Do low-income countries have to wait for the COVID vaccine?

New studies show that developed countries are vaccinated before they are ready, which can delay immunization as well as delay the vaccination of billions of people in less wealthy countries.

High-income and some middle-income countries are full of manufacturing capacity, have already purchased nearly 3.8 billion COVID-19 vaccines, and received an additional 5 billion doses, according to a global assessment of purchase agreements. Is possible.

“… Soon you will find that even countries that have the money to buy vaccines do not have the manufacturing capacity available to meet their needs.”

Analysis shows that many of these countries can vaccinate the entire population before billions of people are vaccinated in low-income countries, and in some countries they are vaccinated multiple times. You can do.

Elina Urli Hodges, head of Duke University, said:Global Health Innovation Center Speedometer activation and scalingAn initiative to identify obstacles to providing health innovation to low-income countries.

“Countries are hedging their bets by trading directly and at the same time participating in multilateral platforms. This promotes inequality and promotes inequality. Global pandemic,“Urli Hodges says.

Other assessments warn of potential inequality in vaccine access, but a new analysis shows the amount of vaccine dose claimed by the national consensus and this to COVID-19 protection across large regions. It is the first to carefully quantify how it can delay access to. Including sub-Saharan Africa — until almost the middle of the decade.

Wait for the COVID-19 vaccine

Launch and scale analysis suggest that it will likely take three to four years to produce enough vaccine to cover the world’s population, but nearly four billion COVID-19 vaccine candidates are already predominantly high-income. Vaccine developers, and global vaccine manufacturers, have been found to be part of a bilateral pre-purchase transaction involving the state. An additional 5 billion doses have been the subject of negotiations between these same parties and have not yet been finalized.

Meanwhile, according to a study, COVAX is a global effort involving both rich and poor countries that promises equal access to the COVID-19 vaccine worldwide, regardless of income level. COVAX has confirmed that so far only enough doses have been purchased to cover 250 million people.

In fact, the data effectively undermine the agreement by several COVAX signatories, including the United Kingdom (UK), the European Union (EU), and Canada, negotiating a “side deal” for large vaccine shipments. It is clear that it is. A small piece of pie available for fair global allocation. However, analysis shows that no low-income country has directly agreed to buy a vaccine. This suggests that low-income countries are limited to COVAX agreements to secure vaccines.

For example, researchers expect COVAX to have enough vaccine to cover 20% of the population in Ethiopia, Africa’s second-largest country, and there is no way to secure additional doses. discovered.

Overall, the study shows disastrous conclusions: most people in low-income countries will be waiting until 2024. COVID-19 vaccination When high-income countries continue to engage in what is called “vaccinationism”.

For example, it is estimated that COVAX will require at least 1.14 billion single-dose vaccines and twice the amount of the double-dose regimen to reach the goal of vaccination of at least 20% of member states. .. Currently, most COVID-19 vaccine candidates require two doses.

“Vaccine-rich countries are in talks to allocate doses purchased through prior market commitments to COVAX efforts after vaccination of specific parts of the population,” leading the analysis of the Launch and Scale initiative. Andrea Taylor said. “But there are no requirements, and there is probably little incentive to do so.”

Hedge bet to obtain COVID-19 vaccine

Taylor and colleagues will review evidence available from public sources by October 8, 2020, in combination with interviews with global and regional vaccine experts, as well as health ministry officials in specific countries. We conducted an evaluation. The analysis examined the COVID-19 vaccine pre-market commitment (AMC) to better understand the overall amount and ultimate destination of the COVID-19 vaccine.

The insights that emerged show that COVAX members Canada and the United Kingdom have already pre-purchased enough vaccines to cover the entire population. The EU has secured the right to give Member States 400 million doses, and future agreements are under discussion, which could grow to nearly 2 billion.

The United States, which is not part of COVAX, has already agreed to purchase enough doses to cover 230% of its population, ultimately about one-quarter of the world’s short-term supply, 1.8 billion. It may be possible to control the dose of.

None of Vaccine candidate However, with regulatory approvals still in place, countries are hedging their bets by purchasing multiple candidates, and some of these doses may not be realized. For example, in the United Kingdom, four different vaccine technologies were used to create AMCs with five different vaccine candidates.

Among middle-income countries, launch and scale data have already secured sufficient vaccine rights for Brazil and India, each with large vaccine manufacturing infrastructure, to cover about half of the population. Indicates that we are negotiating an additional transaction. In addition, some countries, such as Peru, use the status as a site for COVID-19 vaccine trials to ensure AMC of the vaccine, but Peru is also participating in COVAX to meet that need. I will.

The root of the problem

The underlying problem, according to the analysis, is that finite global manufacturing capacity clashes with wealth inequality and self-interest that low-income countries cannot compete with.

“High-income countries do business with major vaccine developers, who have secured most of the world’s manufacturing capacity to meet these promises,” says Taylor.

“We are soon becoming aware that even countries that have the funds to buy vaccines do not have the manufacturing capacity available to meet their needs. We are building additional facilities or building additional facilities. Despite the new investment in remodeling, there is a limit to the amount of vaccine production capacity that can be expanded worldwide in the next few years, “says Taylor.

For example, in this study, a pair of vaccine candidates from the University of Oxford / AstraZeneca (AZ) Vaccine Partnership and vaccine candidates from American vaccine developer Novavax will produce 3.73 billion doses from a global manufacturer. It has become clear that it is the subject of an agreement with. And about 3 billion of those doses will come from the Serum Institute in India.

Both vaccine candidates, on the other hand, are subject to large pre-purchase commitments from high-income or middle-income countries. Oxford / AZ vaccine candidates lead the AMC pack with over 2 billion doses, including 300-500 million doses of COVAX. In response to this situation, COVAX has moved swiftly to secure manufacturing capacity in Spain and South Korea for more than a billion doses of one or more vaccines that have not yet been selected.

Distribution issues

Taylor said the outlook for vaccines in low-income countries could be even darker, given that the majority of low-income countries need vaccines that do not require extreme refrigeration. This means that only certain candidates under development are suitable.

For example, Pfizer’s formulation, which is one of the leading vaccine candidates for late-stage trials, storage At temperatures in the range of -60 to -80 degrees Celsius, or -76 to -112 degrees Fahrenheit.

Johnson & Johnson vaccine candidates, on the other hand, need to be shipped frozen, but can be stored at normal refrigeration temperatures for several months with a single dose. This is two factors that alleviate distribution challenges in low-income countries. However, new analysis shows that the United States, United Kingdom, EU, and Canada have already negotiated large pre-purchase agreements for Johnson & Johnson vaccine candidates, potentially shutting out low-income countries.

Another challenge that disproportionately affects low-income countries, Taylor said, is the need to ship consumables such as syringes and make them available in time for the arrival of vaccines. She also said that while low-income countries have made great strides in developing better infrastructure for childhood immunization, COVID-19 will require vaccination campaigns targeting adults, especially the elderly. Says.

“There are significant challenges that we can overcome,” says Taylor.

But she said, “If they don’t know if vaccines are available, or the number of doses they may get and the type of refrigeration, it’s difficult for the country to actively prepare.” Added.

Source: Duke University