What is syringe nationalism - and how is it slowing the global COVID-19 vaccine roll-out?

The supply of COVID-19 vaccines for developing countries is ramping up. But international efforts to vaccinate at least 70% of the population in every country across the globe by mid-2022 could come up short if billions more syringes aren’t found to administer all those doses.

UNICEF, which is helping lead the drive to deliver vaccines and syringes to countries in need, has warned that there could be a shortfall of up to 2.2 billion of the special syringes required for use in low- and middle-income countries.

With vaccines set to begin pouring into Africa early in 2022, this scarcity of syringes could “paralyse progress,” according to Dr Matshidiso Moeti, World Health Organization Regional Director for Africa. Kenya, Rwanda and South Africa are already experiencing delays in receiving syringes.

Nearly two years into the pandemic, the disparity in vaccination rates between wealthy and developing countries remains stark. Nearly nine out of 10 people in Portugal and the United Arab Emirates are fully vaccinated, while across Africa the number is just 6%. In the Democratic Republic of Congo, less than than 0.1% of the population is fully vaccinated.

A shortage of vaccines is a big part of the problem. Rich countries have been accused of vaccine nationalism - buying up the available production and leaving little for the rest of the world - since the start of the pandemic. Three-quarters of all vaccines have gone to wealthy countries. As UN Secretary‑General António Guterres put it in late October 2021: “Vaccine nationalism and hoarding are putting us all at risk”.

In response, an international initiative known as COVAX was launched to ensure that developing countries had equitable access to tests, treatments and vaccines. To date, it has shipped about 475 million doses to 144 countries. The US and the European Union are among the largest donors.

President Joe Biden announced in September 2021 that the US was donating an additional 500 million doses of the Pfizer-BioNTech COVID-19 vaccine to low- and middle-income countries, with shipments to start in early 2022. That took total US donations to more than 1.1 billion doses.

But doses provided by wealthy countries haven’t always come with the syringes needed to put them to use.

So far, UNICEF has managed to keep up with demand, securing nearly 3 billion ‘auto-disable’ syringes since 2020. This type of syringe, which locks automatically to prevent re-use, is required for use in developing countries under UN safety guidelines to curb the transmission of disease.

The shortage of auto-disable syringes predicted for 2022 is the result of higher demand, the global supply chain crisis and an unpredictable supply of donated vaccines, according to UNICEF. The agency also calls out a new type of nationalism - restrictions on the export of syringes.

India, which along with China makes most of the syringes used in low- and middle-income countries, announced new export limits in October 2021. These include the 0.5ml auto-disable syringes favoured for vaccination against COVID-19. The restrictions will be in place for three months, and are intended to ensure sufficient domestic supply during a vaccination drive, according to a government statement.

The “geographic reliance” on China and India was manageable when demand was more predictable, according to the Bill and Melinda Gates Foundation. But the urgency of the current roll-out, coupled with supply chain disruptions, mean that syringes are being flown to their destination at five to 10 times the cost of the syringes themselves.

To help address this issue, the Foundation has provided a $3.9 million grant to a Kenyan manufacturer that will help Africa make up some of its syringe shortfall as well as diversifying the supplier base.

UNICEF called for an end to syringe nationalism and hoarding of equipment that’s desperately needed.

Expanded access is needed to the supply of the standard 0.5ml auto-disable syringes used for most COVID-19 vaccines, as well as the 0.3ml syringes used to administer the Pfizer-BioNTech vaccine, according to UNICEF. A more predictable, secure supply of vaccines would allow authorities to make the best use of the limited syringe supply.

UNICEF also called for international coordination of immunization campaigns and the consideration of expanded use of so-called ‘reuse prevention syringes’ as the next best alternative to auto-disable syringes.