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Rich countries are acquiring vaccines even before they are ready, and that could mean fewer, as well as delays in vaccination, for billions in less wealthy nations, according to a new study.
The global assessment of the purchase agreements shows that high-income countries, as well as some middle-income countries brimming with manufacturing capacity, have already purchased nearly 3.8 billion doses of the COVID-19 vaccine, with options for another five thousand. millions.
“… soon, even countries that have the financial resources to buy vaccines will find that there is no manufacturing capacity available to meet their needs.”
The analysis shows that many of these countries will be able to vaccinate their entire population, and some will be able to do it many times, before billions of people are vaccinated in low-income countries.
“An ambitious effort to create a global vaccine equity system is undermining as a handful of countries, including those that made a commitment to equality, get as many doses as possible,” says Elina Urli Hodges, director of the University. from Duke. The launch and scale speedometer of the Center for Global Health Innovation, an initiative that identifies impediments to bringing health innovations to low-income countries.
“Countries are hedging their bets by making direct deals and at the same time engaging in multilateral platforms, which drives inequality and threatens to prolong a global pandemic,” says Urli Hodges.
While other evaluations have warned of possible inequalities in access to vaccines, the new analysis is the first to carefully quantify the number of vaccine doses required by country-level agreements and how this could delay access to protection for COVID-19 in large regions: including sub-Saharan Africa, until almost mid-decade.
Long wait for COVID-19 vaccine
The Launch and Scale analysis revealed that while it will likely take three to four years to make enough vaccines to cover the world’s population, nearly four billion doses of COVID-19 vaccine candidates are already part of bilateral COVID-19 agreements. Advance purchase involving mainly high-income countries. , vaccine developers and vaccine manufacturers worldwide. Another five billion doses are the subject of negotiations between these same parties that have not yet been finalized.
Meanwhile, the study found that COVAX has so far confirmed that only enough doses have been purchased to cover 250 million people, a global effort involving rich and poor countries that has promised equitable access to COVID-19 vaccines. around the world, regardless of income levels.
In fact, the data reveals that several COVAX signatories, including the United Kingdom (United Kingdom), the European Union (EU) and Canada, are effectively undermining the pact by negotiating “side deals” for large shipments of vaccines that “will result in a smaller slice of the pie available for an equitable global allocation. ” However, the analysis shows that not a single low-income country has made a direct agreement to buy vaccines, suggesting that low-income countries will stick to the COVAX pact to secure vaccines.
For example, the researchers found that Ethiopia, the second largest country in Africa, relies on COVAX to obtain enough vaccines to cover 20% of its population and has no way to secure additional doses.
Overall, the research points to a grim conclusion: that most people in low-income countries will wait until 2024 to receive COVID-19 vaccines if high-income countries continue to participate in what some call “vaccination.”
For example, it is estimated that to meet its goals of vaccinating at least 20% of member countries, COVAX would need at least 1.14 billion doses of a single-dose vaccine and twice that amount for a two-dose regimen. dose. Currently, most COVID-19 vaccine candidates require two doses.
“There are ongoing negotiations where vaccine-rich countries would allocate the doses purchased through anticipated market commitments to the COVAX effort after having vaccinated a certain part of their population,” says Andrea Taylor, who led the analysis for the Launch and Scale initiative. “But there is no requirement, and there is possibly little incentive to do so.”
Coverage bets to get COVID-19 vaccines
Taylor and his colleagues conducted the assessment by reviewing the evidence available from public sources through October 8, 2020, combined with interviews with global and regional vaccine experts, as well as ministry of health officials in selected countries. The analysis looked at Anticipated Market Commitments (AMC) for COVID-19 vaccines in order to better understand their overall volume and final destination.
The insights that emerged show that COVAX members Canada and the UK have already pre-purchased more than enough vaccines to cover their entire population. The EU has secured rights to 400 million doses for member countries, with future deals under discussion, which could bring that number to nearly two billion.
The United States, which is not part of COVAX, already has agreements to buy enough doses to cover 230% of its population and could eventually control 1.8 billion doses, about a quarter of the world’s short-term supply.
However, none of the vaccine candidates have regulatory approval yet, so countries are hedging their bets by buying multiple candidates and a portion of these doses may never materialize. The UK, for example, has created AMCs with five different vaccine candidates, using four different vaccine technologies.
Among middle-income countries, launch and scale data shows that Brazil and India, each of which has a large vaccine manufacturing infrastructure, have already secured rights to enough vaccines to cover about half of their population and they are negotiating additional agreements. It also shows that some countries, such as Peru, are using their status as a COVID-19 vaccine trial site to secure AMC for vaccines, although Peru is also participating in COVAX to help meet their needs.
Root of the problem
According to the analysis, the root of the problem is that finite global manufacturing capacity is colliding with disparities in wealth and self-interest that low-income countries cannot compete in.
“High-income countries are making deals with the major vaccine developers who, in turn, reserve most of the global manufacturing capacity to meet those commitments,” says Taylor.
“We are rapidly reaching a point where soon, even countries that have the financial resources to buy vaccines will find that there is no manufacturing capacity available to meet their needs. Even with new investments to build or modernize additional facilities, there is a limit to global vaccine manufacturing capacity that can be expanded in the coming years, ”says Taylor.
For example, the study reveals that a pair of candidate vaccines, one from the University of Oxford / Astra-Zeneca (AZ) vaccine association and another from the American vaccine developer Novavax, are the subject of agreements with global manufacturers to produce 3.73 billion doses. And around 3 billion of those doses would come from the Serum Institute of India.
Meanwhile, both candidate vaccines are the subject of significant pre-purchase commitments from high- and middle-income countries. The Oxford / AZ candidate vaccine leads the AMC group in more than two billion doses, although that includes between 300 and 500 million doses of COVAX. In response to this climate, COVAX has moved quickly to reserve manufacturing capacity in Spain and Korea for more than 1 billion doses of one or more vaccines that have yet to be selected.
Distribution challenges
Taylor says the vaccine outlook for low-income countries could be even bleaker when you consider that the vast majority of low-income countries need vaccines that don’t require extreme cold storage. That means only certain candidates in development will be suitable.
For example, one of the main candidate vaccines in late-stage trials, a Pfizer formulation, requires storage at temperatures ranging from -60 to -80 degrees Celsius, or around -76 to -112 degrees Fahrenheit.
Meanwhile, a Johnson & Johnson vaccine candidate, while it must be shipped frozen, can be stored at typical refrigeration temperatures for several months and only requires one dose – two factors that will alleviate distribution challenges in low-income countries. But the new analysis reveals that the US, UK, EU and Canada have already negotiated large pre-purchase deals for Johnson & Johnson’s candidate vaccine, potentially excluding low-income countries.
Taylor notes that other challenges that disproportionately affect low-income countries include the need for supplies such as syringes to be shipped and available in time for the arrival of vaccines. Furthermore, it says that while there have been great strides in developing better infrastructure in low-income countries for childhood vaccines, COVID-19 will require vaccination campaigns targeting adults and especially older adults.
“There are significant challenges and they can be overcome,” says Taylor.
But, he adds, “without knowing if they will have access to vaccines or the number of doses or the type of cold storage necessary for the vaccines they can receive, it is difficult for countries to move aggressively to prepare.”
Source: Duke University
