RIO DE JANEIRO, BRAZIL – Amid the race for a Covid-19 vaccine, a handful of countries such as the United Kingdom, the United States and Canada have taken the lead and started to immunize their populations.
The vaccine chosen by all so far is Pfizer/BioNTech’s, the first to disclose efficacy results and to be registered by a regulatory agency following the standard protocols. Other countries, like Russia and China, have already begun emergency vaccination of part of their populations, with immunizers still under study.
Countries that have signed agreements with leading pharmaceutical companies are now awaiting the completion of phase 3 trials and vaccine registration with their regulatory agencies.
However, according to an article published on Tuesday, December 15th, in the BMJ scientific journal, at least a quarter of the world’s population, or two billion people, will not be immunized before 2022.
The study, conducted by researchers at Johns Hopkins University (U.S.A.), assessed the purchases of doses of 13 of the main vaccine producers contracted by November 15th.
According to the results, purchases equivalent to 7.48 billion doses have already been effected, enough to immunize some 3.8 billion people – considering that the main vaccines use a two-dose scheme for complete immunization.
Of this total, approximately 51% has been reserved by wealthy countries, including the U.S. and the European Union, which represent less than 14% of the global population. The remainder is to be distributed to middle and low-income countries, which represent 85% of the world’s population.
The U.S. has purchased 800 million doses, the equivalent of 2.5 doses per person, and is the country with the highest number of cases in the world – one-fifth of the global total.
On the other hand, Japan, Australia and Canada together reserved 1.03 billion doses, although the three countries combined represent less than 1% of the total number of Covid-19 cases in the world.
Brazil has agreements for 142.9 million doses so far, of which 100.4 million through an agreement with the University of Oxford/AstraZeneca and another 42.5 million through the World Health Organization’s Covax Facility consortium. Another 160 million doses are to be produced by Fiocruz in the second half of 2021.
The country is negotiating the purchase of another 70 million doses with Pfizer/BioNTech. The 46 million doses in the agreement between the São Paulo government, through the Butantan Institute, and the Chinese manufacturer Sinovac were not included in the Ministry of Health’s report.
However, researchers have added the Sinovac doses to the Brazilian numbers for the purposes of their survey.
Middle and low income countries have the lowest amount of reserved doses per capita and should fall behind in the line for a vaccine, say the researchers. “Even the W.H.O. has not yet managed to raise the U$5 billion needed to ensure sufficient doses to the countries subscribing to the Covax,” says Anthony So, leading author of the study and researcher at Johns Hopkins University Institute of International Health.
Of the 189 countries in the consortium, 97 contributed funds to support the consortium, as was Brazil’s case. “However, the problem is the 92 middle- and low-income countries that are relying on the money raised by the W.H.O. to have access to vaccines. Covax’s goal of providing at least two billion doses by the end of 2021 may be compromised if it fails to raise more funds,” he says.
Thus, these countries may have 60% to 40% of their population with no doses in 2021 under the most pessimistic scenario, where wealthy countries increase orders already placed with companies, and also in the most optimistic scenario, where these same countries holding the largest agreements would provide the remaining doses to Covax.
However, at least six companies have signed agreements with low income countries. Among these agreements, AstraZeneca/Oxford is the leader in selling to middle and low-income countries, with more than two billion doses already reserved for these populations.
The pharmaceutical company has closed agreements with countries such as India and Russia to supply doses that will then be distributed to other countries that were unable to enter into individual agreements.
The Gamaleya Institute is developing its Sputnik V vaccine in partnership with the Russian Direct Investment Fund, and has already signed agreements for the distribution of 349 million doses outside Russia. One of these countries is Brazil, but the agreements, reached with the governors of the states of Bahia and Paraná, are stalled.
China is the third nation to contribute doses to low income countries. About 135 million doses of the CanSino and Sinovac manufacturers will be distributed to countries like Brazil, Mexico, Indonesia and Chile.
Other important data reported in the study concern the number of vaccine candidates that each country has chosen. Wealthy nations such as the United States, Canada, the United Kingdom and the European Union have signed agreements with at least six manufacturers, Japan and Australia with four and Chile with three. Brazil, however, has bet on only one vaccine so far: the AstraZeneca/Oxford vaccine.
The disparity between the purchases made by wealthy countries is also reflected in the technology investments. While countries like the U.S., Canada and the UK have bet on vaccines of all types, including the more expensive RNA vaccines (the unit price of the Moderna vaccine dose is US$37 and Pfizer’s is US$19.50, middle and low income countries have been unable to buy these vaccines in sufficient quantities, and have signed agreements mainly with AstraZeneca, whose unit dose price ranges between US$3 and US$4.
The authors acknowledge that the study has limitations, given that contracts are not public and cannot guarantee that doses will be delivered, but it provides a glimpse of the race for vaccines, showing how wealthy countries came out ahead to ensure their own supply, while leaving middle- and low-income countries with unclear access.
“It is possible that many of the vaccine candidates will not progress beyond Phase 3, and other options, more affordable, will emerge over time. But an effective response to the pandemic that has already infected over 73 million people and claimed 1.6 million lives will require greater effort and commitment, particularly from wealthy countries, to ensure the vaccine’s equitable and fair distribution to all nations,” conclude the authors.