over the imprint of the stamps made by the Home Ministry officials. In the event that this was not acceptable, the minister pointed out that BSM had the option of having the whole consignment replaced, since the government had received an offer from Christian donors who were prepared to bear the full cost of purchasing new Bibles.

In response, the CFM issued a statement on March 30 saying, “The offer made does address the substantive issues,” and called on the government “to remove every impediment, whether legal or administrative, to the importation, publication, distribution and use of the [Malay Bible] and indeed to protect and defend our right to use the [Malay Bible].”

Bishop Ng, however, left it to the two importers to decide whether to collect the Bibles based on their specific circumstances.

On March 31, BSM collected the mishandled Bibles “to prevent the possibility of further acts of desecration or disrespect.” In a press statement, BSM officials explained that the copies cannot be sold but “will be respectfully preserved as museum pieces and as a heritage for the Christian Church in Malaysia.” The organization also made it clear that it will only accept compensation from the Home Ministry and not from “Christian donors,” a term it viewed suspiciously.

On Saturday (April 2), Idris issued a 10-point statement to try to resolve the impasse. Significantly, this latest overture by the government included the lifting of present restrictions to allow for the local printing and importation of Malay and other indigenous-language Bibles into the country.

In Sarawak and Sabah, there would be no conditions attached to Bibles printed locally or imported. There also would be no prohibitions and restrictions on residents of these two states carrying such Bibles to other states. A significant 64 percent of Malaysian Christians are indigenous people from Sabah and Sarawak states who use the Malay language in their daily life, and having the Bible in the Malay language is considered critical to the practice of their Christian faith.

In the case of West Malaysia, however, in view of its larger Muslim population, the government imposed the condition that the Bibles must have the words “Christian publication” and the sign of the cross printed on the front covers.

 

Christian Response

Most Christians responded to this latest overture with caution. Many remained skeptical, seeing it as a politically motivated move in view of Sarawak state elections on April 16. Nearly half of Sarawak’s population is Christian.

Bolly Lapok, an Anglican priest, told the online news agency Malaysian Insider, “It’s an assurance, but we have been given such assurances before.” BSM General-Secretary the Rev. Simon Wong reportedly expressed the same sentiments, saying the Home Ministry already has a record of breaking its word.

The Rev. Thomas Phillips of the Mar Thoma Church, who is also president of the Malaysian Consultative Council of Buddhism, Christianity, Hinduism, Sikhism and Taoism, questioned the timing of the proposal: “Why, after all these years?”

The youth wing of the Council of Churches rejected the proposal outright, expressing fears that the government was trying to “buy them over” for the Sarawak election, and that it would go back on its word after that.

Bishop Paul Tan, president of the Catholic Bishops’ Conference of Malaysia, called the proposal an “insidious tactic of ‘divide and rule,’” referring to its different requirements imposed on Malaysians separated by the South China Sea. Dr. Ng Kam Weng, research director at Kairos Research Centre, stressed that the proposal “does not address the root problem of the present crisis, i.e. the Allah issue.”

 

Muslim Reactions

The 10-point proposal has also drawn the ire of Muslim groups, who view it as the government caving in to Christian pressure.

Perak Mufti Harussani Zakaria expressed his disappointment, reportedly saying, “If the government does this, just cancel the law,” in reference to various state Islamic enactments that prohibit the use of the word “Allah” and other so-called Islamic terms that led to the banning of the Malay Bible. Malay Bibles have not been allowed to be printed locally for fear that they will utilize “prohibited” words.

The Muslim Organizations in Defense of Islam (Pembela) threatened to challenge the 10-point proposal in court if it was not reviewed in consultation with Muslim representatives.

On the same day Pembela issued its statement, the government seemed to have retracted its earlier commitment. The Home Minister reportedly said talks on the Malay Bibles were still ongoing despite Idris’ 10-point proposal, which purportedly represents the Cabinet’s decision.

As a result, James Redas Noel of the Gideons said yesterday (April 5) that he was confused by the mixed messages coming from the government and will not make a decision on whether to collect the Bibles until he had consulted church leaders on the matter, according to the Malaysian Insider.

