As Rich Countries Roll Out COVID-19 Vaccines – Will Developing Countries Miss Out? 
Pfizer’s mRNA vaccine is being rolled out in the United Kingdom, to be followed by the United States and Europe. 

While some of the world’s richest countries have now stockpiled more COVID vaccines than they have people to inject, the world’s 67 poorest countries may only be able to vaccinate 1 in 10 people against COVID-19 next year, unless urgent action is taken by governments and the pharmaceutical industry to make sure enough doses are produced.

This was the warning in a report published on Wednesday by Oxfam, Amnesty International and other advocacy groups

The report notes that the massive pre-purchase of leading vaccine candidates by rich countries means that some of the world’s wealthiest nations have bought up enough doses to vaccinate their entire populations nearly three times over by the end of 2021 – supposing the vaccines in clinical trials are all approved for use.

The same data suggests that countries representing just 14% of the world’s population have bought up some 53% of all the most promising vaccines so far. Canada tops the chart with enough vaccines to vaccinate each Canadian 5 times over.

The organizations analyzed data on publicly reported vaccine deals done between countries and the eight leading vaccine candidates. They found that 67 low and lower middle-income countries risk being left behind. Five of those countries – Kenya, Myanmar, Nigeria, Pakistan and Ukraine – have reported nearly 1.5 million COVID cases between them.

The Republic of Korea has vaccines to cover 88% of its population of more than 50 million people. But nearby, the low-income Philippines, has so far secured only 2.6 million doses for next year covering only 1.3 million people out of its total 106 million population, according to the report.

Report Comes Amidst Flurry of Upcoming Vaccine Regulatory Approvals
the total number of confirmed vaccine doses procured, displayed by income level. (Duke Global Health Innovation Centre)

The report comes on the heels of the inaugural jab in the United Kingdom of 90 year-old Margaret Keenan on Tuesday with the first commercially available COVID-19 vaccine.  The UK became the first country to approve Pfizer’s high-tech mRNA vaccine candidate for widespread use last week.

On Thursday, the United States Food and Drug Administration is expected to approve the Pfizer vaccine for emergency use among Americans, after already issuing a positive review of the vaccine’s clinical trial results. That is likely to be followed by FDA approval of a similarly designed mRNA vaccine by Moderna on 17 December, and the European Medicines Agency will review the same vaccines in early January.

The third vaccine-in-waiting is likely to be AstraZeneca’s cheaper and simpler adenovirus vaccine, based on a more common delivery mechanism, that uses a weakened form of a common cold virus to deliver a fragment of the trademark SARS-CoV-2 spike protein into the body, and prompt an immune reaction.

Results of the AstraZeneca vaccine trial involving some 24,000 people and published Tuesday in The Lancet, found that the vaccine was 70% effective on average – with efficacy rising to 90% among trial participants who accidentally received only a half first dose.

In the wake of the serendipitous discovery, a larger trial with the amended dosing regime will be undertaken, AstraZeneca has said. But it said that with average efficacy rates still above the 60% benchmark set by regulatory agencies, it would also seek regulatory approval simultaneously.

A number of low- and middle-income countries (LMICs) like India, Mexico and Brazil have managed to secure large vaccine procurement commitments through manufacturing deals with AstraZeneca, a Swedish firm that undertook its vaccine development effort in collaboration with the UK’s Oxford University.

That joint initiative has championed the development of a low-cost vaccine, which the company has committed to producing on a non-profit basis during the pandemic – leaving an estimated cost of about US$3, per dose, as compared to $20-$30 for the more high-tech Pfizer and Moderna alternatives.

But since a large portion of AstraZeneca’s planned production of nearly 3 billion doses will be directly taken up by India, Brazil and Mexico – also among the LMICs hardest hit by the virus – that will still leave comparatively little to distribute more broadly.

WHO Aims to Get 20% Coverage Worldwide Next Year
Soumya Swaminathan, WHO Chief Scientist

Speaking at last Friday’s WHO briefing, WHO Chief Scientist, Soumya Swaminathan, stated that the WHO co-sponsored COVAX vaccine pool has so far secured deals for 700 million doses of a COVID-19 vaccine.

“That’s not sufficient,” said Swaminathan. “The goal is to get at least two billion doses by the end of 2021, which would be enough to vaccinate approximately 20% of the populations of the countries that are part of COVAX.”

The WHO co-sponsored COVAX vaccine facility, a global collaboration to accelerate development, production, and equitable vaccine access, includes some 187 countries, covering 90% of the global population. WHO officials have held out hope that LMICs could also begin vaccinating the highest-risk groups, like health workers and older people “in the first quarter of 2021,” with the support of vaccines procured through the facility.

Both rich and poor countries have joined the initiative, which aims to offer reduced prices for vaccines to most countries, and use donor funds to supply vaccines to some 92 countries that cannot afford to purchase them on their own.

However, despite repeated pleas to donors for support, the facility remains some US$28 billion short on the funding needed for next year to fully fund the vaccine drive, as well as drugs, tests and health system support services in the world’s poorest 92 countries.

The COVAX programme “urgently needs another US$5 billion in order to meet that goal of two billion doses”, stressed Swaminathan on Friday.

World Trade Organization Debates IP “Waiver” for COVID Medicines and Vaccines

On Thursday, the World Trade Organization (WTO) will resume its review of a proposal by South Africa and India to extend a broad WTO “waiver” over COVID-related patents, copyrights, and trade secrets for vaccines, medicines and health equipment, as part of another access initiative.

The initiative has picked up considerable support among African, Asian and Latin American member states. But it is stiffly opposed by a wall of G-20 countries with huge pharma interests at stake.

Thursday’s debate comes ahead of a full, formal review of the waiver proposal by the WTO’s General Council on 17 December. Leaders of the initiative have also threatened to put it to a vote, if it is not taken seriously.

Medicines access groups are stepping up pressure on governments and organizations to consider the waiver concept, saying that sharing trade secrets and technologies is the only way to ensure fair distribution of brand-new medical technologies such as the COVID vaccines.

On Wednesday, a petition organized by the online campaign organization AVAAZ and signed by some 900,000 people, was delivered to WTO members. The petition called on all governments, WTO members and pharmaceutical companies to “ensure access to lifesaving COVID-19 vaccines, treatments and equipment for everyone in the world”.

“While the world waits with bated breath for the possible approval of these COVID-19 vaccines, it’s not time to celebrate yet,” said Dr Sidney Wong, Executive Co-Director of Médecins Sans Frontières Access Campaign in a press release on Tuesday.

“Right now, we’re in a situation where a lion’s share of the limited number of first doses have already been snatched up by a handful of countries like the US and UK, as well as the EU, leaving very little for other countries in the short term. What we really want to see is a rapid expansion of the overall global supply, so there are more vaccines to go around and doses can be allocated according to WHO’s public health criteria, not a country’s ability to pay.”

Image Credits: Andrew Parsons / No 10 Downing Street, Pfizer, Duke Global Health Innovation Center.

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