The Mass Vaccination: A Struggle in Developing Nations?
Across the last week, we’ve had a lot of news about the myriad of companies rolling out new, hopefully, effective COVID-19 vaccinations ─ and , for example. In all of the articles you’ve no doubt read, you’ll have seen a lot of countries mentioned; more specifically, the United Kingdom, United States, Germany, and leading European nations. The wealthier countries, you might say.
The term ‘wealthier’ is where we now have a new issue. Currently, leading Western countries have, essentially, cleared the shelves of the new vaccine. Due to supply chain issues during our era of pandemic, we’ve returned to a historic norm of stockpiling product, and so, leading nations have reserved doses of the vaccine that far outnumber their populations. On the flip side, poorer nations around the world are unable to acquire enough doses to innoculate their populations against the novel coronavirus.
Preordering Non-Existent Supplies
To put the problem into a percentage basis: the majority of poor countries find themselves in a position where they might be able to vaccinate 20 per cent of their populations in 2021, while wealthy countries can immunise their entire population multiple times.
As it stands, nations like Canada, the United Kingdom, and the United States have preordered the vaccinations, and are betting on certain manufacturers’ ability to actually fulfil the orders ─ something that isn’t guaranteed at this point. According to data analysis provided through , by , , and , If all of the claimed doses do come to fruition, the European Union could inoculate its residents (447.7 million) twice, the United Kingdom (66.2 million) and United States (328.2 million) could do so four times, and Canada (37.59 million) six times.
“The high-income countries have gotten to the front of the line and cleared the shelves,” said Andrea Taylor, a Duke researcher who is studying the contracts.
Some people are shaming the listed countries for their supposed greed, which I can understand ─ I’m sure you can too. It's potentially ill-founded shame, though. As an example, the United States has pumped billions of dollars into research, development, and manufacturing projects surrounding the COVID-19 vaccine, which has scaled up the scope and drastically sped up the quest for a cure. Just like any savvy business, however, the United States put a condition on their funding: that Americans would get priority access to all vaccines created on their land. Similar rules apply across the other countries mentioned. This is somewhat of a justification, I’d say. Let us know how you feel in the comments.
Who’s Manufacturing The Vaccines?
Let’s jot down the order and preorder list of each nation, revealing the crucial manufacturers of the vaccines.
The United States
- 810 million doses have been preordered from AstraZeneca, Johnson & Johnson , , and combined. Potential expansions of these deals could push that number up to 1.5 billion doses.
- 200 million doses have been secured from , with an additional 300 million on offer.
- 100 million doses have been acquired from Pfizer, with a potential addition of 500 million more on the table.
The United Kingdom
- The United Kingdom has claimed 357 million doses from all of the companies listed in The United States’ receipt, with the addition of .
- There are clauses to allow for a further 152 million doses for the UK.
The European Union
- The European Union has apparently secured 1.3 billion doses ─ again, from the same companies as the above ─ as well as a . The bloc has an option to extend that order with a further 600 million doses.
Undermining the Masses
As I’ve alluded to, already, the influx of orders from wealthier nations with expansion deals, the majority of countries find themselves unable to secure the necessary number of doses that they need to innoculate their own populations. Unfortunately, many of the lesser economically developed, second, or third-world countries haven’t got the resources to spare, nor the manufacturing capabilities necessary to develop their own vaccinations and data projections suggest that it could take them until 2024 to obtain sufficient doses to fully immunise their populations.
The Bright Stars in a Dark Time
Fortunately, there are some countries, companies, and individuals that have pledged their support to lower-income countries. Currently, Johnson & Johnson, whose vaccine ─ unlike others ─ is just a single dose (making it cheaper) has already pledged 500 million doses to low-income countries, by their own definition. Ergo, we don’t actually know which countries will be able to access them, but it’s probably safe to say that Johnson & Johnson will follow the average guidelines for what makes a country ‘low-income’. I can imagine we’ll see their vaccine rolled out across either Africa or the war-torn regions of the Middle East. Watch this space.
On the country-side of life, China, which is currently ranked third in the ‘which nation can manufacture the most vaccines’ race, has also suggested that it intends to have a range of vaccines available to developing countries. Again, people aren’t too sure where these will be available, but if you consider the manufacturing hub of the world’s recent movements to maintain dominance over the industry, it would likely be safe to assume that The People’s Republic will look to immunise the Southeast Asian region ahead of any others. China needs to do this to ensure their continued manufacturing, political (debatable), and supply chain dominance over the West and, more specifically, the United States.
