COVID-19 shots: Cost putting rich ahead of the poor

While richer nations plan their vaccination programs through the end of 2021, poorer and developing countries face hurdles that could deny billions from protection.
COVID-19 shots: Cost putting rich ahead of the poor

Pfizer’s headquarters in New York.

Hailed this week as a pandemic game-changer, the latest COVID-19 vaccine offered countries that had pre-ordered doses a potential escape from a cycle of lockdowns and new waves of sickness and death.

But while richer nations plan their vaccination programs through the end of 2021, experts warn that poorer and developing countries face hurdles that could deny billions the first proven protection against the coronavirus.

Vaccine developers Pfizer and BioNTech plan to roll out the first doses within weeks, once they receive emergency use permissions from drug agencies. They expect to have 1.3 billion doses ready next year.

At the cost of US$40 per treatment, which consists of two separate shots, richer nations have rushed to order tens of millions of doses. But it is less clear what poorer nations can expect.

“If we only have the Pfizer vaccine and everyone needs two doses, clearly that’s a difficult ethical dilemma,” said Rudie Lang, director of The Global Health Network at the University of Oxford’s Nuffield Department of Medicine.

Anticipating the massive demand for any approved vaccine, the World Health Organization formed the COVAX facility in April to ensure equitable distribution.

COVAX brought together governments, scientists, civil society and the private sector.

Pfizer is not part of the facility. A company spokesperson said it had “provided an expression of interest for possible supply” to COVAX.

Rachel Silverman, a policy fellow at the Center for Global Development, said it was unlikely that much of the first vaccine batch would end up in poorer nations.

Based on advance purchase agreements signed with Pfizer, she calculated that 1.1 billion doses had been snapped up entirely by wealthy nations.

“There’s not much left for everyone else,” she said.

Some countries that pre-ordered, such as Japan and Britain, are part of COVAX, so some doses are likely to reach less developed nations through their purchase agreements.

Conversely, the United States, which has 600 million doses on order, is not a COVAX member.

Benjamin Schreiber, COVID-19 vaccine coordinator at the UN’s children’s fund UNICEF, said it was vital that all nations had fair access.

“We really need to avoid a situation of rich nations gobbling up all the vaccines and then there’s not enough doses for the poorest nations,” he said.

Ethics aside, epidemiological data underscores the need for equitable vaccine distribution.

This month researchers at America’s Northeastern University published research examining the link between vaccine reach and COVID-19 mortality.

They modeled two scenarios. The first, “uncooperative allocation,” hypothesized what would happen if 50 rich nations monopolized the first 2 billion doses of a vaccine.

The second saw the vaccine distributed based on a country’s population rather than its ability to pay for it.

The researchers found that the rich nation stockpiling scenario reduced COVID-19 deaths by 33 percent globally. The fair-share approach prevented 61 percent.

Commenting on the study, the Gavi vaccine alliance, which co-leads COVAX, said: “the modest gain for high-income countries in monopolizing vaccines was far less than the devastating losses for low-income countries if countries don’t cooperate.”

Logistical challenges

Even if finance for poorer nations materializes, the logistics of getting the new vaccine to everyone remains dizzying.

Pfizer’s vaccine is based on messenger RNA, which tricks the immune system to produce viral proteins itself that are then neutralized. It appears to be effective at bestowing protection against COVID-19, yet is extremely fragile: it must be stored at minus 80 degrees Celsius.

“Most freezers in most hospitals anywhere in the world are minus 20 degrees Celsius,” said Lang. “This is four times colder.”

Silverman said maintaining the vaccine’s “ultra-cold chain” from factory to patients’ arms constituted “an enormous logistical challenge even in the West.”

Although Pfizer and some governments have been preparing delivery protocols for months in anticipation of trial results, “none of that has taken place in low- and middle-income countries,” she said.

Pfizer has designed its own “thermal shipper” that can keep the vaccine supercool for up to 10 days.

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