the wto criticised the implementation of export controls on vaccines by the eu with who assistant director mariangela simao describing it as a "very worrying trend" and who director tedros adhanom stating it could prolongue the pandemic. by november 2020, the wto reported that 88 member states in total had invoked similar clauses to either restrict or facilitate the export of medical supplies in connection with the covid-19-crisis, and over 70 wto member states currently had measures in place to restrict exports of medicaments, medical supplies or food. the us had invoked the defense production act of 1950 to de facto ban any vaccine exports. according to the wto the united kingdom has in place restrictions only on the export of certain covid-19 medications and on personal protective equipment, in the eu personal protective equipment is subject to export authorisation. nevertheless, in february the wto urged the uk to donate vaccines to developing countries now rather than to wait until it has a surplus of doses, in order to help in the global fight against the pandemic. also, on 29 january, the european commission released a redacted version of the bloc's contract with astrazeneca. the redacted portions included those covering prices, delivery dates and intellectual property rights. the commission claimed the contract made it "crystal clear" that astrazeneca had to supply vaccine produced in the uk to make up for the production shortfall at its eu plants but the firm disputed this, citing the best efforts clause. article 5.4 of the contract stated that astra-zeneca should use "best reasonable efforts" to manufacture the vaccine for the eu at sites in the eu and the uk, but that other sites could also be used to accelerate supply to the eu. the contract included agreed delivery amounts and dates. it also included a statement in article 13.1.e that astra-zeneca was not under any obligation to another party, contractual or otherwise, that would impede its complete fulfillment of its obligations under the contract with the eu. any legal proceedings would take place in belgian courts. on 31 january 2021, ursula von der leyen announced by twitter that a "step forward" had been made in negotiations between astrazeneca and the eu. the company committed to delivering a further 9 million doses of vaccine by march 2021, and would be expanding manufacturing capacity in europe. they also stated that deliveries would start being made around a week earlier than previously promised. meanwhile, the european union had been having other vaccine procurement problems; a 25% shortfall it the number of jabs, from the us biotech firm moderna, and major shortfalls in the distribution of the pfizer–biontech vaccine. in a speech to the european parliament on 11 february 2021, ursula von der leyen maintained that when the european commission took over responsibility for the rollout of the vaccine programme across the eu, this was the right thing to do. she admitted underestimating the difficulties of mass production of vaccines, and stated that the eu vaccination rollout was "still not where we want to be". she also stated that she "deeply regretted" the threat that had been made by the eu to restrict the flow of vaccine between the republic of ireland and northern ireland. march export blocks and halting of vaccinations demand and deliveries by the beginning of march, rollout of the vaccination programme in the eu had been fraught with difficulties, especially with regard to the astrazeneca vaccine. reports of side effects in health workers receiving the astrazeneca vaccine led to bad publicity in germany. by 18 march public confidence in the vaccine in eu member nations fell dramatically, with a yougov survey finding 55% of germans and 61% of french people regarding the astrazeneca vaccine as unsafe. the confidence in other vaccines was unaffected and the vast majority of britons continued to regard the astrazeneca vaccine as safe. despite this, demand for the astrazeneca vaccine was very high, for example, in germany by early april. still in mid may, when this vaccine was offered to all age groups and the span of time between the two doses may be reduced from 12 to 4 weeks, demand for the astrazeneca vaccine by far exceeded availability in germany. in early march, over 30% of the uk population had been vaccinated compared to about 8% of the eu population. after astrazeneca supplied new data which for the first time showed efficacy for over 65s, thomas mertens, chairman of germany's standing committee on vaccination, stated that "the whole thing has somehow gone badly" while affirming that the astrazeneca vaccine was "very good". astrazeneca had contracted to supply 120 million doses in the first quarter, but had actually delivered less than 30 million doses. in mid april, the eu had distributed 133 million doses (all home-made) among its member states, but exported 170 million doses world-wide, including 16.2 million doses to the uk alone since the end of january. on 4 march, italy became the first eu country to block exports of the astrazeneca vaccine. it refused the company permission to export 250,000 doses from its rome plant to meet a contract with the australian government. the european commission accepted the italian export block and the australian government has asked for a formal review of the decision. the export was to form part of a batch of vaccines intended to be used while australian production was set-up. by early march, several eec member countries had become frustrated by the shortage of vaccine supplies arranged by the european commission, and began to look for alternative sources of supply. austria, the czech republic, denmark, poland and slovakia joined hungary in sidetracking the eu's common approach by obtaining the sputnik v vaccine from russia, and supplies of vaccines from china. ema had started its rolling review of sputnik v already in early march, but the eu's vaccine chief thierry breton raised doubts that sputnik v will be available in time to boost the european vaccine procurement which was expected to provide enough doses for 70% of the population by the end of june. nevertheless, russian pharmaceutical firm r-pharm expects to produce up to 10 million doses monthly of the sputnik