AAccording to a new analysis, nearly a quarter of the world’s population – mostly in low- and middle-income countries – won’t have access to an injection in the fight to bring in supplies of Covid-19 vaccines until 2022.
As of mid-November, high-income countries, including the European Union bloc, reserved 51% of the nearly 7.5 billion doses of various Covid-19 vaccines, even though these countries make up only 14% of the world’s population. Meanwhile, only six of the 13 manufacturers working on Covid-19 vaccine candidates have entered into agreements to sell their shots to low- and middle-income countries.
The analysis, published in the BMJ, noted that access “differs significantly” between these countries. For example, the US reserved 800 million doses, but accounted for a fifth of all Covid-19 cases worldwide. In contrast, Japan, Australia and Canada reserved more than a billion doses, although these three countries together did not account for even 1% of all current cases.
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If we look differently, the projected vaccine courses per capita by country show that Canada, followed by Australia, the UK, Japan, the European Union and the US, has reserved at least one vaccine course per person. Canada has reserved 9.5 doses or more than four courses per person. In contrast, low- to middle-income countries, such as Brazil and Indonesia, reserved less than one course per two people.
Meanwhile, only high- and upper-middle-income countries have been able to procure mRNA vaccines – notably from the Pfizer (PFE) and BioNTech (BNTX) partnership, as well as Moderna (MRNA). The Pfizer / BioNTech vaccine has created emergency situations in the US and other countries. But both the vaccine and the Moderna vaccine require distribution and storage in the cold chain, which means they are not readily available in countries with limited infrastructure.
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“High-income countries have tried to secure future supplies of Covid-19 vaccines, but have left much of the rest of the world with uncertain access. That hope today is focused on a handful of lead vaccine candidates, some of which may still falter or fail, ”the authors wrote.
However, some contracts have not been disclosed or have been heavily redacted, making it difficult to identify delivery priorities. The authors argued that more transparency is needed about manufacturer agreements and the underlying R&D costs, public sector funding and price fixing to achieve fairer access.
“Such limited transparency will fuel concerns about vaccine nationalism, and planning and accountability to ensure wider access to Covid-19 vaccines could be seriously hampered,” the authors warned.
The situation is compounded by the different priorities for allocation in each country and region, according to a different analysis in the same issue of The BMJ. For example, if vaccines are preferentially assigned to priority workers to maintain social functions, the global target audience is 258.3 million people.
The analyzes come amid growing concerns about access to affordable Covid-19 vaccines as distribution of the Pfizer / BioNTech (BNTX) vaccine – the first vaccine approved in the US – has begun. As it is expected that more vaccines will become available in the coming months, there is increasing pressure from some governments and consumer groups for better access.
For example, 100 advocacy groups, academics and health experts from around the world have urged the chief executives of 15 vaccine manufacturers in the US, Europe, China and Russia to devote some of their output to low- and middle-income countries. They also asked the companies to disclose the results of the trial, various costs, prices, advance payment commitments, and funds received from public and charitable sources.
One reason for such missives is that an ambitious program organized by the World Health Organization called COVAX hoping to provide vaccines to 92 low- and middle-income countries has not achieved all its goals. As of last month, $ 2 billion has been pledged by the European Commission, the Bill & Melinda Gates Foundation and others. But $ 5 billion is still needed to fund the targeted 2 billion doses by the end of 2021.
As the study authors noted, by pooling agents and vaccine candidates, COVAX can provide access to a diversified pool of potential vaccines and economies of scale. But there is concern that some countries will have a “double dip” or be able to buy supplies through both COVAX and individual deals. COVAX is jointly led with the Gavi Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations. So far, about 80 countries have committed to purchase vaccines.
According to the Duke Global Health Innovation Center, the number of confirmed purchases of Covid-19 vaccines to date has been 7.4 billion doses worldwide. Of these, high-income countries bought 3.9 billion doses, countries with a higher middle income secured 1 billion doses and countries with a lower middle income closed 1.8 billion doses. Low-income countries did not buy. COVAX has secured 700 million doses.
“Countries – not Covax – are buying almost all of the output that is produced and expected to be produced by 2021. Countries are paying more per dose on their own than if they were buying collectively through Covax, but by being directly at the front of the line,” Kenneth Shadlen, professor of international development at the London School of Economics who researches pricing, patents and drug access in a recent blog.
However, the fear of access is a moving target.
Earlier this week, the Canadian government pledged to provide $ 380 million to several global initiatives designed to provide fair access to Covid-19 diagnostics, therapies and vaccines. Canada has reportedly been in talks to donate excess vaccine doses as well, but no commitment or details have been made public.
“As uncertainty decreases as to which vaccines will succeed and which will not, Canada’s commitment to ensuring an effective global response will be tested,” wrote Anthony So, one of the study’s authors and a professor at Johns Hopkins Bloomberg School. of Public Health. U.S.
“How and at what point will it share the effective Covid-19 vaccines it has obtained with those who are doing worse in the pandemic or who even need the first round of doses more? The same question may arise with a number of other high-income countries that have bilateral agreements with vaccine manufacturers: scaling up at home or share abroad.
“Investing and coordinating globally through COVAX is helping to meet this challenge, but the US and Russia have declined to participate,” he continued. “So Canada’s commitment to develop a mechanism for equitable redistribution of vaccine doses – through COVAX, through exchange or donation – is an important first step for the global community to follow.”