Experts' fears that people in wealthier countries will be vaccinated before those in poorer nations are coming to fruition. And the inequity could further pressure the global economy, according to a recent study supported by the International Chamber of Commerce.
"Should countries continue to pursue an uncoordinated approach to vaccine distribution, the world risks global GDP losses in 2021 alone of as much as US $9.2 trillion," the study said.
Health officials around the world have criticized the nationalist strategies of the U.S. and Europe, including, most recently, Italy blocking doses of AstraZeneca (AZN) bound for Australia.
Geopolitical forces are compounding experts' economic worries — with Russia and China stepping up to fill the void where vaccines remain scarce. India, too, is vying for global influence by distributing vaccines to low- and middle-income countries, but its outsized role was somewhat expected. The country is home to one of the world's largest vaccine manufacturers, the Serum Institute of India, as well as other vaccine companies producing candidates.
"India is partnering in a very productive way with the multinationals and working [with the] WHO and stringent regulatory authorities. So there's a level of scientific rigor and commitment to excellence that we're not necessarily seeing with China and Russia," said Dr. Peter Hotez, a top vaccine expert at Baylor College of Medicine.
The World Health Organization (WHO) is already addressing those concerns with teams on the ground, according to Bruce Aylward, senior advisor to WHO Director General Dr. Tedros Adhanom Ghebreyesus.
Aylward told Yahoo Finance the WHO is working with China's Sinopham and Sinovac, and the makers of Russia's Sputnik V vaccine, to refine their processes to match stringent global regulatory standards and eventually send their vaccines through the COVAX facility.
But that wasn't always the plan.
"I think we had not expected ... to see such a massive reliance on these countries to manage that combination of political and public health imperative," Aylward said. "Not that China and Russia and India [would] play a role, but at this scale. I think that's a little bit of an interesting development."
Hotez said it could mean a shift in geopolitical tectonic plates.
"The reality is Russia and China are here, they are big producers, and if we could get them into the fold and get them to cooperate ... and improve their regulatory structure, that could be game-changing," Hotez said.
How we got here
President Donald Trump's policies are to blame, Dr. Angela Rasmussen, a virologist at the Georgetown University Center for Global Health Science and Security, told Yahoo Finance.
"President Trump, in his zeal to disassociate with the World Health Organization, didn't seem to realize that that would also leave a vacuum for some of our rivals to step in and fill [the void]. In particular, China has done just that," Rasmussen said, calling it a "missed opportunity" for the United States to lead fight against the pandemic on the global stage.
But bioethicist and NYU Langone professor Dr. Arthur Caplan notes that the "America First" policy is popular, and President Joe Biden needs to find a balance. Caplan told Yahoo Finance that he supports the U.S. vaccinating its population first.
"It's not just travel agencies that are getting hit by the crisis. Look at retail, at the food and agriculture industries, and even some of the mining sector has been hit really hard," he said.
Meanwhile, researchers have been analyzing vaccine purchase commitments. In December, Johns Hopkins University published a study of pre-market commitments, concluding that 51% of vaccine dose commitments were for high-income countries, or about 14% of the world's population.
The study found that China and Russia, as well as AstraZeneca (AZN) and Oxford (through the Serum Institute of India), and Novavax (NVAX) were going to be the largest distributors. Meanwhile, Pfizer (PFE) and BioNTech (BNTX) have also secured several global commitments.
"It just tells you how we're in a very different operating environment that we would have thought," Aylward said.
Last month, McKinsey analyzed the vaccine commitments, and determined the U.S., China, India and the European Union would be the largest exporters of vaccines, while Asia and Africa would the be largest importers.
And while countries like France have committed to donating a small percentage of existing vaccines to African countries, the amount is "not even a drop in the bucket," said Lusiani.
A call for all G20 countries
The U.S. recently rejoined the World Health Organization, but White House officials have not commented on when the U.S. will begin donating excess doses.
Meanwhile, some of the same struggles plaguing U.S. companies, including a squeeze on necessary raw materials and equipment, are hampering global production as well.
"In recent months we have become particularly concerned that the existing capacity could be constrained by shortages in the supply chain— either the supply of critical consumables or raw materials required for the manufacturing of vaccine or shortages of finishing and filling capacity, shortages of medical glass products ... to actually put the vaccine into," said Richard Hatchett, Coalition for Epidemic Preparedness (CEPI) CEO at a recent WHO virtual briefing.
So waiting for more Western-based companies to get regulatory authorization or ramp up supplies is not an option. The European Medicines Agency said it was reviewing Russia's Sputnik V vaccine for potential use in its 27 countries instead. European and Latin American countries have already committed to purchasing doses of the vaccine or have authorized its use. Meanwhile, AstraZeneca is launching a combined trial to test both its and Russia's vaccine together.
Hotez, who recently penned a book on the topic, "Preventing the next Pandemic," is working on a vaccine with Indian company Biological E, says the solution is for greater "vaccine diplomacy."
"We're overly reliant on the U.S. and the U.K. It's not working for us. We need to bring in all the G20 countries," Hotez said.
Until then, the vaccine battle is morphing into a longer-term problem.
"This is going to be something that continues to affect the global economy, to affect travel, to affect, probably, all geopolitics globally for some time to come," Rasmussen said.
"I don't think that a lot of people in the public in the U.S. appreciate that," she said.
