Poor countries, big losers in access to Covid vaccines

In early February, the milestone of 100 million doses of anti-Covid vaccines administered worldwide was crossed, according to Our World in Data, an online publication that lists in real time the data available on vaccines. Vaccination campaigns are in full swing in Europe, the United States, Russia and China, but first poor countries They will have to wait until the end of February to see the precious sesame arrive.

Furious at inequalities in vaccine access between poor and rich countries, Tedros Adhanom Ghebreyesus, the Director General of the World Health Organization (WHO), banged his fist on the table January 18, claiming that “The world is on the brink of catastrophic moral failure”.

How did we get here? During the first months of the epidemic, however, there was a collective awareness of the need for a vaccine accessible to all. As of May 2020, the 194 Member States of WHO approved so a resolution that all access to a vaccine should be “Fast and fair, of high quality, safe and affordable”. European leaders spoke of explicitly the term of “Unique global public good of the 21st century”.

Yet, behind the scenes, another scenario is playing out. “From the start of the pandemic, Western countries entered into bilateral agreements with biotechs and Big Pharma who were developing candidate vaccines, buying at risk, that is to say without having any guarantee of effectiveness. This quickly saturated global production capacity ”, explains Els Torreele, former director of the campaign for access to medicines for Doctors Without Borders (MSF).

The United States is leading the vaccine race, investing $ 10 billion (€ 8.3 billion) in theopération «Warp Speed», to stock up on promising vaccines. European states are quickly taking the same path.

Covax, a denatured vaccine solidarity mechanism

However, the WHO set up in April a mechanism of global solidarity for an equitable distribution of vaccines in the world: the Covax solidarity fund, which displays the goal of vaccinating 20% ​​of almost all countries in the world by 2021.

Covax is led by the Global Alliance for Vaccines Gavi, a public-private organization created in 2000, responsible for negotiating the purchase and distribution of vaccines in poor countries and by the WHO, which provides technical expertise to manage logistics and support national vaccination campaigns. A third partner, CEPI, is responsible for research & development projects relating to Covax’s vaccine portfolio.

“The original idea was that Covax buys vaccines in large volumes to negotiate cheaper prices with pharmaceutical companies, which are then distributed to everyone, rather than each country buying them separately”says Ken Shadlen, professor of development studies at the London School of Economics.

While it takes two doses to vaccinate 70% of the world’s population, Covax’s effort seems largely insufficient.

But developed countries do not want to limit themselves to vaccinating 20% ​​of their population, and as they buy en masse from pharmaceutical companies, they are abandoning Covax, which, at the end of 2020, had only collected $ 2.4 billion. So far, the mechanism claims to have been able to secure 1.3 billion doses, which will be sent as a priority to 92 low and middle income countries. Almost 90% of the 337 million doses distributed by Covax in the first half of 2021 will go to these countries. But while it takes two doses to vaccinate 70% of the 7.8 billion people on the planet, the effort seems largely insufficient.

A scenario has nevertheless been envisaged by some Western countries such as Sweden: the surplus of vaccines ordered could supply the poor countries members of Covax. In the best-case scenario, however, this shouldn’t happen until this summer.

Faced with Covax’s deficiencies, more and more low and middle-income countries have started to enter into bilateral agreements with large pharmaceutical groups, even for small quantities of vaccines. The African Union thus entered into agreements in mid-January with the groups AstraZeneca, Pfizer and Johnson & Johnson to receive 670 million doses. Negotiations are arduous, especially since transparency on the terms of contracts is far from being achieved.

New vaccines more suitable for developing countries

Of the five vaccines that have completed their Phase 3 trials and have been approved or are in the process of being approved by the WHO, the Oxford-AstraZeneca vaccine is on paper the cheapest. The AstraZeneca group has indeed claimed to produce at “cost price” for low- and middle-income countries, around $ 3 per dose, But nothing is less certain.

“We don’t know the true production costs. The vaccine uses fairly traditional technology, and the production of conventional vaccines costs on average less than a dollar. Countries like South Africa and Brazil have paid more than 5 dollars per dose, or even 7 dollars for Angola, that is to say beyond the price announced by the pharmaceutical group initially ”, laments Els Torreele.

The vaccine developed by the University of Oxford has another advantage for developing countries: it can be stored at a temperature between 2 and 8 ° C. This is not the case for the two vaccines developed by Pfizer and Moderna, which are based on innovative messenger RNA technology, and require long-term storage at very low temperature (-70 ° C for the first, -20 ° C for the second).

Johnson & Johnson has, like AstraZeneca, announced that it wants to sell its vaccine at “cost price”, and has developed a single dose vaccine, unlike the others.

Two new vaccines have also been pre-ordered by some low- and middle-income countries: Novavax and Johnson & Johnson. Entering the race later, they announced their results of phase 3 clinical trials at the end of January, with 89% efficiency for the first, and 66% for the second. Johnson & Johnson has, like AstraZeneca, announced that it wants to sell its vaccine at “cost price”, and has developed a single dose vaccine, unlike all the others, at a price of $ 8.50 per serving. The price of the Novavax vaccine is higher, at $ 16 per dose.

These two vaccines, which could receive approval from health authorities in the coming weeks, are good news for developing countries, as they will be produced in large quantities, like that of Oxford-AstraZeneca.

Finally, Russian and Chinese vaccines are already distributed in a number of countries. In addition to Russia, the Sputnik V vaccine was ordered by seventeen countries, including some with low and middle incomes, like Egypt, India, Vietnam, and allied countries like Venezuela or theIran. Its price is around $ 7.5 per dose, it can be stored in the refrigerator between 2 and 8 ° C, and according to results published in the medical journal The Lancet, it is effective in 91,6%.

On the Chinese side, two vaccines are already distributed in poor countries, but in much smaller quantities: this is the one from the laboratory Sinovac, a private company in Beijing that owns CoronaVac, and Sinopharm, the pharmaceutical arm of the Chinese state. We find them in some countries like the Philippines, Ukraine, Egypt or Pakistan.

Despite the proliferation of vaccines, a fifth of the population world will not be vaccinated until 2022, said the Bloomberg School of Public Health at Johns Hopkins University.

Source: Slate.fr by www.slate.fr.

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