After 10 months to plan, why is the world muddling through vaccination? 

The incompetence of countries in dealing with the onslaught of Covid-19 is being mirrored in their incompetence at vaccination, writes Clara Ferreira Marques
After 10 months to plan, why is the world muddling through vaccination? 

A Romanian gendarme waits to get a Covid-19 vaccine at a hospital in Bucharest, Romania. Across the Balkans and the rest of the nations in the southeastern corner of Europe, a vaccination campaign against the coronavirus is overshadowed by heated political debates or conspiracy theories that threaten to thwart the process. Picture: AP

Covid-19 exposed all the flaws of both national and international governance. 

The World Health Organization struggled. 

Too many countries, even those supposedly best prepared for a pandemic, flailed and failed to grasp lessons from each other’s experiences, at the cost of 2 million lives and trillions of euros.

Has the world rectified those weaknesses?

A vaccination campaign of record size is the first opportunity to at least partly assess that, and the global results are not as encouraging as they should be.

Take the United States, which had hoped to give at least 20 million people their first coronavirus shots by the end of last year, but has so far managed a little over half that. 

The US, hampered by poor federal-level support, have struggled with basics like who goes first, and both excessively stringent and excessively broad stances have caused problems. 

France has struggled with vaccine hesitancy. 

Russia raced to develop and approve homegrown jabs, but a skeptical population remains less than eager. The vast majority of countries have not even started.

The pandemic was identified as a threat well before 2020 but, for most of us, the reality was unimaginable in its eventual scale, and certainly in the devastating cascade of social and economic problems it created. 

When it comes to inoculations, though, we knew this day would come eventually. 

Governments were cognizant that it would be an unprecedented logistical challenge. 

They knew it could well happen in the northern hemisphere winter when case numbers were bound to be higher. 

They had months to plan, put strategies in place and debate basics like whether to prioritize one dose or aim straight for two. Too many are still scrambling.

It is true that these are very early days. Countries that do well in the initial stages may not look as good when we get to the finish line. 

But it is vital, as we go, to evaluate whether there is progress. 

Providing public goods at scale is, after all, the very essence of a government’s function. 

More importantly, the basics we need to get right now — from being agile to following science and combating misinformation — will underpin our fight against every subsequent global challenge, not least a changing climate.

Of course, as with everything in this pandemic, measuring vaccination success isn’t straightforward. 

We could do worse, though, than start by weighing up how countries did in securing vaccines, distributing doses and communicating effectively to build trust.

Supply is immediately problematic as a gauge of government success on its own. 

We can of course count the volume of doses countries secured and there were high-profile blunders, as with the United States passing on the chance to buy extra Pfizer doses last summer. 

But wins here are predicated on wealth and sharp elbows as much as they are on administrative capacity and quality of governance. 

Israel, for example, paid a hefty premium for its vaccines, something not all Covid-battered budgets allow, and was able to throw data into the deal too, thanks to an unusually personalized and digitized health system.

Members of staff prepare to administer injections of a Covid-19 vaccine at the NHS vaccine centre that has been set up at the Millennium Point centre in Birmingham in the UK. Picture: PA

Members of staff prepare to administer injections of a Covid-19 vaccine at the NHS vaccine centre that has been set up at the Millennium Point centre in Birmingham in the UK. Picture: PA

Then there’s speed of delivery — actually getting the shots and rolling them out.

Again, though, this isn’t just about good governance. 

Certainly, Israel is a standout when considering doses delivered per capita, having delivered more than 2 million doses for a population of just over 9 million. 

So too are the United Arab Emirates, and even Britain. 

But speed here has been largely dictated by circumstance — it’s a race against an out-of-control outbreak. 

Israel has had over 535,000 cases, almost 6% of its population. Britain registered almost 56,000 new cases on Friday, one of the worst rates globally. In both, the fate of politicians depends on it.

By contrast, the “go slower” approach taken by some Asian countries isn’t exactly failure by comparison — certainly not yet. 

Even if a decision to “sit back” is open to question during an economically devastating pandemic where millions have already been inoculated elsewhere. 

Vaccine side effects typically show up quickly, and we know that even jabs that prevent complications will help.

So what’s a better test of how governments have actually done, irrespective of pre-existing wealth and Covid-19 status?

One, did they make room for ethically tricky discussions? 

This was already necessary last year, when lockdowns forced the damage to economies to be weighed against the risk to human lives, but, as Donald Low, professor of practice in public policy at Hong Kong University of Science and Technology, put it to me, there is precious little space for ethics when conversations focus on cost-benefit analysis. 

Hence much of the floundering in debates where there is no perfect answer, like whether to bet on the probable protection of one dose or the near-certainty of two, or whether to vaccinate the elderly before school teachers.

It is hoped the Oxford/AstraZeneca vaccine will be approved by the European Medicines Agency by the end of the month. File Picture: Peter Byrne/PA Wire

It is hoped the Oxford/AstraZeneca vaccine will be approved by the European Medicines Agency by the end of the month. File Picture: Peter Byrne/PA Wire

Deliberations on doses, for example, could have started earlier, says Keiji Fukuda, director and clinical professor at the University of Hong Kong’s School of Public Health, though he adds final decisions were not possible far in advance without a sense of the immune response to the first dose of specific vaccines, manufacturing capacity and the speed at which infection is spreading, which only come with the outbreak.

Even if a decision to “sit back” is open to question during an economically devastating pandemic where millions have already been inoculated elsewhere. 

Finally, the least forgivable oversight of all: Did governments educate and communicate to get citizens rolling up their sleeves and avoid the greatest collective action failure of our time? 

That’s not about inoculating the president on live television as Indonesia did, but explaining the science, the testing process, the risks and rewards. 

Most people, after all, are not hard-bitten vaccine skeptics. 

Instead, officials — as in Hong Kong, for example, where a lack of trust in government should have made this a priority — talk publicly about vaccines that do not fully protect from infection without adequately explaining what that means.

Perhaps, in a few months, as James Crabtree of Singapore’s Lee Kuan Yew School of Public Policy puts it, we’ll find that most rich countries will have muddled through, but left emerging economies lagging. 

That, he rightly adds, is not governance success either. 

The one lesson we should have learnt from 2020 is that no one is safe until everyone is.

  • Clara Ferreira Marques is a Bloomberg Opinion columnist covering commodities and environmental, social and governance issues.

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