Shots that were once rare are now piling up and even expiring, a problem on the agenda of a second global COVID-19 summit the U.S. is co-hosting on Thursday. President Joe Biden kicked off the first summit eight months ago by announcing the U.S. would donate another 500 million doses to the international vaccination campaign, nearly doubling its total pledge.

But now, vaccine makers are idling production or face shutdowns as demand for shots wanes, even with the world still far from a target of inoculating 70% of humanity. Republicans in Congress have so far blocked additional funding for the U.S. and international vaccination campaigns. 

Advocates for widespread inoculation say participants at the virtual summit need to come up with a plan to shift focus from producing vaccines to administering shots. They warn that failure raises the risk of new variants arising, potentially with the ability to evade vaccine immunity and spark yet another wave of infections and deaths.

“We need to invest now because we’re going to continue to see more transmissible variants,” said Thomas Bollyky, director of the global health program at the Council on Foreign Relations. “We are rolling the dice, in a game that we keep losing, to bet that we’re not going to end up with a variant that upends the progress we’ve seen.” 

Shifting priorities

A group of Nobel laureates and dignitaries urged Biden this week to keep up pressure on Congress to approve billions in funding for international vaccinations. 

Financing is essential “for building the staffing and the capacity to deliver these medical treatments,” they wrote. “The consequences of the lack of critical funding for the global COVID-19 response are clear. It will damage global vaccination and COVID-19 treatment efforts.”

With broad vaccination targets out of reach, the priority is shifting to protecting the most vulnerable people and tackling distribution hurdles as demand ebbs and many countries abandon mitigation efforts.

At least 11 billion shots have been distributed globally, data compiled by Bloomberg show. About 46% of the populations of a group of 92 low- and middle-income nations have completed their initial vaccination course, compared with 60% globally, according to the vaccine alliance Gavi, an organization coordinating the global rollout. 

But many developing countries, particularly in Africa, still lag far behind the wealthy world.

“The pandemic isn’t over, but if you look at the world there is a general sense that it is,” said Gavi CEO Seth Berkley.

The case of Aspen Pharmacare Holdings Ltd. illustrates how quickly things have changed. Aspen won a license to produce Johnson & Johnson’s COVID-19 vaccine at a plant in South Africa. It was a high-profile project, funded by the US and others, in a country on the front lines of the fight over vaccine inequity.

But for all its fanfare, Aspen had too few customers. African governments it hoped would buy shots failed to place orders, and the company is now considering making anesthetics instead.

“We had counted on, and were assured, that the regional manufacturing platform was critical and would be supported,” Stavros Nicolaou, the company’s head of strategic trade, said in an interview. “If Aspen cannot obtain production, what hope is there for others?”

South Africa is also preparing to destroy vaccines that will expire and shutter costly mass-vaccination programs amid low demand, said Nicholas Crisp, who leads the country’s vaccination program. 

“We are very disappointed. It’s way below what we had hoped for—it’s going to mean less immunity and a stretching out of this pandemic,” he said.

A similar problem emerged in India, where the Serum Institute, a major vaccine producer, recently halted production of its shot when stockpiles hit 200 million doses. That’s a sharp change from last year, when India stopped exports amid soaring domestic demand. That move rippled through the world, underscoring scarcity; now, the Serum Institute found demand collapsed. 

Raising demand

Vaccination campaigns rely on supply, demand and the logistics to administer shots, Bollyky said. “We’ve spent an awful amount of time talking about supply, and very little talking about the constraints that apply to demand and administration,” he said.

Talks about how to raise demand for COVID-19 vaccines are underway, said John Nkengasong, director of Africa Centers for Disease Control and Prevention. The organization has appealed to African countries to place orders with local manufacturers. 

But even free doses are languishing. The U.S. has pledged to donate 1.2 billion doses, more than any nation in the world. Yet less than half have been distributed, despite ample supply. 

Donated vaccines are arriving to recipient nations with little notice and short shelf lives, taxing already-stretched local health systems.

“Those doses are getting harder to place because countries’ reserves are simply full,” White House Press Secretary Jen Psaki said Monday. “We have tens of millions of unclaimed doses because countries lack the resources to build out their cold chains, which basically is the refrigeration systems, to fight disinformation, and to hire vaccinators.” 

The U.S. is now abandoning plans to send a billion adult Pfizer Inc. doses abroad, instead replacing some with pediatric doses that are in higher demand to meet the full pledge.

Covax, the global vaccine distribution initiative, struggled to get supplies last year. Now, it’s facing a different dilemma. The program has enough doses for countries to meet their vaccination targets, officials said, but deliveries and demand are slowing. The African Union and Covax recently declined options to purchase hundreds of millions of additional doses from Moderna Inc.

“There is plenty of supply now—the real question is doing everything possible to support delivery in countries that are still lagging,” said Kate O’Brien, who heads the vaccination division at the World Health Organization.

—With assistance from Janice Kew.