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Vaccine nationalism hangs over 2021 recovery

Richer countries locked up most of 2021's COVID-19 vaccine supply despite the COVAX Facility's multilateral efforts to ensure all nations have equal access.

Dr. Anthony Fauci receives the Moderna COVID-19 vaccine
Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, receives the Moderna COVID-19 vaccine on December 22, 2020 (AN/NIH)

GENEVA (AN) — Wealthy countries locked up most of 2021's COVID-19 vaccine supply — six times what developing nations expect to get over the next four years — despite the COVAX Facility's multilateral efforts to ensure all nations have equal access, global health data shows.

Experts project the world will not have enough vaccines to cover the world's 7.8 billion population until two or three years from now. But wealthy nations in Europe and North America have secured most of the global vaccine supply, clinching "advance market commitments" of 8.6 billion doses, with additional options or negotiations underway for another 3.5 billion shots. Developing countries with most of the world's population get whatever is left.

Canada lined up enough shots from seven deals to potentially vaccinate each of its nearly 38 million inhabitants six times over. Britain and the European Union have at least seven deals to cover their populations two to four times over. The United States has at least six deals for 1 billion doses, more than enough to cover the 331 million U.S. population, according to figures from Duke Global Health Innovation Center, which tracks vaccine procurement.

By contrast, the poorest countries secured 2 billion doses to protect high-risk populations by the end of 2021 through the COVAX international alliance, co-led by Gavi, the Vaccine Alliance and the World Health Organization, both based in Geneva, and by the Coalition for Epidemic Preparedness Innovations, based in Oslo, Norway.

Some 90% of the global population is eligible to receive vaccines through COVAX, which aims to provide funded countries with enough doses to cover 20% of their population. Self-financing countries can buy different levels of population coverage.

"Vaccine nationalism is not only unfair, it is self-defeating. No country will be safe from COVID-19 until all countries are safe," U.N. Secretary-General António Guterres said on Sunday, referring to a theme that he and WHO Director-General Tedros Adhanom Ghebreyesus have emphasized to little effect.

Countries with high and upper middle incomes confirmed purchases for 5.25 billion doses, compared to countries with lower middle incomes that have agreements for 2 billion doses. "We have not been able to find evidence of any direct deals made by low income countries, suggesting that low income countries will be entirely reliant on the 20% population coverage from COVAX," the U.S.-based Duke global health center said.

Some middle income countries with their own manufacturing capacity, such as Brazil and India, negotiated deals to get significant amounts of leading vaccine candidates. Others like Peru that can host clinical trials managed to use their leverage to secure advance deals. The African Union and Africa Centers for Disease Control and Prevention stepped in on behalf of less fortunate countries to pool financing for buying shots and making vaccines.

Wealthier nations not only have the edge when it comes to vaccine supply. They also are first in line to take deliveries of the most promising vaccine candidates as soon as national regulators approve them. Last month nations such as Britain, Canada, Serbia, Switzerland and the United States, along with the European Union, began vaccination programs with the first approved shots. China and Russia also have begun using their own formulations.

COVAX'S first 2021 deliveries are expected to arrive in spring, with a first tranche of doses — enough to protect health and social care workers — to be delivered by summer among all nations that requested doses in that time frame. The next deliveries are due in the second half of 2021, making for enough doses to cover up to a fifth of those nations’ populations. Still more doses would be available in 2022, but deliveries depend on regulatory approval.

51% for the 15%

COVAX is part of Access to Covid-19 Tools (ACT) Accelerator, a global collaboration among 10 international organizations seeking tens of billions of dollars for tests, medicines and vaccines. After WHO declared COVID-19 was a pandemic, the ACT-Accelerator was launched last April at an event co-hosted by Tedros, French President Emmanuel Macron, European Commission President Ursula von der Leyen and the Bill & Melinda Gates Foundation.

The aim of COVAX is to accelerate the development and production of COVID-19 vaccines and to guarantee all nations have fair and equitable access. Its agreements secured doses of emerging vaccines and vaccine candidates from drug makers such as AstraZeneca, Novavax, Janssen and Sanofi-GSK.