Nonprofits and W.H.O
In further efforts to build up equality in the vaccination-space, the (W.H.O) and two nonprofits that are supported by Microsoft Founder and tycoon, Bill Gates, are working to procure approximately one billion doses for 92 poor or low-income countries and one billion to be given out to middle- and high-income nations too. This collaboration is known as ‘’, which is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), and W.H.O. The organisation is aiming to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee “fair and equitable access for every country in the world.”
Hopefully, COVAX is a success ─ but, for now, it’s anyone’s game, and we’ll have to check back in later.
Contributing to COVAX
So, it’s evident that huge wealth disparity is leading to absolutely massive vaccine access inequality. As these stark disparities become more visible, wealthier nations are being pressured to provide for those less fortunate ─ as they should. Currently, Australia, Canada, the European Union, and the United Kingdom have all made large financial commitments to COVAX.
“The worst possible outcome is you’re offering vaccines to a whole country’s population before we’re able to offer it to the highest-risk ones in other countries,” said Dr Bruce Aylward, a senior adviser to the W.H.O’s director-general who is working on the global vaccine initiative.
As a result of recent comments by health officials and industry-leaders, these nations are being pushed to either stagger their vaccine deliveries so that low-income countries can access vaccinations simultaneously or donate vaccinations from the surplus. Canada happens to already be pushing the latter agenda, with an indication that they might donate doses to the World Health Organisation for further distribution.
More may follow in their footsteps ─ we’ll find out in the coming weeks, no doubt.
These are all excellent initiatives, but the unfortunate fact of the matter is that even if the leading nations donate doses that are surplus to requirement, we still cannot cover the volume of doses that are needed worldwide. Experts in the immunisation and medical fields are suggesting that it’ll take another three years before we have manufactured enough vaccines, while some suggest that we’ll have built a natural immunity by then.
Whatever the result… we have to be prepared for further death, and we must continue to innovate new solutions to the existing problems.
NTT DATA Services, Remodelling Supply Chains for Resilience
Joey Dean, the man with the coolest name ever and Managing Director in the healthcare consulting practice for NTT DATA and is focused on delivering workplace transformation and enabling the future workforce for healthcare providers. Dean also leads client innovation programs to enhance service delivery and business outcomes for clients.
The pandemic has shifted priorities and created opportunities to do things differently, and companies are now looking to build more resilient supply chains, none needed more urgently than those within the healthcare system. Dean shares with us how he feels they can get there.
A Multi-Vendor Sourcing Approach
“Healthcare systems cannot afford delays in the supply chain when there are lives at stake. Healthcare procurement teams are looking at multi-vendor sourcing strategies, stockpiling more inventory, and ways to use data and AI to have a predictive view into the future and drive greater efficiency.
“The priority should be to shore up procurement channels and re-evaluate inventory management norms, i.e. stockpiling for assurance. Health systems should take the opportunity to renegotiate with their current vendors and broaden the supplier channel. Through those efforts, work with suppliers that have greater geographic diversity and transparency around manufacturing data, process, and continuity plans,” says Dean.
But here ensues the never-ending battle of domestic vs global supply chains. As I see it, domestic sourcing limits the high-risk exposure related to offshore sourcing— Canada’s issue with importing the vaccine is a good example of that. So, of course, I had to ask, for lifesaving products, is building domestic capabilities an option that is being considered?
“Domestic supply chains are sparse or have a high dependence on overseas centres for parts and raw materials. There are measures being discussed from a legislative perspective to drive more domestic sourcing, and there will need to be a concerted effort by Western countries through a mix of investments and financial incentives,” Dean explains.
Wielding Big Tech for Better Outcomes
So, that’s a long way off. In the meantime, leveraging technology is another way to mitigate the risks that lie within global supply chains while decreasing costs and improving quality. Dean expands on the potential of blockchain and AI in the industry.
“Blockchain is particularly interesting in creating more transparency and visibility across all supply chain activities. Organisations can create a decentralised record of all transactions to track assets from production to delivery or use by end-user. This increased supply chain transparency provides more visibility to both buyers and suppliers to resolve disputes and build more trusting relationships. Another benefit is that the validation of data is more efficient to prioritise time on the delivery of goods and services to reduce cost and improve quality.
