Rich nations had vaccine options after AstraZeneca and J&J faced clot reports. Others may not have that luxury

Elderly people queue for the Sinopharm vaccine at a local hospital on March 29 in Harare, Zimbabwe.

Abuja, Nigeria (CNN)It was nothing short of a miracle when it became clear that scientists had developed several effective vaccines against Covid-19 in less than a year. Announcements last week from European Union and British drug regulators finding a possible link between AstraZeneca's Covid-19 shot and rare blood clots, however, have been a real low point in the pandemic.

This isn't only because developed countries, like those in Western Europe, had purchased a large number of AstraZeneca doses to dig their way out of the pandemic but, more consequentially, because so much of the developing world was relying on this one vaccine to do the same.
The double blow is that a picture is emerging that the AstraZeneca vaccine -- which appears to have caused a very rare, sometimes fatal, condition of severe clotting with low blood platelet counts -- may be affecting younger adults more than the elderly. Developing countries, in general, have significantly younger populations than their wealthier counterparts.
    And to add insult to injury, just as Africa was pivoting toward the single-dose Johnson & Johnson vaccine, US medicines regulators on Tuesday paused use of the J&J shot across the country as well, after just six cases of the same clotting symptoms were reported among nearly 7 million people who had been given the vaccine. One of those cases was fatal. The company itself paused its rollout across Europe.
      The African Union had already ordered up to 220 million doses of the J&J shots to be shared among its 55 states in the third quarter of this year. That's on top of any shots it may get through the COVAX scheme.
        A link between the rare blood clots and J&J's vaccine has not been officially confirmed, but US officials want to pause it and use alternative shots while they work out if there is indeed a connection, and if so, how prevalent it might be. Europe is waiting to see what an investigation finds.
        But much of the developing world doesn't have that luxury. New type of vaccines based on mRNA technology -- like the Pfizer/BioNTech and Moderna shots vaccines widely used in the US -- are typically three to four times more expensive than the AstraZeneca shot, which is being manufactured on a not-for-profit basis, or the J&J shot, considering that vaccine requires just one dose. Pfizer, however, is offering these vaccines at lower prices to the African Union, Reuters reports.
          Many developing nations are having to wait longer than wealthier countries to receive these vaccines. In earlier stages of their development, mRNA vaccines needed to be kept at such cold temperatures, most developing nations couldn't use them without purchasing new, expensive equipment to store them. Those requirements are improving -- the Pfizer vaccine can now be stored at normal freezer temperatures when being transported -- but the storage challenge months ago meant that most developing countries focused on shots like AstraZeneca and J&J when making purchase agreements with drug companies.
          Dr. Peter Drobac, Director of the Skoll Centre for Social Entrepreneurship at Oxford Saïd Business School, said that despite the rarity of the blood clots in both AstraZeneca and Johnson & Johnson's vaccines, any adverse effects could worsen vaccine hesitancy and even misinformation.
          "It may fuel conspiracy theories around the world about a two-tiered society. If wealthy countries say they are only going to have 'gold standard' with the most expensive vaccines and then say AstraZeneca is not good enough for us in the global north, but it is good enough for the global south, it could reduce uptake of the vaccine and hamper efforts to vaccinate the world," he told CNN.
          The Africa Centres for Disease Control and Prevention (CDC) says it has no plans to advise against the rollout or acquisition of the shots, saying that cases are too rare to change course now.
          "For the Covid-19 vaccines, the benefits outweigh the potential side effects," Benjamin Djoudalbaye, the head of Policy, Health Diplomacy and Communication at Africa CDC, told CNN on Monday.
          But the picture is more nuanced than that. The United Kingdom has data to suggest that while the benefits outweigh the risks overall, they don't necessarily do so for every age group in every circumstance.
          Last week, its medicines regulator advised people under the age of 30 be offered alternative vaccines, arguing that people in that age group are more likely to suffer serious harm from the AstraZeneca vaccine than they were likely to avoid getting very seriously ill. That's only in a situation where exposure to the virus is low. Any return to "normal" will increase exposure. Other European countries and Australia have limited the use of the vaccine in older age groups.
          Denmark is so advanced in its vaccination program it announced on Wednesday it was dropping the AstraZeneca shot from its inoculation program altogether. It simply doesn't need it, having also obtained enough other vaccines to rely on.