KAMPALA, UGANDA – Responding to a swell of global criticism, a senior Ugandan health official told Health Policy Watch that Uganda’s government is not paying unreasonably higher prices for it’s AstraZeneca vaccines, in comparison to other African countries – or Europe. 

“You cannot compare prices directly between countries because there are many factors to consider. Prices have to vary anyway,” said Alfred Driwale the manager of the Uganda National Expanded Programme on Immunization (UNEPI) at the Ministry of Health, in an exclusive interview.  

News that Uganda will be paying USD $7 per dose for its 18 million dose order of the Astra Zeneca vaccine – a price that is 20% more than South Africa and roughly triple that being paid by the European Union – sparked anger and outrage around global medicines access advocates – and on social media channels. 

“This is unjust & unfair. Bilateral deals between wealthier countries & companies means low income countries like Uganda get a raw deal with price hikes.” protested one Ugandan human rights advocate on social media.   

This is unjust & unfair. Bilateral deals between wealthier countries& companies means low income countries like Uganda get a raw deal with price hikes. Need #PeoplesVaccine These vaccines funded by govts. That said @GovUganda what other candidates did you consider& at what cost?

— Allana Kembabazi (@Kemba_A) February 2, 2021

The two-dose vaccine, together with shipping and handling costs, would bring the total cost of each immunization regime to USD $17, government officials said.

But Driwale told Health Policy Watch that the prices countries may quote, per vaccine, vary because there are many factors to consider including overhead costs, the timing of orders; transport costs; the amounts of cash down payments or deposits, as well as economies of scale etc. 

“You can not expect a country with a big population to pay the same price, the  big country will definitely have a higher bargaining power,” says Driwale while comparing the prices a country like Uganda and Nigeria may pay for the vaccine. 

Uganda has some 48 million people while South Africa has nearly 60 million.

Driwale who did not want to comment on whether this sets a precedent for what  Uganda might pay in the event  it procures other types of vaccines saying ‘ it is still too early to have that conversation now.”  

Ugandan Ministry Of Health Placing Order For 18 Million Doses  

Following a cabinet meeting on Monday, The Ministry of Health and the National Medicines Stores (NMS) announced that they had placed an order of 18 million doses of the Astra Zeneca from the Serum Institute of India, which will be used to vaccinate people above  50 years of age, as well as people with underlying health conditions, health workers, security personnel, teachers and other essential social service providers.

But on Wednesday, a spokesman for the Serum Institute of India told Reuters that the institute has not yet signed any deal with Uganda. “While discussions are ongoing, there has been no finalization of price or volumes,” the spokesman said.

The Serum Institute is supplying doses of the vaccine to Brazil, Saudi Arabia and South Africa at $5.25 per dose.

Ugandan government officials did not seem ruffled by the Serum Institute Statement, saying that the country’s order placed will only be confirmed upon remission of US$ 5 million as a down payment for the vaccine.

Uganda is also expecting to receive soon a supply of some  3.552 million AstraZeneca vaccines  from the WHO-co-sponsored COVAX global facility – enough to immunize about another 1.77 million people, according to the first interim plan.

Good News on AstraZeneca Potential For Greater Dose Spacing & Containing Disease Transmission

Meanwhile, for countries that have secured AstraZeneca doses, there was good news in a pre-print study published by researchers at the University of Oxford suggesting that the AstraZeneca vaccine was not only effective in preventing disease – but also in reducing transmission to others.

Efficacy of COVID vaccines to prevent transmisison has been a hotly debated topic – with huge policy implications.  The new paper, which examined weekly swab tests that had been administered to a group of 17,177 AstraZeneca clinical trial participants in Brazil, the United Kingdom and South Africa, found a 67% reduction in positive coronavirus swab tests, among those vaccinated as compared to those who were not.

Just as important, the analysis found that vaccine efficacy, averaging 76% at three months, was higher if the second dose was administered after three months, rather than earlier – a finding which could support country decisions to space initial and booster vaccine doses further apart in order to ration precious doses.

British Health Secretary, Matt Hancock,  welcomed the results on Wednesday as “absolutely superb.”

“We now know that the Oxford vaccine also reduces transmission and that will help us all get out of this pandemic,” Hancock said in an interview morning with the BBC.

