Vaccine inequality in the brutal race to ensure the dose

No one doubts that the world is unfair. But no one expected that the global vaccine gap between rich and poor would be so severe, and it would have been so far in the pandemic.

Inequality is everywhere: vaccines are begging in the United States, but only a short voyage from Haiti. After several months of commitments, the first batch of vaccines was received on July 15-providing 500,000 doses to more than 11 million people . Canada purchased more than 10 doses for each resident; Sierra Leone’s vaccination rate just exceeded 1% on June 20.

Strive Masiyiwa, the African Union’s special envoy for vaccine procurement, said it was like a famine, “the richest people robbed the baker”.

In fact, European and American officials who are deeply involved in funding and distributing coronavirus vaccines told the Associated Press that they have not thought about how to deal with this situation on a global scale. Instead, they quarrel for their own domestic purposes.

But there are more specific reasons why vaccines have and have not reached people with and without.

COVID-19 unexpectedly destroyed wealthy countries first—some of them were one of the few places where vaccines were produced. Export restrictions limit the dose within its borders.

There is a global procurement plan to provide vaccines to poorer countries, but it is flawed and insufficiently funded to compete in fierce procurement competition. Intellectual property rights compete with global public health for priority. Rich countries have expanded vaccination coverage to younger and younger populations, ignoring repeated requests from health officials to donate vaccines, and debated strengthening injections even if poor countries cannot vaccinate the most susceptible population.

This difference is inevitable in some respects. Rich countries expect them to get a return on the investment of taxpayers' money. But the scale of inequality, stockpiles of unused vaccines, and the lack of viable global plans to solve global problems have shocked health officials, although this is not the first time.

"This is a deliberate structure of global unfairness," Massiiva said at a meeting at the Milkin Institute.

"We cannot get vaccines as donations or available for purchase. Am I surprised? No, because this is where we are infected with HIV. After eight years of treatment in the West, we did not get them, and we lost 10 million people. "

"This is simple math," he said. "We don't have the right to visit. We don't have a vaccine miracle."

From the very beginning, the alliance of organizations that created COVAX found themselves fighting the final war.

Winnie Byanyima, head of UNAIDS, said the plan is intended as an international funding pool to stimulate demand for vaccines and disease treatments with a relatively small global footprint.

Ebola or something. But the coronavirus pandemic looks completely different from the Ebola epidemic.

"This is a structural weakness in itself," she said.

Although the World Bank and the International Monetary Fund have allocated billions of dollars to vaccinate developing countries, the money is intended to flow to countries and is beyond the scope of global vaccine sharing programs like COVAX. The Rockefeller Foundation’s Innovative finance.

At the same time, governments are competing for hundreds of millions of vaccine contracts.

On December 8, the United Kingdom became the first country officially authorized to start widespread vaccination, giving 90-year-old Margaret Keenan a dose of Pfizer-BioNTech vaccine. Six days later, the United States began its own vaccination. On December 26, the European Union followed suit. China and Russia were vaccinated even before the release of their national vaccination data.

Western companies with the most promising doses, including Pfizer/BioNTech, Moderna, and AstraZeneca, have been producing medicine bottles for several months, waiting for a huge market, according to the promises of wealthy countries before the official approval. These doses are stored in Europe and North America, as well as a few countries that pay premiums, such as Israel.

COVAX asks for cash to do the same thing. Instead, it was promised.

CEPI CEO Dr. Richard Hatchett told the Associated Press: “Over time, which vaccine candidates will become major competitors and which ones are most likely to succeed, and those governments with the resources will buy supplies. "COVAX can't do this."

A few months later, when COVAX finally had the money to sign a global supply agreement, Hatchett admitted that they had reached the end.

Hatchett said that vaccine manufacturers' lack of funds to increase their capacity outside of the few existing manufacturing centers is also a "lost opportunity."

"We have contacted international financial institutions including the World Bank and (International Finance Corporation) to make these investments, but they are unwilling to do so," he said. CEPI eventually invested approximately US$1.5 billion, far below the amount that a major financial institution might be able to promise.

COVAX failed to achieve its goal of starting vaccination in both poor and rich countries. It finally shipped the vaccine to Ghana on February 24, the 600,000 doses of AstraZeneca vaccine manufactured by the Serum Institute of India and transported by UNICEF aircraft.

By that time, 27% of the population in the United Kingdom had been vaccinated, 13% in the United States, 5% in Europe, and 0.23% in Africa. The cracks grow at the rate of millions of doses every day.

The pharmaceutical factory began to collapse under the promise they made.

AstraZeneca announced several reductions in deliveries to Europe. Pfizer's production slowed briefly. The fire at the Serum Institute’s construction site prompted a letter to Brazil warning that “supply cannot be guaranteed for you in the foreseeable months”. Moderna's supply cuts soon appeared in the UK and Canada.

IIn the United States, after finding that workers had inadvertently mixed ingredients from AstraZeneca and Johnson & Johnson vaccines, officials threw away millions of doses of damaged vaccines from the Emergent Biosolutions plant in Baltimore. Due to new restrictions designed to prevent errors, countless doses have never been produced. Many of these vaccines are for export.

Therefore, COVAX has to hope that the AstraZeneca vaccine produced in India will pass, because it has obtained very few innovative mRNA doses, and these doses are now considered to be the most effective against coronavirus variants. The initial cold storage requirements are daunting and the price is higher than traditional vaccine candidates.

The mRNA vaccine is widely regarded as a victory in science and manufacturing—and a risky bet. They have never been approved for the treatment of any disease before, and they are now considered a very promising medical innovation and a potential game changer in the fight against infection.

However, when mRNA doses are clearly a viable alternative, even in poor countries with limited cold chains, the available supply has been sold out in Europe, the United States, and Canada. And India, in the throes of its own COVID-19 surge, converted its vaccine to its own use.

According to the People’s Vaccine Alliance, a human rights organization that advocates for wider sharing of vaccines and their underlying technologies, the coronavirus has created nine new billionaires. The top six are related to successful mRNA vaccines.

For Byanyima of UNAIDS, this is a kind of irony and a sign that since the United States has contained the AIDS pandemic, the world has learned very little in the past few decades. Treated and killed millions in Africa: "Drugs should be a global public product, not just luxury handbags you buy in the market."

COVAX has only provided 107 million doses and is now forced to rely on uncertain donations from countries that may be more willing to donate directly to those in need, so that they can obtain credit.

Readings from its June board meeting show that it needs to better explain and respond to market conditions and "the reality of a higher risk appetite in a pandemic environment."