Pushing to bring COVID-19 vaccines to the poor faces problems

LONDON: An ambitious humanitarian project to deliver coronavirus vaccines to the world’s poorest people is facing a potential shortage of money, cargo planes, refrigeration and vaccines, and faces skepticism from even some of those most affected. aims to help.

In one of the biggest hurdles, rich countries have blocked most of the world’s potential vaccine supply through 2021, and the United States and others have refused to join the project, called COVAX.

“The vaccine supply is not going to be there any time soon, and neither is the money,” warned Rohit Malpani, a public health consultant who previously worked for Doctors Without Borders.

COVAX was conceived as a way to provide countries with access to coronavirus vaccines regardless of their wealth.

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It is run by the World Health Organization (WHO), a UN agency; GAVI, a public-private partnership funded in part by the Bill and Melinda Gates Foundation, which purchases vaccines for 60 percent of the world’s children; and the Coalition for Epidemic Preparedness Innovations (CEPI), another public-private partnership endorsed by Gates.

COVAX’s goal is to purchase 2 billion doses by the end of 2021, although it is not yet clear whether the successful vaccine will require one or two doses for the 7.8 billion people in the world. Countries participating in the project can purchase vaccines from COVAX or obtain them free of charge, if necessary.

An early problem that came up: Some of the richest nations in the world negotiated their own deals directly with drug companies, meaning they don’t need to be involved in the effort at all. China, France, Germany, Russia and the US do not intend to join.

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And so many rich countries bought vaccines from manufacturers, even before the injections were approved, that they have already used up most of the vaccine supply by 2021.

The European Union has contributed 400 million euros ($ 469 million) to support COVAX, but the 27-country bloc will not use it to buy vaccines, in what some see as a vote of no confidence in the project’s ability to comply.

Instead, the EU has signed its own deals to buy more than 1 billion doses, depriving COVAX of the bulk bargaining power to buy injections for the mainland.

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GAVI, WHO, and CEPI announced in September that countries representing two-thirds of the world’s population had joined COVAX, but recognized that they still need an additional $ 400 million from governments or elsewhere. Without it, according to internal documents seen by the Associated Press ahead of the organization’s board of directors meeting this week, GAVI cannot sign deals to buy vaccines.

COVAX struck a major deal this week for 200 million doses from Indian vaccine maker Serum Institute, though the company made clear that a large portion of those will go to people in India.

GAVI estimates that by the end of next year, the project will need an additional $ 5 billion.

COVAX said negotiations to secure the vaccines are progressing despite a lack of funds.

“We are working with governments that have expressed interest in the past to ensure that we receive compromise agreements in the coming days,” Aurelia Nguyen, GAVI’s COVAX CEO, said in an email. She added that nothing similar has ever been tried in public health.

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COVAX “is an enormously ambitious project,” he said, “but it is the only plan on the table to end the pandemic around the world.”

Still, the project faces doubts and questions from poor countries and activists about how it will operate and how effective it will be.

Dr Clemens Auer, who sits on the WHO executive board and was the EU’s main negotiator for its vaccine deals, said there is a worrying lack of transparency about how COVAX will work.

“We would have nothing to say about the vaccines, the price, the quality, the technical platform or the risks,” Auer said. “This is totally unacceptable.”

He said the WHO never consulted countries on its proposed vaccination strategy and called the health agency’s goal of vaccinating the world’s most vulnerable people before anyone else as a “noble notion” but politically naive.

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As part of COVAX, the WHO and GAVI have asked countries to prioritize frontline healthcare workers first, then the elderly, with the goal of vaccinating 20 percent of the world’s population.

A costly hurdle is that many vaccine candidates must be kept cold from the factory to the patient, according to internal GAVI documents. The industry has noted that “the air transport of COVID vaccines will be a major constraint”, and that “a significant and urgent increase in cold chain capacity may be necessary.”

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Another hurdle: Many of the leading vaccine candidates require two doses. That will mean double the syringes, double the waste disposal, and the complications involved to ensure that patients in remote corners of the world receive the second dose on time and suffer no side effects.

“Due to the fact that we are trying to get vaccines out as quickly as possible, we are looking at limited monitoring and efficacy data,” said Gian Gandhi, who heads logistics for UNICEF’s supply division in Copenhagen.

There are also concerns that fear of lawsuits could ruin deals. According to internal documents, GAVI told countries that drug companies will likely require guarantees that they will not face product liability claims for deaths or other side effects of the vaccine.

Dr. Nakorn Premsi, director of the National Vaccine Institute of Thailand, said officials are reviewing whether the condition is acceptable. Thailand has so far only signed a non-binding agreement with COVAX.

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If anything, some critics say, GAVI is not ambitious enough. The pandemic will not end, and the world cannot reopen its borders, until there is herd immunity far beyond wealthy nations that have secured their own doses, said Eric Friedman, a global health law scholar at Georgetown University who generally supports COVAX. .

“If we want to achieve herd immunity and get rid of this, 20 percent will not do it,” he said. “What is the end game?”

Alicia Yamin, associate professor of global health at Harvard University, said she fears “the window is closing” for COVAX to become viable. She said it is disappointing that GAVI, WHO and their partners have not put more pressure on drug companies on issues like intellectual property or open licenses, which could make more vaccines available.

With little evidence of such a fundamental shift in the world of global health, Yamin said developing countries will likely have to rely on donated vaccines rather than any equitable allocation program.

“I would say poor countries probably won’t get vaccinated until 2022 or 2023,” Yamin said.

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