COVAX Dose Distribution Plan Unveiled 

The good news about the AstraZeneca vaccine came just before the COVAX global vaccine facility, co-sponsored by WHO and GAVI, The Vaccine Alliance, published their list indicating how many vaccines each participating country expect to receive in the first half of 2021, with deliveries beginning in late February or early March. 

The total worldwide distribution would include about 336 million doses of the AstraZeneca vaccine and another 1.2 million doses of a promised 40 million vaccine doses from Pfizer – reflecting what COVAX will be able to roll out immediately, said GAVI CEO Seth Berkley, speaking at a press briefing today in Geneva.  

At the briefing, Berkley and other officials said that they still expected COVAX to deliver as many as 2.3 million doses in 2021 including “as many as ~1.8 billion doses” to the 92 countries that receive donor-supported vaccine aid – providing them with about 27% coverage with COVID vaccines. 

“Today is a positive day as we think about this equity agenda we have been talking about for a long time now..” declared Berkley. “At this point soon we will be able to start delivering life saving vaccines globally, an outcome that we know is essential if we are to have any chance of being able to beat this pandemic as well as being able to deal with the new scientific challenges such as the new variants.”

But Uganda, whose economy has suffered heavily from the impacts of COVID-related lockdowns – despite comparatively low infection rates – clearly wants to ensure a higher level of coverage as quickly as possible. 

COVAX Doses Through Advance Market Commitments – Donor Supported 

For the 92 countries primarily dependent on donor aid to access vaccines, doses are being allocated proportionate to their population size, at-risk groups as well as other criteria, in line with a “fair allocation mechanism” developed by WHO. 

“It is a strategy to rapidly contain the pandemic, save  lives, protect health care systems,and restore the global economies, based on human rights principles of equity and epidemiological evidence from the pandemic,” said WHO’s Ann Lindstrand of the fair allocation mechanism.

“All countries should receive doses in proportion to their population size, to immunize the highest priority groups, especially those most likely to die, who have severe disease.”

In the first phase of the COVAX distribution, Kenya would receive some 4.176 million doses,  although self-financed South Africa – which is signing other large purchase arrangements – would only receive 3.1 million doses. Nigeria, with a population of 200 million that makes it by far the largest country in Africa, would receive some 16 million COVAX doses. 

In the first round of allocations, AstraZeneca vaccines will make up most of the doses being supplied by COVAX. However, Pfizer also has signed a commitment to supply up to 40 million doses of its  Pfizer-BioNTech vaccine candidate, which has already received WHO emergency use listing, on an at-cost basis.  According to the WHO distribution list, countries that will receive the Pfizer vaccine are primarily in Latin America, eastern Europe and Asia or South-East Asia – presumably where the vaccinés ultra-freeze cold chain requirements can be managed.  

While most of the 135 countries signed up to receive the first COVAX vaccine shipments are low-income or middle-income countries, while most G-20 countries were noticeably absent, a few high income participants stood out on the list.  

For instance, the Republic of Korea is set to receive some 2.6 million doses of AstraZeneca vaccines and 117,000 doses of the Pfizer vaccine through the global facility on a for-pay basis. Upper middle income countries like Chile and Argentina are also set to receive some initial doses through the facility.  

Vaccines for countries that had access to other vaccine sources were limited in these first rounds, said Lindstrand, as part of the “fair allocation mechanism.”.  In addition to population, and other vaccine access, the mechanism considers other criteria such as country readiness to receive the vaccines and risks to health workers.

Said Lindstrand, “Review and assessment was done on the basis of first-participant readiness, whether participants had already initiated vaccines – we thought it was important for those that had not started, to be able to access doses to be able to protect their high priority populations.”

Another criteria considered was the risk of health care worker exposures, in terms of health care worker mortality over the past 28 days, she said.  That was seen as a wider indicator of “the highest possible public health impact.”

GAVI, which published the list, also noted that the final allocations will be subject to approval by WHO of the AstraZeneca vaccine for an Emergency Use Listing (EUL), as well as manufacturing and supply chain constraints. WHO has already approved the Pfizer vaccine, which was registered earlier with national regulatory authorities.

According to the COVAX arrangements, about 35-40% of the promised doses would be supplied by end March 2021, with another 60-65% made available by the end of June. 

Image Credits: Sasmson Wamani .