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TOAfter months of uncertainty and frustration, a World Health Organization program designed to ensure access to Covid-19 vaccines in dozens of low-income countries late last week received a host of good news.
First, a vaccine manufacturer, Novavax (NVAX), promised 1.1 billion doses of its injection to the WHO effort, which is known as COVAX. Meanwhile, the United States agreed to contribute $ 4 billion in aid over the next two years, with Germany adding $ 1.2 billion and the European Commission providing $ 600 million. And the UK promised to provide surplus vaccines to low-income countries.
The sudden flurry of ads was in contrast to growing concerns that COVAX was faltering. For much of the past year, wealthy nations and drug makers have struck deals that critics say would leave low-income nations with little access to vaccines. As a result, the vast majority of vaccinations so far have been in high-income countries.
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Now, however, WHO officials are more optimistic about successfully achieving approximately 2 billion doses of vaccines for at least 20% of the population of 92 low-income economies by the end of this year.
“There is a growing movement behind vaccine equity,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement. “This cannot continue to work as usual and there is an urgent need for countries to share doses and technology, scale up manufacturing and ensure a sustainable supply of vaccines so that everyone, everywhere, can receive a vaccine.”
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But despite the obvious signs of progress, questions remain about the extent to which the effort, known as COVAX, can be successful. At the moment, the offer is limited. COVAX expects 336 million doses of AstraZeneca and 1.2 million doses of Pfizer to cover only 3.3% of the population of the 145 countries participating in the program.
“It depends on what you consider to be the goal,” said Kenneth Shadlen, a professor of international development at the London School of Economics, who studies pharmaceutical pricing and access issues. “Are we trying to avoid a situation where poor countries don’t have access to vaccines? Or are we trying to achieve something closer to the equitable distribution of vaccines in terms of what percentage of the population gets vaccinated and at what rate? Obviously those are extreme, but it helps to think of it that way. “
In his opinion, the latest announcements suggest that COVAX may, in fact, help low-income countries gain access to vaccines. But Shadlen is less confident that poorer economies will get a proportional share that resembles the kind of distribution that occurs in richer nations.
“It would be great if COVAX could help us avoid the worst case scenario where poor countries would not have vaccines until 2022 or later,” he continued. “It is an achievement that we can celebrate, but we must also recognize the achievement for what it is: avoiding the worst case scenario.”
COVAX was established last year with the help of Gavi, Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations. And like the wealthiest nations, COVAX has made deals with vaccine manufacturers to buy large quantities of doses. In fact, after the US and the European Union, COVAX has agreed to buy the largest number of doses, according to the Duke Global Health Innovation Center.
However, until last week, it was unclear whether COVAX would have the money to meet its commitments. Funding for the program comes largely from rich countries and various organizations, such as the Bill and Melinda Gates Foundation. Upper-middle and high-income countries can also participate in COVAX, but will have to pay for the vaccines themselves.
At the same time, the commitment of the pharmaceutical industry has been debated, although several companies have reached agreements with COVAX.
In the long term, Pfizer (PFE) and its partner, BioNTech (BNTX), agreed to supply up to 40 million doses of their vaccine. Johnson & Johnson (JNJ) will provide 100 million doses this year and up to 500 million doses through 2022. AstraZeneca (AZN), which developed a Covid-19 vaccine with the University of Oxford, agreed to share its technology with the Serum Institute of India to accelerate distribution to low-income countries. And Moderna (MRNA) will not enforce the patent rights to its vaccine.
In a statement, the International Federation of Associations and Manufacturers of Pharmaceutical Products said it shares the goal of achieving equitable access to vaccines for healthcare workers. “Since the beginning of this pandemic, the industry has spared no effort to develop, register and distribute high-quality, effective vaccines,” the trade group said.
However, advocacy groups remain unconvinced, noting that some vaccines, such as the Novavax injection, have not yet been licensed or are still being tested in clinical trials, although J&J has now applied for WHO approval for emergency use. . Meanwhile, Oxfam noted that wealthy nations have secured enough vaccines for each of their citizens to be vaccinated three times, while many low-income countries have yet to receive a single dose.
“In terms of financing, the gaps are beginning to be filled, but the key issue is transparency,” said Manuel Martín, policy advisor and medical innovation for the access campaign of Doctors Without Borders. “Manufacturers are offering doses but under what terms, we have no idea, but agreements are moving forward and there is not enough information to exert pressure.”
A key issue, he continued, is the need to support technology transfer, which refers to providing knowledge to other companies so that the manufacture of vaccines can be accelerated. This argument has gone hand in hand with calls to temporarily waive the provisions of a World Trade Organization agreement in hopes of making Covid-19 medical products more accessible, especially for low-income economies.
“The key barrier here is knowledge,” Martin said, “and it is necessary for companies to transfer it to increase production capacity in the short term.”
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