The healthcare workers watching from afar as rich countries begin vaccine rollout

Dr. Alfonso Velandia starts each hospital shift by counting his troops in the battle against coronavirus.

The 46-year-old emergency specialist manages intensive care units (ICUs) at the Cardiovascular Hospital in Soacha, a working-class suburb of Colombia’s capital Bogotá. Since the pandemic began, he says he has seen the number of healthcare workers under his watch dwindle, even as the hospital expands its ICU to confront a relentless second wave of cases.

Velandia is proud of the hospital’s response to Covid-19 and recently showed CNN a new ICU facility that added 12 beds to the hospital’s arsenal. But he is also worried about his team — that same day, he said 5% of his staff was at home, sick with Covid. One was intubated in the emergency ward where they work.

Even for health workers who’ve avoided infection so far, fear and fatigue have crippled the unit after the near year-long pandemic.

“My team… They are tired, exhausted. They spend as many as 24 or 36 hours here, working all the time and we don’t have any more personnel,” Velandia told CNN.

Velandia looks with frustration at statistics on vaccine distribution in Europe and North America, where hundreds of thousands of frontline healthcare workers have already been vaccinated against the deadly virus. “I recently had a meeting, and my team was like ‘We can’t hold anymore’… we need the vaccine now!” he told CNN.

But like many countries in the developing world, Colombia is yet to receive a single dose of a vaccine.

Colombia’s conundrum

Colombian President Ivan Duque’s government was lauded last year by the World Health Organization (WHO) for its swift and well-coordinated pandemic response. After implementing social distancing measures early on, it increased the number of beds for intensive care, which almost doubled between March and August 2020, according to the health ministry.

But Colombia fell behind in the race to acquire vaccines. Now it finds itself essentially at the back of the queue, while nearby Brazil, Argentina, Mexico and Chile have already begun to administer the lifesaving inoculations.

Mass vaccinations in Colombia will start on February 20, 2021, Duque has promised. His government has struck deals to buy enough vaccine for over 35 million people — the minimum the WHO recommends for a population of about 50 million — though a mix of privately purchased vaccine doses and 20 million doses secured through the COVAX mechanism, he said.

Formally known as the Covid-19 Vaccines Global Access Facility, COVAX is an initiative of co-led by the World Health Organization aimed at distributing vaccines to low-income countries who cannot easily purchase them directly from manufacturers. But it has not yet started dispatching vaccines anywhere in the world.

When it does, Colombia expects to be among the first in the world to receive COVAX vaccines, Colombian health minister Fernando Ruiz told CNN. But for now, the majority of the world’s nations have not begun distributing first doses of any vaccine.

Aurélia Nguyen, the managing director of COVAX, told CNN the initiative plans to deliver up to two billion doses of coronavirus vaccine to poorer countries by the end of 2021, but the road ahead will be difficult.

“It’s not going to be a straightforward pathway throughout the whole year, that’s for sure,” she said in an exclusive CNN interview. “Demand is going to outstrip supply.”

‘On the brink of a catastrophic moral failure’

WHO Director General Tedros Adhanom Ghebreyesus has criticized wealthier countries for stockpiling excessive amounts, warning that unequal distribution between rich and poor countries could prolong the pandemic.

“I need to be blunt: the world is on the brink of a catastrophic moral failure — and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries,” Ghebreyesus said, while speaking at the WHO headquarters in Geneva on January 18.

Canada, for example, has purchased enough doses of Covid-19 vaccines to immunize its citizens five times over if all the leading vaccines are approved, the People’s Vaccine Alliance an international vaccine watchdog, said in December. The new Biden administration has secured in six days more than three times the vaccines Colombia was able to secure in ten months. And Germany is already ordering coronavirus vaccines for 2022, German Health Minister Jens Spahn said during an online town hall on Saturday.

But even among wealthy nations, trouble is already brewing as manufacturers struggle to meet delivery commitments. Last week, the EU introduced a measure requiring export authorization for vaccine-makers with whom it had signed purchasing deals.

Some less wealthy countries have been able to ensure earlier vaccine access through clinical trial agreements. An analysis by Duke University;s Global Health Institute shows that some countries that participated in large scale vaccine clinical trials or with vaccine manufacturing capabilities were able to secure earlier doses and larger and advance market commitments from manufacturers.

“The investment to develop the vaccine has been enormous. Those who could not put in the money participated with volunteers for the trials,” Dr. Maribel Arrieta, an epidemiologist and spokesperson for Bogotá’s College of Doctors, told CNN. “And because of that, those who invested earlier are those who are receiving the vaccine now.”

How poorer countries will obtain vaccines

However governments acquire the vaccines, the WHO says it makes little sense for a limited number of nations to vaccinate their whole populations while the virus largely runs wild in the rest of the world. The organization is now calling for a radical re-thinking of how the vaccines are distributed.

“We must use them as effectively and as fairly as we can,” said Ghebreyesus, the WHO director general, on January 29. “That’s why I have challenged government and industry leaders to work together to ensure that in the first 100 days of 2021, vaccination of health workers and older people is underway in all countries.”

To do so could require wealthier nations to give up their current widespread vaccination goals, and share some of the vaccines they have already purchased with poorer nations, Ghebreyesus said.

Beyond issues of fairness, it may also make more economic sense to vaccinate the most vulnerable worldwide instead of racing to achieve herd immunity among wealthy nations, Lawrence Gostin, the O’Neill Chair of Global Health Law at Georgetown University recently argued in Foreign Affairs.

Gostin and his co-authors cite research published in November by RAND Europe Europe, nonprofit global policy think tank, which estimates that the total GDP of high-income nations including places like India, China, and Russia would take a hit of around US$119 billion every year that low-income countries are unable to access vaccines, due to reduced spending in “high-contact intensive service sectors” such as hospitality, recreation, retail and wholesale, transportation and health and social care..

“If these high-income countries paid for the supply of vaccines, there could be a benefit-to-cost ratio of 4.8 to 1. For every $1 spent, high-income countries would get back about $4.80,” RAND Europe says.

For Dr. Velandia at Soacha’s public hospital, each day without a vaccine means a new day of counting the human cost among his troops.

A couple of weeks after CNN’s visit to his ICU, Velandia told CNN that the intubated doctor had since recovered.

But another colleague has passed away from Covid-19, he says. “He was a therapist, his condition deteriorated really fast,” Velandia says. “A week ago, he was ok and working. We buried him yesterday.”