“Artificial Intelligence and Machine Learning (AI/ML) is another area where there’s incredible value in processing massive amounts of data to aggregate and normalise the data to produce proactive recommendations on actions to improve the speed and cost-efficiency of the supply chain.”
Evolving Procurement Models
From asking more of suppliers to beefing up stocks, Dean believes procurement models should be remodelled to favour resilience, mitigate risk and ensure the needs of the customer are kept in view.
“The bottom line is that healthcare systems are expecting more from their suppliers. While transactional approaches focused solely on price and transactions have been the norm, collaborative relationships, where the buyer and supplier establish mutual objectives and outcomes, drives a trusting and transparent relationship. Healthcare systems are also looking to multi-vendor strategies to mitigate risk, so it is imperative for suppliers to stand out and embrace evolving procurement models.
“Healthcare systems are looking at partners that can establish domestic centres for supplies to mitigate the risks of having ‘all of their eggs’ in overseas locations. Suppliers should look to perform a strategic evaluation review that includes a distribution network analysis and distribution footprint review to understand cost, service, flexibility, and risks. Included in that strategy should be a “voice of the customer” assessment to understand current pain points and needs of customers.”
“Healthcare supply chain leaders are re-evaluating the Just In Time (JIT) model with supplies delivered on a regular basis. The approach does not require an investment in infrastructure but leaves organisations open to risk of disruption. Having domestic centres and warehousing from suppliers gives healthcare systems the ability to have inventory on hand without having to invest in their own infrastructure. Also, in the spirit of transparency, having predictive views into inventory levels can help enable better decision making from both sides.”
But, again, I had to ask, what about the risks and associated costs that come with higher inventory levels, such as expired product if there isn’t fast enough turnover, tying up cash flow, warehousing and inventory management costs?
“In the current supply chain environment, it is advisable for buyers to carry an in-house inventory on a just-in-time basis, while suppliers take a just-in-case approach, preserving capacity for surges, retaining safety stock, and building rapid replenishment channels for restock. But the risk of expired product is very real. This could be curbed with better data intelligence and improved technology that could forecast surges and predictively automate future supply needs. In this way, ordering would be more data-driven and rationalised to align with anticipated surges. Further adoption of data and intelligence and will be crucial for modernised buying in the new normal.
These are tough tasks, so I asked Dean to speak to some of the challenges. Luckily, he’s a patient guy with a lot to say.
On managing stakeholders and ensuring alignment on priorities and objectives, Dean says, “In order for managing stakeholders to stay aligned on priorities, they’ll need more transparency and collaborative win-win business relationships in which both healthcare systems and medical device manufacturers are equally committed to each other’s success. On the healthcare side, they need to understand where parts and products are manufactured to perform more predictive data and analytics for forecasting and planning efforts. And the manufacturers should offer more data transparency which will result in better planning and forecasting to navigate the ebbs and flows and enable better decision-making by healthcare systems.
Due to the sensitive nature of the information being requested, the effort to increase visibility is typically met with a lot of reluctance and push back. Dean essentially puts the onus back on suppliers to get with the times. “Traditionally, the relationships between buyers and suppliers are transactional, based only on the transaction between the two parties: what is the supplier providing, at what cost, and for what length of time. The relationship begins and ends there. The tide is shifting, and buyers expect more from their suppliers, especially given what the pandemic exposed around the fragility of the supply chain. The suppliers that get ahead of this will not only reap the benefits of improved relationships, but they will be able to take action on insights derived from greater visibility to manage risks more effectively.”
He offers a final tip. “A first step in enabling a supply chain data exchange is to make sure partners and buyers are aware of the conditions throughout the supply chain based on real-time data to enable predictive views into delays and disruptions. With well understand data sets, both parties can respond more effectively and work together when disruptions occur.”
As for where supply chain is heading, Dean says, “Moving forward, we’ll continue to see a shift toward Robotic Process Automation (RPA), Artificial Intelligence (AI), and advanced analytics to optimise the supply chain. The pandemic, as it has done in many other industries, will accelerate the move to digital, with the benefits of improving efficiency, visibility, and error rate. AI can consume enormous amounts of data to drive real-time pattern detection and mitigate risk from global disruptive events.”