He is central to the work of securing vaccines for the whole world. One year ago, John Arne Røttingen warned against vaccine nationalism. Developing countries receive only half of the vaccines they thought they would receive in 2021.
When we entered Advent last year, a new virus variant aroused concern. It originated in the United Kingdom. The name became alpha, after the first letter of the British alphabet.
Well into a new Advent season, one year after warnings that more varieties could develop if not all were vaccinated, we have come to letter number 15.
Omikron mutated in southern Africa. The conditions are right for us to continue counting.
0–3 per cent fully vaccinated
– The challenge is clearly greatest in low-income countries in general. And especially in Africa, vaccine coverage is still low, says John-Arne Røttingen to Aftenposten.
Røttingen is Norway’s ambassador for global health and works at the Ministry of Foreign Affairs.
Through the global corona collaboration «ACT-A»The world is trying to ensure that all countries have access to vaccines, tests and treatment. Norway is one of two leading countries in ACT-A. When the Norwegian Prime Minister and Minister for Development Aid lead this work, together with South Africa, it is with Røttingen as the backer.
Figures from the WHO show that large countries in central Africa have very low vaccine coverage. Of the 20 countries with the lowest proportion of fully vaccinated, 16 are in Africa. They have between 0 and 3 percent fully vaccinated. In sub-Saharan Africa in general, about ten percent of the population is vaccinated, Røttingen explains.
– It is a challenge for the world. It is important to prioritize vaccination of risk groups there, says Røttingen.
So what are the biggest challenges?
Freezing capacity, skepticism and few tests
It is almost a year since Røttingen warned against vaccine nationalism in a column in Aftenposten. Vaccination is still slow in developing countries. Access to vaccines is the biggest problem.
– The international vaccine collaboration Covax had a goal of distributing at least 2 billion vaccine doses. It was really up to them with the agreements that had been entered into, but we will only deliver half by the end of the year, says Røttingen.
Covax is the body that works for vaccines internationally, as part of the ACT-A collaboration. That they do not reach their vaccine goal, goes mostly beyond the poor countries, Røttingen says.
– Are there also challenges in getting vaccines out in these countries?
– Yes, there are also challenges with capacity for vaccination in the health care system. And there will be practical challenges in handling mRNA vaccines, because, among other things, it requires freezing capacity over a longer period of time, in a different way than for the vaccines that these countries tend to use, Røttingen explains.
Tests fewer than Europe
And if the inequality between rich and poor countries was not big enough on the vaccine front:
– In numbers, the difference in testing is perhaps even greater than the difference in vaccine access. The test frequency is at least 100 times higher in Europe than in Africa. This means that in practice we have little knowledge about the prevalence of covid-19. Sequencing capacity is also much lower in Africa, with South Africa as an exception.
On Wednesday, The New York Times wrote that several countries in southern Africa asked for a halt in vaccine deliveries. They feared the vaccines would be discarded. However, lack of knowledge and skepticism is also a barrier to vaccination in some countries.
– Not least, we hear about it in Eastern European countries and also from some countries in Africa, says Røttingen.
The figures show that European countries such as Ukraine, Bulgaria, Moldova and Bosnia also have low vaccine coverage. The proportion of fully vaccinated in these countries is on a par with, or below, South Africa – the home country of the omicron variant.
Delivers far less than planned
The vaccine manufacturers say they can produce very many vaccines in the future. The rooting calls for caution around the estimates.
– It is positive and means that you can produce a maximum of two billion vaccines per day during the spring. month. But production has so far not fully followed the forecasts. There may be challenges with the estimates. And then the skewed distribution is the biggest challenge. In practice, we have made it difficult for Covax to buy vaccines, says Røttingen.
Agreements have been secured through Covax for almost six billion vaccines, but so far only around 590 million have been delivered. Export restrictions from India and problems with production in several places are to blame.
– Covax has probably lost more than individual countries that are in the same queue, and which have a stronger economy and stronger political impact. We really know too little about this, because we have too little insight into deliveries and agreements, Røttingen believes.
Even though there are over 400 million doses left to one billion, Røttingen thinks it is realistic. The number of doses delivered increases every week.
Vaccines for your own population or for the rest of the world? This dilemma is about to disappear.
According to Unicef, only around 83 million of the nearly 590 million vaccines have gone to what is defined as a low-income country.
– Why do not more people go to low-income countries?
– Low-income countries are relatively fewer and smaller. Therefore, in absolute numbers, more has gone to lower middle-income countries. Per population, the picture is different, says Røttingen.
Must expect new viruses to develop
These days, he sits on board meetings of the vaccine alliance Gavi, one of the bodies behind the vaccine program Covax. In the meetings, they look at the status of Covax and purchasing challenges right now.
– Based on the plans, deliveries will pick up. Towards the end of the year, the challenges in some countries will be to get vaccinated quickly enough, so that you avoid having to throw out doses that are out of date.
“No one is safe until everyone is safe,” Prime Minister Jonas Gahr Støre recalled in recent days. In the state budget, two billion was added to the global pandemic management and the bodies Røttingen is centrally located in.
– The experiences from the various waves of infection show that there are no miracle cures here. The important thing going forward is to put in place a sum of measures that do not complicate the entire social machinery. Some developing countries have significant challenges in terms of lockdown. It is a crisis for the economy and society to shut down.
We must expect new viruses to develop, says Røttingen.
– Therefore, we must have a capacity over time to keep measures at a level that allows societies to move around. And therefore, adequate vaccination in all countries is a necessary priority.