v vaccine against covid-19 at its plant in bavaria, southern germany, in the second half of 2021. on 9 march, charles michel, the president of the european council, accused the uk of banning the export of covid-19 vaccines stating "the united kingdom and the united states have imposed an outright ban on the export of vaccines or vaccine components produced on their territory". this statement was fervently denied by boris johnson, the uk prime minister, who denied that the government had blocked sales of vaccines to other countries. at the time, publicly available information suggested vaccines had not been exported from the uk either to the eu or within the international equitable-access initiative covax, and british officials declined to comment. however, boris johnson said to the irish prime minister micheál martin that he wants to prioritise his people and that "until then he won't be in a position to give vaccines to anybody". still on 27 april, when india was faced with a particularly bad pandemic situation, the british government said that the uk had no surplus vaccine doses at the time and was prioritising vaccinating its own population. safety issues in mid-march, national medical regulators of thirteen member states of the eu, including germany, france, italy, spain, cyprus, latvia and lithuania, joined several other countries around the world and suspended using the astrazeneca vaccine after reports of blood clots in some recipients. for example, by the end of march germany reported 31 cases of very rare cerebral venous sinus thrombosis, primarily in under 55s, after 2.7 million doses of the astrazeneca vaccine had been administered, and a case fatality for this condition of up to 40%, causing canada to suspend the use of this vaccine as well. the company, uk regulators and the european medicines agency stated that the vaccine was safe and there was no evidence of an increased risk of blood clots among recipients. following this, germany, france and others continued the use of the astrazeneca vaccine. other eu member states (primarily those in eastern europe, such as poland) declared they will not suspend az vaccinations as "the benefit of taking the vaccine is incomparably greater than the potential so-called post-vaccination symptoms". in an opinion piece, a times journalist criticised the approach of countries that suspended vaccinations quoting "precautionary principle" as "focusing on completely wrong risk". german health minister jens spahn defended the decision, saying that this was "based on facts, not politics" and meant to enhance confidence in the vaccination program in order to ensure as many citizens as possible will eventually consent to get vaccinated and so to return to normality for good. allegations of unused stockpiles and response these reports of dangerous blood clots led to large falls in public confidence in the vaccine across the eu; in france some 61% of the population believed the astrazeneca vaccine was unsafe, an increase of 18% from before the row. similar decreases in confidence were seen in italy and spain. this contrasted with the uk where confidence in the vaccine remained high, with just 9% believing it unsafe, a rise of 4%. the british medical journal reported that the effects of the row over safety were likely to cause a long-lasting reduction in the willingness of people living in the eu to take the vaccine. on 17 march the european commission accused some member states of stockpiling vaccine doses in the aftermath of the safety row, according to the daily telegraph. this refers to a virtual summit on 16 march when eu health commissioner kyriakides said that "we urge member states to use all available doses" and that member states are fully in their right to suspend astrazeneca vaccinations while the ema investigation into the rare blood clots was still ongoing. germany's biggest state, north rhine-westphalia called media reports on unused stockpiles "fake news". stockpiles of astrazeneca doses were particularly small because much fewer doses than expected had been delivered. on 24 march, the state with a population of roughly 18 million had 549,354 doses of the biontech vaccine, 142,360 doses of the moderna vaccine, and 107,320 doses of the astrazeneca vaccine in store. these astrazeneca doses were reserved for appointments up to sunday, 28 march (before new deliveries were expected). second shots of astrazeneca doses were not kept on stock. not a single dose of any brand was left unused. the recommendation of germany's federal ministry of health from 15 february was to keep 50% of the moderna doses and 25% of biontech/pfizer on stock and most states followed this advice until the federal ministry changed its recommendation on 24 march. dispute over unregistered stockpiles on 20 march, the european commission asked the italian government to verify some unreported batches of vaccine at an astrazeneca filling plant near rome. eu sources told journalists that they thought the plant was filling vaccine vials for export for the uk, against an italian export ban. the carabinieri raided the plant over the following days and found 29 million doses. astrazeneca said that 13 million doses were due for export to the covax scheme (which is part funded by the uk and eu) to supply vaccines to low-income countries and the remaining 16 million were due for export to the eu in march and april. those 29 million doses were roughly twice as many as the eu had received from astrazeneca by that time. as reported by la stampa, there was suspicion that astrazeneca had deliberately delayed their request for regulatory approval of their own anagni-based fill-finish plant in order to avoid eu-registration and with the possible intention to divert part of the stockpile to the uk. on 21 march, ursula von der leyen had announced that the eu might ban astrazeneca shipments from the eu to the uk unless astrazeneca fulfill their contractual obligation first. according to a guardian analysis, an export ban has the potential to delay the british vaccination programme by two months and speed up the eu vaccination programme by one week. the british government stated that the plant at the centre of the row, at halix in the netherlands was under contractual obligations to supply