False safety fears could lead to global vaccine disparities
Misconceptions around the safety of the AstraZeneca jab could help fuel a vaccine divide between richer and poorer countries, experts have said. According to UK data, one in 250,000 people are expected to develop a type of blood clot that has been linked to the vaccine. The risk of death from this rare side effect, at one in a million, is far lower than that of dying from the coronavirus.
Regulators across Europe have insisted that the benefits of the vaccine in protecting against Covid-19 vastly outweigh its risks. Some, including Britain’s Medicines and Healthcare products Regulatory Agency, have chosen to limit use of the jab to certain age groups. This regulatory variation is “not unexpected” and has
been done “out of an abundance of caution to maintain confidence,” said Dr Claas Kirchhelle, a medicines historian at University College Dublin. However, he warned that lingering concerns around the jab – which has been repeatedly criticised by public officials outside of Britain – and wider supply issues in poorer countries could lead to vaccine divisions between the global north and south.
Separately, Professor Sir John Bell, a scientific adviser to the UK government, said the world is going to face a “massive problem” if people “keep beating this vaccine up” and undermining public confidence.
Dr Kirchhelle described the political discourse that has surrounded the vaccine in recent months as “unfortunate”, highlighting early statements made by EU officials which wrongfully claimed the vaccine was ineffective among the elderly. “But at the same time there was a backlash by certain parts of the establishment and the British press against alleged EU [overcaution], which then turned out not to be based completely on thin air,” he told The Independent.
These narratives, along with the different risk assessments made by each regulator, have led some to wrongly assume that the AstraZeneca vaccine is inferior, Dr Kirchhelle suggested. As a result, he warned, there is a “big danger” of richer countries further hoarding vaccines perceived to be safer and more effective, thereby limiting the range of options and supplies available to poorer nations.
“I would say there is an unfortunate history of this happening in the past,” Dr Kirchhelle added. “Of different drug availability and especially of expensive [drugs] perceived [as] safer being reserved for northern countries, and some nations having cheaper vaccines with a higher risk profile. But I’m not in any way saying the AstraZeneca vaccine isn’t safe, because it is. It’s very, very safe.”
There is an unfortunate tradition in the long term of the north having first choice and the south having to scavenge what falls off the table
He pointed to the example of two vaccines that were developed against yellow fever in the mid-20th century: one made by the Rockefeller Foundation in the US, and another by the Institut Pasteur in France. The Pasteur vaccine was found to cause inflammation of the brain in some recipients, driving western markets to stockpile the Rockefeller jab. This forced African populations, which were hardest hit by yellow fever, to become reliant on the Pasteur candidate instead. This lack of equal access continued well into the 1980s, Dr Kirchhelle explained. “There is an unfortunate tradition in the long term of the north having first choice and the south having to scavenge what falls off the table.”
Tania Cernuschi, a vaccine access expert at the World Health Organisation (WHO), acknowledged that poorer nations are already more limited in their vaccine options. “High-income countries have more choice than lower-income countries do,” she told The Independent. “I think that’s a fair concern in that sense. And countries that have more choice will be more risk-averse than countries that have less [access to] vaccine supplies. It’s speculation but a behaviour I would expect to see.”
According to WHO data, roughly 50 per cent of all vaccine deals struck by AstraZeneca are targeted at lowand middle-income countries. The manufacturer has committed to providing 170 million doses to the world’s poorest nations for as little as $3 per dose, and subcontracting deals are in place with the Serum Institute of India to increase this figure to 1.1 billion.
As well as being cheaper than other vaccines, the AstraZeneca jab is also logistically easier to handle, further highlighting its importance to the global south. Doses can be stored at refrigerator temperatures for up to six months, unlike the Pfizer or Moderna shots, which need to be kept in sub-zero conditions – a logistical requirement which many poorer countries cannot meet.
Ms Cernuschi said it is vital that the world maintains its faith in the vaccine, adding that the ability of regulators to detect adverse events following immunisation shows that “the system is working”. “My hope is that globally – not just in the global south – this will increase confidence in the system,” she said.
Global Justice Now, which campaigns on issues of health care and trade in the developing world, said that pharmaceutical monopolies and high prices have left the global south “desperately reliant” on AstraZeneca doses through the Covax facility. “Concerns over the vaccine could reduce take-up of even the very limited supplies countries have received,” Heidi Chow, a senior policy manager, told The Independent. “Governments should intervene to ensure all vaccines are openly licensed and priced at cost, so that all countries can access the doses they need for widespread vaccination.”
Dr Kirchhelle said: “I hope that the rollouts continue at pace, but I also hope that all countries will have the option to choose between all the vaccine candidates.”