COVID-19 vaccines in a rich-country, poor-country world

That we live in an unequal world is nothing new. Now, though, that reality may have unpredictable consequences for all of us. We are living through a pandemic and desperately waiting for vaccines to help us put an end to this endurance marathon we find ourselves running.

As the Pfizer/BioNTech COVID-19 vaccine becomes the first to be approved in the U.S., Canada, the U.K., Saudi Arabia, Mexico and Bahrain, anxiety is spreading in other parts of the world. The world’s capacity for vaccine production is limited, and the buying power of low and middle-income countries cannot match that of wealthier nations. Even though a rallying cry during the pandemic has been that No one is safe until everyone is safe, people in less well-off countries may have to wait until the middle of the decade to be vaccinated. In that scenario, the threat of Covid might not wane for several years despite the approval of vaccines.

As Gavi, the Vaccine Alliance, reminds us:

Only once COVID-19 vaccines are available to priority populations in all countries           around the world will we bring the pandemic under control.

Amnesty International reports that Rich countries have bought up enough doses to vaccinate their entire populations nearly 3 times over. Deutsche Welle (DW,) Germany’s international broadcaster, points out that the claim is somewhat misleading:

The claim assumes that all vaccines will pass clinical trials and be approved. Although more affluent countries have signed agreements with leading vaccination companies, the global scramble to secure doses occurred well before their safety and efficacy were established. While doses have been reserved, this does not necessarily mean that all companies will produce an effective vaccine that is then approved. In short, doses have been reserved for vaccines that are still being tested.

Status of leading vaccine candidates

Johnson & Johnson’s vaccine, which is much desired as it is given in a one-shot dose, is, as of yet, unapproved anywhere. But the U.S. has pre-ordered 200 million doses of the Johnson & Johnson vaccine, Canada has a bid in for 38 million doses, and the U. K. has ordered 30 million doses.

And the US has preordered 100 million doses of Moderna’s vaccine, Canada 56 million doses and the UK 50 million. The Moderna vaccine has the advantage of being 94 percent effective and can be distributed more easily than the Pfizer/BioNTech vaccine, as it remains stable at minus 20 Celsius for up to six months. The vaccine maintains potency in a standard refrigerator for up to a month. And yet, no Latin American country has preordered the Moderna vaccine, even though Brazil, Argentina, Colombia, Peru and Mexico are among the countries most impacted by Covid. Why not? The simple answer is cost. The Moderna vaccine is the most expensive in the marketplace and out of the reach of many.

The European Union had ordered 300 million doses of the Pfizer/BioNTech vaccine, as of Nov. 11. Japan wants 120 million doses, and the U.S. has bought 100 million doses. AstraZeneca/Oxford offered to deliver their vaccine at a no-profit price, which offered hope to developing countries, but their vaccine has run into problems. Released Phase 3 data confused more than assured many, and their trials are being repeated. Countries that had preordered only the AstraZeneca/Oxford vaccine were left scrambling.

Russia’s Sputnik V Vaccine

The Russian Sputnik V is a possibility. Sputnik V, also known as the Gamaleya vaccine, has been given short shrift in higher-income countries. Even though Russia has done pioneering work on vaccines in the past, when Russia fast-forwarded approval of its Sputnik V vaccine before Phase 3 trials were complete, many raised an eyebrow. Even so, early data on the Sputnik V vaccine suggest that it is 92% effective according to the BBC. Russia began offering broad Sputnik V immunizations to its citizens this past week. There were few takers. Distrust of the government is so widespread that 59 percent of Russians say they have no intention of getting a shot, the New York Times reports. Yet, this disparaged vaccine might just be the salvation of millions. Right now, we just don’t know. Just in case, Brazil has ordered 50 million doses, Mexico 32 million, Argentina 25 million and Venezuela 10 million.

Chinese Vaccines

A number of Chinese vaccines are also candidates. The efficacy of the Chinese Sinovac vaccine will not be known until January. Nevertheless, the Sinovac vaccine and Sinopharm, another Chinese vaccine, have been administered under emergency-use orders in China since as early as last July. More than 1 million Chinese have been vaccinated with the Sinopharm vaccine. On December 9, the Sinopharm vaccine was registered in the United Arab Emirates after it was found to be 86% effective in Phase 3 trials there. Bahrain approved the use of the Sinopharm vaccine on Dec 10. Morocco has said that it will initially rely on the Sinopharm vaccine for its plan to vaccinate 80% of its adult population. The Philippines plans to vaccinate 9 million people with the Sinovac vaccine. Chile has ordered 60 million doses of the Sinovac vaccine, and Brazil another 46 million. Mexico has just signed an agreement to buy 35 million doses of another unapproved Chinese product, CanSino Biologics’ COVID-19 vaccine.

It is worth noting that, as of mid-November 2020, no country in sub-Saharan Africa had made any prepurchase agreements for any COVID-19 vaccines in development.

Leveling the Playing Field

COVAX AMC (Advance Market Commitment) is a vaccine purchasing fund led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations (CEPI) and the WHO. COVAX was established to support vaccine development and to try to level the playing field of vaccine accessibility worldwide. So far, COVAX has secured 700 million doses of vaccine to distribute among its 92 low-income country members. The EU, the UK and Canada have been key financial contributors to COVAX, as has the Bill & Melinda Gates Foundation. The United States had not participated.

The inequality inherent in the rich country poor country vaccine availability divide has pushed India and South Africa to petition the World Trade Organization to temporarily suspend certain intellectual property rights and medical patents in order to speed up COVID-19 vaccine production in less wealthy areas of the world, at least until herd immunity is achieved. And a group called the People’s Vaccine Alliance, a coalition of organizations including Free the Vaccine, the Yunus Centre, Frontline AIDS, Oxfam, SumOfUs and UNAIDS, is spearheading the call for COVID-19 vaccines free from patents. This group is asking for the fair allocation of vaccines, the prevention of vaccine monopolies, and vaccines available to all, everywhere, free of charge.

The immunity question

In the meantime, in their paper published in the medical journal The Lancet (Nov. 2020), Roy M Anderson, Carolin Vegvari, James Truscott and Benjamin S Collyer remind us of the unwelcome reality of the conundrum we find ourselves in:

Data on immunity to other coronaviruses suggest that immunity to SARS-CoV-2 might be short lived, perhaps 12–18 months in duration. Whether past infection will prevent severe COVID-19 on re-exposure to SARS-CoV-2 is not known at present.

In other words, even after herd immunity is achieved, vaccination against COVID-19 might need to become an annual jab.