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More than 600 million people worldwide have been at least partially vaccinated against Covid-19 – meaning more than seven billion still have not. It is a striking achievement in the shadow of a staggering challenge.

Half of all doses delivered so far have gone to the arms of people living in countries with one-seventh of the world’s population, primarily the United States and European countries. Dozens of countries, especially in Africa, have barely started their vaccination campaigns.

As rich countries envision the pandemic receding within months – while the poorest face years of suffering – frustration is causing people around the world to wonder why more vaccines are not available.

Nationalism and government actions go a long way in explaining the glaring inequality between the haves and have-nots of the world. So, moreover, the government’s inaction. And the power of the pharmaceutical companies, which sometimes seem to hold all the cards, cannot be ignored.

But a lot of it depends on the simple logistics.

Immunizing most of humanity in a short period of time is a monumental task, never attempted before, and one that experts say the world was not ready to face. They note that things have already moved at an unprecedented speed: a year and a half ago, the disease was unknown, and the first vaccine authorizations came less than six months ago.

But there is a long way to go. Here is an overview of the reasons for the vaccine shortage.

There are only a limited number of factories in the world that make vaccines and a limited number of people trained in how to make them – and they were very busy before the pandemic. Likewise, the production capacity of biological raw materials, cell culture media, specialized filters, pumps, tubes, preservatives, glass vials and rubber stoppers is also limited.

“We don’t suddenly stop making all the other vaccines,” said Sarah Schiffling, an expert in pharmaceutical supply chains and humanitarian aid at John Moores University in Liverpool in Britain. “We add that on top of that. We are essentially doubling production. Supply chains of this magnitude typically take years to materialize. “

The world’s largest vaccine maker, the Serum Institute of India, manufactures the Covid-19 vaccine developed by AstraZeneca and the University of Oxford, and expects production of one billion doses this year, in addition to the roughly 1 , 5 billion doses that it produces annually. other diseases. But it took months to reach that pace.

Thanks to heavy investment from governments, companies have overhauled their factories, built new ones and trained new employees, an effort that began last year and is still far from being completed.

The richest countries in the world have pledged more than $ 6 billion to Covax, the global effort to provide vaccines to developing countries at little or no cost.

But some of the commitments have yet to be met. And in any case, they represent a small fraction of what rich countries have spent on themselves, and a small fraction of global needs.

The Covax campaign also lost ground when concerns emerged that the AstraZeneca shot – which was supposed to be the backbone of the effort – could be linked to very rare but serious side effects. This has led to some public distrust of its use.

Many public health advocates have called on Western governments to force drugmakers to share their own patented processes with the rest of the world. No vaccine producer has done so voluntarily, and no government has indicated it will move in this direction.

Given the world’s limited production capacity and recent vaccine development, patent sharing might not have significantly increased supply at this time. But later, as the capacity increases, it could become a major factor.

The Biden administration has announced financial support for an Indian company, Biological E, to speed up mass production of the Johnson & Johnson bullet for people in other parts of the world. And the administration said this week it would send up to 60 million doses of AstraZeneca’s vaccine – which the United States has bought but is not using – to other countries.

But the United States remains well behind China and Russia in such “vaccine diplomacy”.

The United States and other countries have also restricted exports of certain vaccine-manufacturing materials, drawing intense criticism, especially from India, as Covid is ravaging that country on a scale unseen go elsewhere. The Indian government has banned exports of finished vaccines, hampering vaccination efforts in Africa.

Last week, the Biden administration announced it would ease export controls for India.

The United States and other developed countries have invested billions of dollars in vaccine development and manufacturing expansion, and they have spent billions more on the resulting injections. The US government also controls a crucial patent on a process used in the manufacture of vaccines, and its National Institutes of Health helped develop the Moderna vaccine.

All of this gives governments enormous power to force companies to work across borders, both national and national, but they have been hesitant to use it. In the United States, that has started to change since President Biden took office in January.

“The government has a huge clout, the most over Moderna,” said Tinglong Dai, associate professor at Johns Hopkins University School of Business who specializes in healthcare management.

Patents are an area where governments could be more aggressive in using their influence. But in the short term, Dr Dai said, what would have had the biggest impact was if officials had acted sooner and more forcefully to insist that companies developing vaccines make deals with their competitors to scale up. mass production.

This type of cooperation has proven to be essential.

Several Indian companies have agreed to manufacture the Russian vaccine Sputnik. Sanofi, which is already involved in the production of the Pfizer-BioNTech and Johnson & Johnson inoculations, recently reached an agreement with Moderna to work on its shot as well. Moderna had already concluded agreements with three other European companies.

The Biden administration urged Johnson & Johnson to register its competitor, Merck, in March to produce its vaccine, and the government has committed $ 105 million to redevelop a Merck plant in North Carolina for this purpose.

Former President Donald J. Trump has refused to use the Defense Production Act to give vaccine makers privileged access to the materials they need, a step Mr Biden has taken.

Even with an established product and stable demand, vaccine manufacturing is a demanding process. With a new plan, new production lines and growing global expectations, it becomes more and more difficult.

AstraZeneca and Johnson & Johnson, two of the world’s largest pharmaceutical companies, have faced serious production issues with their Covid-19 vaccines – lessons to be learned from the challenges of moving quickly from nothing to hundreds of millions of doses.

To add to the difficulty, the Pfizer-BioNTech and Moderna injections are built on an extract of the genetic code of the coronavirus called messenger RNA or mRNA. Until last year, this process had never been used in a mass produced vaccine. It requires different equipment, materials, techniques and expertise than standard vaccines.

MRNA vaccines enclose genetic material in “lipid nanoparticles”, microscopic bubbles of fat. Few facilities in the world have comparable mass production experience. Vaccines also require extremely cold temperatures, which experts say limits their use – at least for now – to richer countries.

Many pharmaceutical companies insist they could take on this production, but experts say it would likely take them a lot of time and investment to prepare, a point Stéphane Bancel, CEO of Moderna, made. argued in February during a hearing in the European Parliament.

Even contracting with highly advanced companies to do the work, Mr Bancel said, Moderna had to spend months gutting the facilities, rebuilding them to new specifications with new equipment, testing and retesting this. equipment and teach people the process.

“You can’t go into a company and ask them to start making an mRNA product right away,” he said.

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