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Covid-19: Many poor countries will see almost no vaccine next year, aid groups warn

BMJ 2020; 371 doi: (Published 11 December 2020) Cite this as: BMJ 2020;371:m4809

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  1. Owen Dyer
  1. Montreal

At least 90% of people in 67 low income countries stand little chance of getting vaccinated against covid-19 in 2021 because wealthy nations have reserved more than they need and developers will not share their intellectual property, says the People’s Vaccine Alliance, which includes Amnesty International, Frontline AIDS, Global Justice Now, and Oxfam.1

“Unless something changes dramatically, billions of people around the world will not receive a safe and effective vaccine for covid-19 for years to come,” said Anna Marriott, Oxfam’s health policy manager.

Rich countries with only 14% of the world’s population have bought up 53% of the eight most promising vaccines, the alliance said, including all of the Moderna vaccine doses expected to be produced over the next year and 96% of the Pfizer-BioNTech vaccine doses.

Oxford University and AstraZeneca have pledged to distribute 64% of their vaccine in developing nations, but at best this will reach only 18% of the world’s population next year, the alliance said.

Mohga Kamal Yanni, a physician speaking for the People’s Vaccine Alliance, said, “Rich countries have enough doses to vaccinate everyone nearly three times over, whilst poor countries don’t even have enough to reach health workers and people at risk.

“The current system—where pharmaceutical corporations use government funding for research, retain exclusive rights, and keep their technology secret to boost profits—could cost many lives.”

The alliance is asking vaccine makers to share their intellectual property with the World Health Organization’s covid-19 technology access pool. It said that AstraZeneca-Oxford, Moderna, and Pfizer-BioNTech had received more than $5bn (£3.79bn; €4.13bn) of public funding in developing their vaccines.

Hoarding vaccine

The People’s Vaccine Alliance analysed eight vaccines for which significant supply deals had been struck with national governments: Pfizer-BioNTech, Moderna, AstraZeneca-Oxford, Novavax, Johnson & Johnson, Sanofi-GSK, Gamaleya-Sputnik, and Sinovac.

Some 67 low income countries have made no purchases of their own and are wholly reliant on the Covax programme—a collaboration involving WHO, Unicef, the World Bank, and the Bill & Melinda Gates Foundation, among others. That programme has secured about 700 million doses, enough to immunise just 10% of the population in those 67 countries.

The country with the biggest per capita hoard of the eight vaccines analysed is Canada, which has reserved enough for about five complete immunisations per citizen, the People’s Vaccine Alliance found. The United States comes second with roughly four vaccinations ordered per capita. The UK has ordered enough for about three vaccinations (5.7 vaccine doses) per head.

But these nations’ prospective stockpiles of vaccine shrank suddenly on 11 December—after the alliance published those figures—as two major vaccine programmes seemed to hit a wall. The Sanofi-GSK vaccine showed an insufficient immune response in older patients, its maker said, and would be delayed at least six months. Canada, the US, and the UK had ordered the largest stocks of this vaccine.

Meanwhile, on 11 December Australia cancelled its deal to buy the University of Queensland and GSK vaccine, which was recently blamed for false positive HIV test results. That vaccine, not included in the alliance’s analysis, represented more than a third of Australia’s vaccine orders.

A spokesman for Health Canada, when asked about its large vaccine orders, noted that the country had invested C$440m (£262m; €284m; US$345m) in Covax, most of which would go to vaccines used in other countries. Most experts believe that rich countries will eventually also donate their unneeded doses directly to Covax, although that was not how the programme was meant to work. But those countries will first wait to see how each vaccine performs and for how long they confer immunity. The likely result is that many poor countries will not see mass immunisation until 2022 or 2023.

One unapologetic hoarder of vaccines is the outgoing government of the United States, as President Trump this week signed an executive order telling vaccine makers to prioritise Americans. The order is widely seen as an attempt to neutralise a damaging New York Times story, which reported that in July the Trump administration had turned down the chance to reserve as many as 500 million doses of the Pfizer and BioNTech vaccine.2 As a result, the United States will probably receive only 100 million doses (50 million vaccinations) of that vaccine in 2021, while the EU has bought or reserved 300 million.

There is no mechanism for enforcing Trump’s order, which is purely symbolic. Moncef Slaoui, who leads the US government’s vaccine development programme, Operation Warp Speed, was asked at a press conference how the order was supposed to work. He answered, “Frankly, I don’t know, and frankly, I’m staying out of this.”

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