Why developing countries may be last to get the vaccine

Coronavirus is only making things worse.

The Global Alliance for Vaccines and Immunisation (Gavi) recently announced that 80 million children in at least 68 countries may now be at risk of contracting a range of regular diseases after the pandemic heavily disrupted routine immunisation programmes.

Systems to deliver and administer vaccines have been hit by a mixture of travel restrictions, delivery delays and people choosing not to leave their homes to be vaccinated due to the ever present threat of infection.

If this continues, health experts fear that low income countries won't be able to effectively administer a new coronavirus vaccine.

"If we neglect the supply chains and immunisation infrastructure that keep these programmes running, we also risk harming our ability to roll out the Covid-19 vaccine that represents our best chance of defeating this pandemic," said Gavi chief executive Seth Berkley.

Traditionally, the cost of securing vaccines has always hindered developing countries. To put it bluntly, they simply can't afford most of the new vaccines being produced.

Improving this has been the toil of Gavi since it began 20 years ago: to try and improve access to vaccines for the world's poorest children. They do this by encouraging manufacturers to lower prices for developing countries with the promise of long-term and high-volume deals from these places.

If a new coronavirus vaccine is found, however, it may be selfishness rather than cost that leaves the developing world waiting for deliveries.

Only a handful of coronavirus vaccine projects are taking place in lower income countries, with most operations based in the US or Europe.

Five billion doses

This could see much of the developing world miss out, says Kalipso Chalkidou, director of global health policy at the Center for Global Development.

"There's no way we will produce five billion doses of a new vaccine within a month, so there is going to be staggered production.

"The question is how likely is it that a European or US company will take a few million doses for frontline health workers and people at higher risk and give the rest to everyone else before waiting their turn for the next batch to then vaccinate others? That won't happen."

Costs and politics aside, the next challenge emerges: how do you distribute huge quantities of a new vaccine to communities in the world's poorest countries?

The answer: with great difficulty.

All vaccines must be kept at the correct temperature from the point of manufacture to the point of use to ensure that they remain effective. This is known as the cold chain.

"The current standard for vaccines is to be kept at two to eight degrees and that is really tough in many developing countries when it can be up to 50 degrees outside. You need a really specially engineered refrigerator to cope.

Vaccines also need fridges

"There can be power cuts too, sometimes up to 16 or more hours a day, causing many older refrigerators to just die," says James Cheyne who worked with the Cold Chain Unit at the World Health Organisation.

In some developed nations, the cold chain process is outsourced to huge logistics companies like DHL and FedEx, where they are supported by access to reliable electricity and well-maintained roads.

This outsourcing model is much less feasible in poorer countries as many courier companies either aren't in operation or are unlikely to be interested with the little money to be made.

Local health teams are generally involved in transporting and storing vaccines.

"Ministry of Health staff are dedicated to what they do and they work like hell to make things happen under extraordinarily difficult systems," Cheyne explains.

He says to be successful in low and middle income countries , vaccine vials need to be as small as possible to reduce the amount of cold storage space needed and cost required to deliver it.

This is a big issue in many poorer countries where health centres may be inaccessible, making follow-up appointments all the more tricky.

Vaccine hesitancy is also causing developing countries to have lower immunisation levels.

Unlike the anti-vax movement in the West, Lavnaya Vasudevan from Duke University's Global Health Institute says people in developing countries may just not have enough understanding on vaccines causing them to be distrustful:

"In some areas there may be traditional beliefs and practices which come into play but a lot of it is down to people not understanding what vaccines are. They don't know how they work and why they are important.

"Governments in developing countries are now focusing a lot more on education about vaccines, and trying to deal with social media and misinformation that is posted online."

Whilst the world anxiously waits for a coronavirus vaccine, if these issues are not solved many could be left waiting a lot longer than others.