The issue with the Malay Bibles is closely tied to the dispute over use of the word “Allah” by non-Muslims.

In a controversial court ruling on Dec. 31, 2009, judge Lau Bee Lan had allowed The Herald, a Catholic newspaper, to use “Allah” for God in the Malay section of its multilingual newspaper.

The Home Ministry filed an appeal against this decision on Jan. 4, 2010. To date, there is no indication as to when the case will be heard.

Christians make up more than 9 percent of Malaysia’s nearly 28 million people, according to Operation World.

Report from Compass Direct News
http://www.compassdirect.org

Christians Decry Malaysia’s Detention of Bible Books

After stopping 5,100 Bibles in 2009, authorities withhold 30,000 Malay-language copies.

KUALA LUMPUR, Malaysia, March 14 (CDN) — The detaining of 30,000 copies of the New Testament, Psalms and Proverbs in the Malay language at Malaysia’s Kuching Port has “greatly disillusioned” the nation’s Christian community.

The books, imported from Indonesia by the local branch of Gideons International for distribution in schools, churches and longhouses in Betong, Saratok and other Christian areas in Sarawak state, have been detained at the Kuching Port since January.

Authorities told an unnamed officer of the importer on Jan. 12 that he could not distribute the books in Sarawak state, on the island of Borneo, since they “contained words which are also found in the Quran,” according to online news agency Malaysiakini. The officer was ordered to transport the books to the Home Ministry’s office for storage.

Last week, when the same officer enquired of the Home Ministry officials on the status of the Malay Bibles, authorities said they had yet to receive instructions on the matter.

This is not the first time government authorities have detained Malay-language Bibles, and Bishop Ng Moon Hing, chairman of Christian Federation of Malaysia, decried the action.

“The CFM is greatly disillusioned, fed-up and angered by the repeated detention of Bibles written in our national language,” Ng said. “It would appear as if the authorities are waging a continuous, surreptitious and systematic program against Christians in Malaysia to deny them access to the Bible in [Malay].”

An earlier consignment of 5,100 copies of the Good News Bible in Malay, imported by the Bible Society of Malaysia, was detained in Port Klang in March 2009. Together with this latest seizure, the total number of Bibles seized and remaining in possession of the Home Ministry amounts to 35,100 copies.

The CFM, representing a majority of Christians in Malaysia, released a statement on March 10 asserting, “All attempts to import the Bible in Bahasa Malaysia [Malay], i.e. the Alkitab, whether through Port Klang or the Port of Kuching, have been thwarted” since March 2009.

Prior to March 2009, there had been several such incidents, and “each time, tedious steps had to be taken to secure their release,” according to the CFM.

A significant 64 percent of Malaysian Christians are indigenous people from Sabah and Sarawak states who use the Malay language in their daily life. Christian leaders say having Bibles in the Malay language is crucial to the practice of their Christian faith.

Christians make up more than 9 percent of Malaysia’s nearly 28 million people, according to Operation World.

This latest Bible book seizure has irked Christians and drawn criticisms from politicians spanning both sides of the political divide.

The Sarawak Ministers Fellowship issued a statement registering its “strong protest,” describing the detention of the books as “unconstitutional” and in violation of the 18-point agreement for Sarawak in the formation of Malaysia.

Representing the opposition political party, People’s Justice Party (Sarawak Parti Keadilan Rakyat) Chief Baru Bian described the withholding as “religious harassment” and “a blatant disregard of our constitutional right as Christians in Malaysia.”

Chua Soi Lek, president of the Malaysian Chinese Association, a political party within the ruling coalition National Front, proposed that Malay Bibles be allowed to be printed locally. The deputy chief minister of Sarawak, Dr. George Chan, expressed the state government’s willingness to publish the Malay Bible locally.

Home Minister Hishammuddin Hussein was quoted in The Star newspaper today as saying, “The issue … is being resolved amicably with the parties concerned,” though how this was taking place was not apparent. The home minister has reportedly said the books had been withheld pending an appeal over the use of the word “Allah” in The Herald catholic newspaper.

