Vaccine roll-out begins, but could developing countries miss out?

London. The cameras were focused on the face of 90 year-old Margaret Keenan, the first UK citizen to receive the newly approved Pfizer / BioNTech Covid-19 vaccine on Tuesday at University Hospital in the city of Coventry. After her jab, she passed through a corridor of applauding nurses. Behind her mask was the glint of a smile as she described the experience as an “early birthday present”. She turns 91 next week.

But underneath the hopeful photo-ops, staged in one of the areas hardest hit by the coronavirus, a technically complex “V-Day” operation - a name hearkening back to Britain's World War II D-Day landing at Normandy - was getting underway across the first 50 hospital hubs. It was to be followed by vaccine distribution next week at 300 primary health care centres of the UK's National Health Service (NHS).

“Today marks the start of the fight back against our common enemy, the coronavirus,” said Prime Minister Boris Johnson, on a visit to a London hospital where others were lining up to receive their first vaccine doses. He summoned national pride, declaring that getting vaccinated was “good for you and good for the whole country”.

Famed for its octopus-like bureaucracy, the NHS vaccine rollout could still be a model for other countries if the vaccine drive, which requires two doses, goes off smoothly. Some 800,000 Pfizer vaccines are to be delivered this month, to be followed by four million more, beginning in January 2021.

A vaccine can't come too soon. With today's likely approval by the United States Food and Drug Administration (FDA) of the same Pfizer mRNA vaccine, followed by an expected FDA approval of a similar vaccine produced by Moderna next week, the vaccine flood gates are expected to open even wider, with more military-style vaccine operations getting underway elsewhere in North America and Europe this month and in early January.

For most countries, weary of economic lockdowns, social strains, and pressured hospitals, not to mention the human tragedies of serious illness, death and “long Covid” aftereffects, the introduction of vaccines cannot come too soon.

Over 1.5 million people have died since the pandemic began nearly a year ago, including more than 61,000 people in the UK alone, the fifth hardest hit in terms of mortality, coming after the United States, Brazil, India and Mexico – and just ahead of Italy, France, Iran, Spain and Russia. Many of those same countries are now in the thralls of a second or third wave of virus infections and deaths.

Could poor countries miss out? At a press briefing on Friday, WHO officials held out hope that low- and middle-income countries could also begin vaccinating their highest-risk groups, particularly health workers and older people “in the first quarter of 2021,” with the support of the WHO co-sponsored Covax vaccine facility. Most of the world’s countries, rich and poor, have joined the initiative – which also aims to raise donor funds to purchase and distribute vaccines to some 92 countries that cannot afford to buy them on their own.

However, despite repeated pleas to donors for support, Covax and other arms of the broader ACT Accelerator initiative remain some $28 bn short on the funding needed in 2021 year to fully fund the vaccine drive, as well as parallel initiatives to provide Covid drugs, tests and health system support services to low- and middle-income countries. .

As things stand now, the world’s 67 poorest countries will only be able to vaccinate one in ten people against Covid-19 next year - unless urgent action is taken by governments and the pharmaceutical industry to make sure enough doses are produced and distributed, warned a report published Wednesday by Oxfam along with Amnesty International and other advocacy groups.

The report notes that the massive pre-purchases of the leading vaccine candidates by rich countries means that some countries have bought up enough doses to vaccinate their entire populations nearly three times over by the end of 2021 - if the vaccines now in advanced clinical trials are all approved for use.

Meanwhile, 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.

Rich nations representing just 14 per cent of the world’s population have bought up 53 per cent of all the most promising vaccines so far. Canada tops the chart with enough vaccines to vaccinate each Canadian five times, according to the report that analysed data on vaccine purchase deals already concluded between countries and companies developing the eight leading vaccine candidates. .

The Republic of Korea has vaccines to cover 88 per cent of its population of more than 50 million people. But nearby, 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 population of more than 100 million.

On the other hand,  a few low- and middle-income nations like India, Mexico and Brazil have managed to secure large vaccine procurement commitments, primarily through manufacturing deals with AstraZeneca, which is offering a low-cost vaccine, that uses a more conventional technology to prompt immunity. And that vaccine, being produced on a non-profit basis, would cost only about $3, per dose, as compared to $20-$30  for the more high-tech Pfizer and Moderna alternatives,

WHO aims to get 20 per cent coverage worldwide next year. Speaking at Friday’s WHO press briefing, Dr Soumya Swaminathan, WHO’s chief scientist, stated that the WHO co-sponsored Covax vaccine pool has so far secured deals for only 700 million vaccine doses.

“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 per cent of the populations of the countries that are part of Covax.”

Covax, a global pool to procure and distribute Covid-19 vacines equitably and affordably includes 187 member states; among those, some 92 countries will also require donor support for their vaccine purchases.

The Covax programme  “urgently needs another $5bn in order to meet that goal of two billion doses”, stressed Swaminathan.  She stressed that there is “no point in having products that do not reach the majority of the world’s population”.

WHO has also argued that rich countries stand to gain by providing the missing funds. A recent study supported by the Bill and Melinda Gates Foundation, found that the world’s ten largest donor countries could reap over $466bn in economic benefits by 2025 if they would fully fund the ACT Accelerator’s 2021 needs for Covid vaccines, tests and treatments. The funding would bring the pandemic under control faster, kickstarting the global economy more effectively, the report concludes.

World Trade Organization (WTO) debates IP “waiver” for Covid medicines and vaccines. Meanwhile, a parallel initiative by India and South Africa in the World Trade Organization (WTO) is attempting to address the access gap from another angle - proposing a broad WTO “waiver” on patents, copyrights, and trade secrets for Covid-related health products. The waiver proposal 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 which see this as a threat to domestic pharma interests.

WTO members are due to meet again today (10 December) to debate the waiver proposal – ahead of a full hearing by the WTO’s General Council on 17 December. A number of high- and middle-income countries, including Canada and Australia, have tried to mediate in the highly polarised debate, while leaders of the initiative have also threatened to put it to a vote.

Medicines access groups are stepping up their campaign on behalf of the waiver concept.

On Wednesday, a petition organised by the online campaign organisation 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.”