Despite promises, poor countries have to wait a long time for vaccines

NEW DELHI (AP) – With Americans, British and Canadians rolling up their sleeves to receive coronavirus vaccines, the way out of the pandemic now seems clear to many in the West, even though the rollout will take many months. But for poorer countries the road will be much longer and rougher.

The ambitious initiative, known as COVAX, set up to ensure the entire world has access to COVID-19 vaccines, has secured only a fraction of the 2 billion doses it hopes to purchase in the coming year, has not yet confirmed actual deals to ship vaccines and short of cash.

The virus that has killed more than 1.6 million people has exposed enormous inequalities between countries as vulnerable health systems and smaller economies were often hit harder. COVAX was founded by the World Health Organization, vaccine alliance GAVI and CEPI, a global coalition to fight epidemics, to avoid the international rush for vaccines that accompanied previous outbreaks that would amplify imbalances.

But now some experts say the chances of coronavirus withdrawals being shared fairly between wealthy countries and the rest is rapidly declining. With vaccine supplies currently limited, developed countries, some of which have helped finance the research with tax money, are under tremendous pressure to protect their own populations and are buying up injections. Meanwhile, some poorer countries that have joined the initiative are looking for alternatives because they fear it won’t deliver.

“It’s simple math,” said Arnaud Bernaert, head of global healthcare at the World Economic Forum. Of the approximately 12 billion doses the pharmaceutical industry expects to produce next year, about 9 billion shots have already been reserved by wealthy countries. “COVAX hasn’t secured enough doses, and the way the situation may unfold is that they probably won’t get these doses released until late.”

To date, COVAX’s only confirmed legally binding agreement is for up to 200 million doses, although that includes an option to order multiple times as many additional doses, GAVI spokesman James Fulker said. It has agreements for an additional 500 million vaccines, but they are not legally binding.

The 200 million doses come from the Serum Institute of India, the company that is likely to make a large portion of the coronavirus shots destined for the developing world. CEO Adar Poonawalla says it has a confirmed order for 100 million doses each of a vaccine developed by Oxford University and AstraZeneca and one from Novovax.

“We haven’t put anything else in writing,” he told The Associated Press. “If they want more, they will have to place more orders.”

He said the lack of deployment of COVAX means a much longer wait for people in developing countries. Poonawalla also noted that his company’s first priority would be shooting for India, which has suggested it wants at least 300 million vaccines. It’s likely India wouldn’t be able to take them all at once, but a large order could slow down the distribution of vaccines for other parts of the developing world, Poonawalla said.

Potentially further delaying the process is that neither the AstraZeneca vaccine nor the Novovax vaccine has yet been approved by a regulatory body – and every injection distributed by COVAX is likely to require WHO approval. COVAX does not stock the two vaccines that appear to be the most effective to date – the Pfizer-BioNTech Injection and the Moderna Injection. The United Kingdom has already started giving the Pfizer vaccine, and the United States and Canada are introducing it this week. Some Gulf States have also authorized it.

Still, GAVI said they “aim to roll out safe and effective vaccines to COVAX (member states) on a large scale in the first and second quarters of the new year.”

Even with vaccines in hand, the rollout will take many months, even in rich countries, and many developing countries are facing serious logistical challenges that will cause further delays, noted Dr. Gagandeep Kang, an infectious disease expert at Christian Medical College in Vellore. in South India.

Even senior WHO officials have privately acknowledged that attempts to allocate vaccines fairly through the initiative have been flawed, despite public praise for its success.

“The whole call for global solidarity has largely been lost,” said Dr. Katherine O’Brien, WHO vaccines chief, during a recent internal discussion, a recording of which was obtained by the AP.

Asked to clarify her comments, O’Brien said in an email that “every country should have access to COVID-19 vaccines as soon as possible.”

In addition to COVAX’s troubles, O’Brien noted at a press conference this month that it was still $ 5 billion short of buying the doses it plans to get next year.

According to a report GAVI published this week ahead of a meeting, the alliance itself concluded that the risk that COVAX will fail is “very high,” saying it “was established in record time and must move into unknown territory.”

But John Nkengasong, director of the Africa Centers for Disease Control and Prevention, criticized Western countries for buying up the global vaccine supply “above their needs, while we in Africa are still grappling with the COVAX (effort).”

With no certainty as to which shots would work, the governments have been trying to sign multiple deals over the past few months to ensure their citizens get at least some COVID-19 injections. For example, Canada bought nearly 200 million vaccines – enough to cover the population of 38 million about five times.

Nkengasong cited the idea that people in rich countries would be immunized while Africans would do without “a moral issue”.

Ethics aside, experts note that failing to protect people in the developing world leaves behind a reservoir of coronavirus that could trigger new outbreaks at any time.

Amid fears that COVAX cannot deliver, some developing countries are withdrawing completely or seeking their own private deals. Earlier this month, the tiny Pacific island of Palau announced it was leaving the initiative and getting vaccines from the US instead. Other low- and middle-income countries, including Malaysia, Peru and Bangladesh, have stuck with the initiative, but have also recently signed their own deals with drug manufacturers such as Plan B.

Anban Pillay from the South African Ministry of Health said joining COVAX was only an emergency measure before negotiating bilateral agreements with pharmaceutical companies.

Kate Elder, vaccines policy adviser at MSF, said: “It looks increasingly like the ship has sailed on fair distribution of vaccines” – and GAVI, WHO and others should discuss how to increase vaccine production .

To this end, South Africa and India have asked the World Trade Organization to waive some intellectual property rights provisions to make it easier for manufacturers in poor countries to make COVID-19 drugs and vaccines. But many rich countries are reluctant to do so.

As more countries in the West approve the vaccine, “the gap between people in rich countries getting vaccinated and the lack of vaccines for developing countries will become quite significant,” said Anna Marriott, Oxfam’s health policy manager. “And it will only prolong the pandemic.”


Cheng reported from Toronto. Associated Press writers Cara Anna in Nairobi; Lori Hinnant in Paris; Julhas Alham in Dhaka, Bangladesh; Victoria Milko in Jakarta, Indonesia; Eileen Ng in Kuala Lumpur, Malaysia; and Krishan Francis in Colombo, Sri Lanka contributed to this report.


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