Secretary-General of Malaysian Muslim Youth Movement Mohamad Raimi Abdul Rahim has called for the government to enforce the ban on use of the word “Allah” by non-Muslims nationwide, including in Sabah and Sarawak.

In a controversial court ruling on Dec. 31, 2009, Judge Lau Bee Lan had allowed The Herald to use the word “Allah” for God in the Malay section of its multilingual newspaper. The Home Ministry filed an appeal against the decision on Jan. 4, 2010, but to date there is no indication as to when the case will be heard.

Report from Compass Direct News

Islamic Groups Aim to Shut Down Church in Indonesia

Muslims protest West Java congregation as it worships.

JAKARTA, Indonesia, November 19 (CDN) — More than 50 people from Islamic groups demonstrated against a church in West Java on Nov. 7, chanting for it to stop worshipping during its Sunday service, according to Muslim online news site Arrahmah.com.

The King of Glory church of the Christian Congregation of Indonesia denomination (Jemat Kristen Indonesia or JKI) was worshipping in the Graha Mulia (Planet of Glory) Multi-purpose Building in Karasak village, Astanaanyar district of Bandung City, when the protestors gathered. Chanting “Allahu akbar [God is greater],” the crowd claimed the building was not approved for worship purposes, according to another Islamic Web site, Hidayatullah.com.

Protesting members of the Karasak Muslim Citizens Communication Forum, the Islamic Congregation Front and West Java Islamic Reformation Movement (GARIS) said the church did not have permission from area residents, although church leaders said an area official had given permission since 2005.

With 100 police officers on hand to maintain order, the poster-waving crowed chanted for an hour before slowly dispersing. During the protest, Muslim Citizens Communication Forum leader Fikri Saeful said, “The citizens reject church activities in this area because there is no permission from local citizens,” according Hidayatullah.com.

Fikri added that the church had reached out to area residents with free medical clinics and distribution of basic food items.

Agus Nugroho, a leader of the JKI church and an administrator of the Graha Mulia building, told Compass that the church had permission from the local area official known as a ward captain. The church submitted an application for a permit at a higher governmental level in 2005, he said. Church permit applications are often stalled in Indonesian government offices, opening the way for Muslim groups to accuse them of worshipping without official permission.

“We have been worshipping here since 2005 because we had trouble finding a place to worship,” Agus said. “We do have permission from the local government for worship.”

According to Agus, that permission did not have an expiration date. Moreover, he said, neither the building managers nor the church leaders have ever received a written complaint about the worship services.

“There have never been any problems between the citizens and the building managers or with the church,” Agus said.

He said that there was no regulation against using a multi-purpose building for worship services.

“We managers have no objections,” he added.

Anyone with objections to the use of a multi-purpose building by a church should pursue legal remedies, he said. The Graha Mulia building is also the location for the JKI Raja Kemuliaan Church.

GARIS leader Surayana Nurfatwa, however, told Compass the church his organization had received complaints from area residents, and that the church had no official permission for worship from them.

“We have received many reports from citizens who objected to these worship services,” Nurfatwa said, adding that the church’s continued worship would disrupt “religious harmony” and could result in conflict with the Muslim majority.

Report from Compass Direct News

Pakistani Taliban Kills Three Foreign Christian Aid Workers

Kidnapped relief workers had come to provide aid to victims of massive flooding.

ISLAMABAD, Pakistan, August 27 (CDN) — Authorities on Wednesday (Aug. 25) recovered the bodies of three Christian relief workers who had been kidnapped and killed by members of the Pakistani Taliban in the flood-ravaged country, area officials said.

Swat District Coordination Officer Atif-ur-Rehman told Compass that the Pakistan Army recovered the bodies of the three foreign flood-relief workers at about 7 a.m. on Wednesday. An official at the international humanitarian organization that employed the workers withheld their names and requested that the agency remain unnamed for security reasons. Military sources who withheld news of the deaths from electronic and print media to avoid panicking other relief workers granted permission to Compass to publish it in limited form.