Rich countries with 15% of the global population, however, have reserved 51% of the most promising vaccine candidates, according to a peer-reviewed study published last month in the BMJ medical trade journal by researchers at U.S.-based Johns Hopkins Bloomberg School of Public Health.

"High income countries have reserved just over half of these vaccine doses from 13 leading vaccine manufacturers. Low and middle income countries have the remainder, despite these countries comprising more than 85% of the world’s population," the study found. "Even if all 13 of these vaccine manufacturers were to succeed in reaching their maximum production capacity, at least a fifth of the world’s population would not have access to vaccines until 2022."

Industrialized nations nonetheless are providing something of a lifeline. Just weeks ago, WHO complained that it lacked sufficient funding to fulfill COVAX's mission. Soon afterwards, eight nations pledged US$2.4 billion and the United States approved $4 billion for Gavi to help meet COVAX's 20% global vaccination goal. “If we can ensure greater access to COVID-19 vaccines globally, we will accelerate the end of the pandemic," Dr. Seth Berkley, Gavi's CEO, said of the U.S. commitment. "It will also shorten this crisis, save lives and help restart the global economy."

End of the line forms around 2024

Coronvirus vaccines arrived unusually quickly compared to the usual pace of development. Many benefited from massive government investment. But the global vaccination campaign still faces major obstacles such as gaining public trust, meeting cold storage requirements and hiring enough health workers.

“To have multiple vaccines authorized before the end of 2020 is truly remarkable. This is an extraordinary moment in the history of vaccinology but also medicine more generally," CEPI’s CEO, Dr. Richard Hatchett, said last week. "What is critical now, especially in light of the emergence of new strains of COVID-19 with increased transmissibility, is that we continue to scale up and scale out production of successful vaccines to ensure that they are made available globally without delay."

Though COVAX's mission is to ensure that all 190 member nations will have access to doses that protect vulnerable groups, the timetables for when they will receive them remains uncertain at best. The member nations include 98 higher income economies and 92 low and middle income economies. Gavi officials said 86 of the 92 less wealthy economies submitted detailed vaccine requests, offering the clearest picture yet on global demand for vaccines.

For the poorest among them, it will likely take until next year, and maybe until 2023 or 2024, to innoculate their populations, according to global health officials. Even an upper middle income nation like South Africa that is towards the front of the line will wait until this coming spring or early summer.

"We are part of the first group of countries that will receive an allocation of vaccines from COVAX," South African President Cyril Ramaphosa said last week. "We have been advised that we should expect the vaccines in the second quarter of 2021."

That timetable prompted South African lawmaker and opposition leader John Steenhuisen to suggest doing what many other relatively well off nations have done: contracting with drug makers for their own supplies. "Given the gravity of the situation and the clear delays with COVAX, surely the time has come to consider bilateral arrangements with manufacturers to get the vaccine to our shores far sooner," he said. "This should be a priority."

Tedros, the U.N. health agency chief, cautioned last August that nations must pull together and stop competing over access to potential COVID-19 vaccines if they want the pandemic to end. He denounced “vaccine nationalism” and the global race to develop, distribute and line up vaccine supplies.

When he spoke, more than 21.9 million people had been infected with COVID-19, at least 773,000 people had died, including more than 170,000 in the United States, and some 13.8 million people had recovered from it, according to Johns Hopkins University and Google data trackers.

But less than five months later, 2021 has begun with staggering pandemic figures: 84.8 million people have been infected with COVID-19, 1.84 million people have died from it — including 351,000 deaths in the United States, more than double the amount in August — and 47.7 million people have recovered from their infections worldwide. In an end-of-year message, Tedros said vaccines offer great hope to turn the tide of the pandemic.

"But to protect the world, we must ensure that all people at risk everywhere — not just in countries who can afford vaccines — are immunized," he said in a video message. "We must commit to working together in solidarity, as a global community, to promote and protect health today, and in the future. We have seen how divisions in politics and communities feed the virus and foment the crisis."