Cash is dominating the global distribution of life-saving COVID vaccines with rich countries commandeering the supply. Ten have administered 75 per cent of available doses and have ordered more than 1 billion doses more than their populations need. The World Health Organisation's (WHO's) COVAX programme for providing doses for poor countries is due to begin distributing its modest supplies by the end of this month. Hundreds of millions of dozes are due for delivery during the year but they will not meet demand.

The UK has offered to donate surplus doses once its citizens and residents are vaccinated, France has called for sharing of 4-5 per cent of doses acquired by the fortunate, and the US, as usual, has thrown money at the problem by pledging $2 billion this year and $2 billion next to the WHO's $5 billion programme for inoculating the most vulnerable 20 per cent of populations in low-income countries this year. The US is clearly reluctant to share. It has cornered 600 million doses, enough to vaccinate its population. Canada has ordered five time more doses than needed for its citizens. Hoarding is short-sighted because no one is safe unless all are safe.

While Israel, which counts as a rich, Western country has run a successful inoculation campaign, most of this region's countries have had to scramble for protective doses. This has allowed China and Russia to exploit opportunities to gift and sell their vaccines at prices lower than US and European-made vaccines, earning gratitude from some and scorn from others who fear some vaccines may not be efficacious or harmful because they have not been thoroughly tested. Concerns over the Russian vaccine have recently been allayed by a positive report in the prestigious British medical journal, The Lancet, which said that Sputnik-V is 92 per cent effective and does not have negative side effects.

Politics and pragmatism have dominated the regional vaccine roll-out.

Iran's choices have been driven purely by politics. It has rejected Western vaccines, launched testing of its own vaccine, and begun inoculations with an initial consignment of 10,000 Sputnik-V doses. Some 400,000 are expected to arrive by the end of March. Iran will also have a share of COVAX vaccines.

Israel made a political-pragmatic deal with the US Pfizer firm for millions of doses of the German researched BioNTech vaccine, the first to receive US and WHO approval. Israel's choice was political because it selected a vaccine made by Western allies and concluded a deal that included providing data on the vaccine's performance, transforming its use into a fourth phase mass trial.

Arch pragmatists, the UAE and Bahrain contracted with China's Sinopharm for third phase trials of its vaccine and in early December were first in the region to endorse a vaccine for public use after Sinopharm and Russia's Sputnik-V vaccine were approved by Bejing and Moscow. The UAE has since balanced its options by adopting the whole range of available vaccines, Sinopharm, Sputnik-V, Gerrman/US BoioNTech/Pfizer and Britain's AstraZeneca, and has inoculated more than four million people.

While politics-driven Iran is struggling to secure vaccines for its 83 million people, Israel, the UAE and Bahrain have benefitted from pragmatism.

Israel is currently the region's front runner, having vaccinated 78 per cent of its population; the UAE is second, with 52.6 per cent; and Bahrain is fifth, with 14.9 per cent. These figures are far higher than the 5.78 per cent vaccinated in the US.

Once the Sinopharm vaccine was adopted by the UAE, Egypt, Iraq and Turkey ordered doses. Turkey has carried out a mass vaccination programme.

Other countries have had choices made for them by politics.

Lebanon which has received a consignment of BioNTec/Pfizer began vaccinating a fraction of its residents in mid-February. Since there is no effective government in the country and no money to pay for vaccines, the World Bank, which is dominated by the US and other Western powers, has provided $34 million to inoculate two million persons to launch Lebanon's programme. It is supposed to cover all those living in the country — Lebanese, Syrian and Palestinian refugees, and migrant workers from across the developing world. The World Bank's Covax programme is set to provide Lebanon with more doses when they become available.

Jordan, which began its vaccination programme with Sinopharm and BioNTeech in mid-January, has extended coverage to refugee camps but Israel has refused to meet its legal obligation to provide medical aid and vaccines to 5 million Palestinians in the West Bank and Gaza occupied in 1967. Israel has donated only 2,000 vaccines for West Bank medical staff, prompting international outrage. This spiked after 10,000 Sputnik-V doses were delivered to Ramallah. Israel delayed sending 2,000 doses of this consignment to Gaza and only made the transfer under pressure.

Having refused for a year to vaccinate the 133,000 West Bank Palestinians who work in Israel, it has suddenly awakened to the risk that they could infect Israelis and has decided to vaccinate 100,000.

Israel has, covertly, agreed with Russia to purchase $1.2 million worth of Sputnik-V doses for Syria in exchange for an Israeli woman who crossed into Syria and has been held in Damascus. Israel also repatriated two Syrian shepherds it had detained. Israeli Prime Minister Binyamin Netanyahu confirmed the deal by stating that "not one dose of Israel's vaccines was used".

The cash strapped, vaccine-poor Palestinian Authority expects to receive by the end of this month some of 240,000 doses of AstraZeneca and 37,440 doses of BioNTech/Pfizer. Once these allocations are delivered, they will provide for only 138,720 Palestinians.

Qatar is subsidising civil servants' salaries in Gaza while rival UAE has supplied Gaza with 20,000 vaccines, a gift reportedly arranged by the strip's former strongman Mohammad Dahlan, a potential rival of Palestinian President Mahmoud Abbas in the presidential election scheduled for the end of July.

Despite Western sanctions, the WHO plans to vaccinate 5 million people throughout war-ridden Syria this spring. No one is safe unless all are safe.