“The foreign aid workers have been working in Mingora and the surrounding areas,” Rehman said. “On Aug. 23 they were returning to their base at around 5:35 p.m. when a group of Taliban attacked their vehicle. They injured around five-six people and kidnapped three foreign humanitarian workers.”

Pakistan has been hit by its worst flooding in decades, with the United Nations now estimating more than 21.8 million people have been affected. Foreign aid workers are involved in relief activities across the country, including Swat district in Khyber-Paktunkhwa Province in northern Pakistan. At least 8 million people require emergency relief, with hundreds of thousands reportedly isolated from aid supplies.

An army Inter-Services Public Relations (ISPR) source said rangers have been deployed in Swat and other potential target areas to help provide security for relief workers.

“The Taliban had warned about attacks on foreigner aid workers and Christian organizations,” the ISPR source said. “All the international humanitarian organizations have been notified, and their security has also been increased.”

Rehman noted that the Taliban also has been trying to bring relief to flood victims.

“The Taliban are also trying to support the flood victims, and many other banned organizations have set up camps in southern Punjab to support the victims,” he said. “They intend to sympathize with the affected and gain their support.”

The president of advocacy organization Life for All, Rizwan Paul, said the bodies of the three relief workers had been sent to Islamabad under the supervision of the Pakistan Army.

“We strongly condemn the killing of the three humanitarian workers,” Paul said. “These aid workers came to support us, and we are thankful to the humanitarian organizations that came to help us in a time of need.”

Pointing to alleged discrimination against minorities in distribution of humanitarian aid, Paul added that Christians in severely flood-damaged areas in Punjab Province have been neglected. The majority of the effected Christians in Punjab are in Narowal, Shakargarh, Muzzafargarh, Rahim Yar Khan and Layyah, he said.

“The Christians living around Maralla, Narowal, and Shakargarh were shifted to the U.N.- administered camps, but they are facing problems in the camps,” he said. “There are reports that the Christians are not given tents, clean water and food. In most of the camps the Christians have totally been ignored.”

Life for All complained to U.N. agencies and the government of Pakistan regarding the discrimination, but no one has responded yet, he said.

“There have been reports from Muzzaffargarh and Layyah that the Christians are living on the damaged roads in temporary tents, as they were not allowed in the government camps,” he said.

In Sindh Province Thatta has been flooded, and around 300 Christian families who tried to move from there to Punjab were forbidden from doing so, a source said. Meteorologists are predicting more rains in coming days, with the already catastrophic flooding expected to get worse.

Kashif Mazhar, vice president of Life for All, said that in the northern province of Khyber-Pakhtunkhwa conditions for Christians are better as there are Christian camps established, and Garrison Church in Risalpur is also providing aid to victims.

“It is discouraging to see that the Christian organizations are wholeheartedly supporting the victims regardless of the religion or race, but in most of the areas the Christians are totally ignored and not even allowed to stay,” Mazhar said.

Foreign targets are rarely attacked directly in Pakistan, despite chronic insecurity in the nuclear-armed state, which is a key ally in the U.S.-led war on Al Qaeda and the Taliban in neighboring Afghanistan. On March 10, however, suspected Islamic militants armed with guns and grenades stormed the offices of a Christian relief and development organization in northwest Pakistan, killing six aid workers and wounding seven others.

The gunmen besieged the offices of international humanitarian organization World Vision near Oghi, in Mansehra district, of the North West Frontier Province. Suicide and bomb attacks across Pakistan have killed more than 3,000 people since 2007. Blame has fallen on Taliban and Al Qaeda-linked militants bitterly opposed to the alliance with the United States.

The U.N. decided last year to relocate a limited number of its international staff from Pakistan because of security concerns. Its World Food Program office in Islamabad was attacked in October last year, with five aid workers killed in a suicide bombing.

Then on Feb. 3, a bomb attack in the NWFP district of Lower Dir killed three U.S. soldiers and five other people at the opening of a school just rebuilt with Western funding after an Islamist attack.

Report from Compass Direct News