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How Chile achieved Latin America’s most extensive and efficient vaccination program

RIO DE JANEIRO, BRAZIL – On average, Chile has been immunizing more than 200,000 people a day since February 3rd, and expects to reach 2 million people vaccinated within the next 72 hours.

Even the deadlines that the government had proposed have been beaten. According to health experts, one of the main reasons is the country’s vast experience in immunization programs. The truth is that beyond historical calculations and analysis, Chile became in just a few days a model to follow for its successful vaccination plan against SARS-CoV-2.

Chile achieved Latin America's most extensive and efficient vaccination program
Chile achieved Latin America’s most extensive and efficient vaccination program. (Photo internet reproduction)

According to the latest report, on Thursday, Chile had already immunized 1,550,594 people, a number that would rise on Friday with the routine 2 daily reports delivered by the Ministry of Health (MINSAL). This bold progress positions Chile as the country with the highest percentage of population vaccinated in the region. Such is the efficiency of its vaccination campaign that financial giant JP Morgan announced this week that, should Chile maintain its current pace, it will be the first emerging country to achieve herd immunity by the end of 2021.

According to the ‘Our World in Data’ website, Chile is the regional leader in this field, and has even outperformed countries such as China and Brazil in terms of the number of daily vaccinations per 100 inhabitants.

As a result, Chile is projected to exceed 5 million people vaccinated during the first quarter and to cover 80% of its population by June 2021, i.e., some 15 million people immunized.

However, the success of the Chilean vaccination program against the coronavirus is no coincidence. So far, two laboratories have supplied vaccines: Pfizer/BioNTech and Sinovac. So, how did the plan that is now considered a model to be followed start, and when did negotiations with these pharmaceutical companies to secure the doses available in the country begin?

Preliminary steps

May 2020 was one of the most critical months in Chile in terms of pandemic impact. According to figures at the time, 99,688 of the 723,493 total infections were recorded during this period, resulting in 827 deaths out of the 19,262 cases reported during the month.

While the pandemic was raging and the prospect of a vaccine was still distant, a group of health authorities planned a strategy to anticipate agreements with those who, in an as yet unspecified future, would become the drug’s main suppliers.

Authorities in an interdisciplinary group set up by then Health Minister Jaime Mañalich, along with the Ministry of Science and the Ministry of Foreign Affairs, set up meetings with a total of 11 laboratories. Soon after, agreements were reached with five of them. The Chilean government’s plan was to establish early communication with these companies. As their vaccines were approved by regulatory agencies in their own countries, the signing of a pre-contract was quickly agreed upon. The months went by and, despite a change in Health Minister, negotiations did not stop.

In the most difficult days of the pandemic, the Chilean health authorities decided on a two-fold task: on the one hand, to control the spread of the virus and its consequences with measures, and on the other, to negotiate agreements with pharmaceutical companies in order to secure vaccines.

In order to reach urgent agreements, several meetings were required, first online and then with trips to the city of Abu Dhabi, in the Arab Emirates, Pfizer and BioNTech’s main operations hub, where confidentiality clauses and letters of intent were agreed upon to arrange clinical trials in Chile in exchange for special conditions that would guarantee a considerable number of doses, promptly and at a low price.

August was the peak month in terms of negotiations. Coordination was established with LATAM and MartinAir airlines, which were asked to provide special logistical support, crucial for closing agreements. The use of highly refrigerated and exclusive containers was required for the shipment of doses – a key requirement that Chile managed to guarantee through public-private agreements with transport companies.

In late September, MINSAL authorized two clinical trials of Sinovac Biotech Co., Ltd. and Janssen Pharmaceutical Companies’ vaccines, which gave the go-ahead for the conducting of tests and quality checks in its territory. These clinical trials began between late October and the first days of November, with no more than 3,000 volunteers. The vaccines were gradually approaching.

Authorities comprising an interdisciplinary group set up by then Health Minister Jaime Mañalich, along with the Ministry of Science and the Ministry of Foreign Affairs, set up meetings with a total of 11 laboratories
Authorities comprising an interdisciplinary group set up by then Health Minister Jaime Mañalich, along with the Ministry of Science and the Ministry of Foreign Affairs, set up meetings with a total of 11 laboratories. (Photo internet reproduction)

The first agreements

In late July 2020, the Catholic University of Chile (UC) and the Millennium Institute signed a clinical trial agreement with Sinovac. This was the first contact with the CoronaVac manufacturer for clinical trials to begin in November that same year.

This approach was crucial for the Chilean government to reduce the vaccine’s end price, which in other countries is sold at US$14 per dose. This guaranteed Chile the availability of 10 million doses in a first stage and, moreover, to reserve a second “purchase option” for another 10 million doses.

Despite the fact that the information was highly confidential, it was reported from within the government that health authorities were in favor of the Sinovac vaccine proposal, given that it was positively evaluated, according to portfolio data which showed that it was “less risky”. In addition to the approval of trials being conducted at the Catholic University of Chile, which confirmed the positive outlook for the future.

Complex negotiations with Pfizer

In July 2020, along with the progress achieved with Sinovac, negotiations were also being held with Pfizer-BioNTech through its general manager in Chile, Marta Diez. However, initially, the company demanded the signing of preliminary contracts before making a reservation. A deal that was a novelty for Chile and therefore difficult to close, because it had not encountered this contractual arrangement with other laboratories.

Although it was the first vaccine to reach Chile, it was the one that caused the most complications during the negotiation process.

Negotiations took longer than expected. Moreover, the contract was subject to US laws, which led the Chilean government to hire a New York law firm to assist in the process. In addition, Chile intended to be dealt with in the agreement as a ‘middle-income country’, so that the price to be set would be lower than what was being offered to developed countries. To this end, documents from the Chilean Central Bank had to be submitted, which confirmed that the Chilean economy had regressed 8 years following the 2019 social crisis and the subsequent health crisis.

Despite concerns and mistrust, in September a contract was signed with Pfizer-BioNTech for the purchase of 10 million vaccines doses.

The arrival of the first doses

As announced by President Sebastián Piñera, the first doses of the Pfizer vaccine arrived on December 24th, 2020. Chile was the second country in Latin America to receive the drug, after Mexico. “These vaccines are a glimmer of hope that will light the way for us,” said the president after supervising the first shipment to land on Chilean soil.

On the same stage of the reception ceremony, Piñera announced that another 10,000 doses would arrive during the following week, thus completing the first 20,000 vaccines pledged. “Many people have worked hard for a long time to guarantee that our people will have a safe, effective and prompt vaccine,” explained the head of state.

Days later, on January 20th, 2021, the exceptional use of Sinovac’s CoronaVac vaccine was also approved by the Institute of Public Health (ISP) and its administration in seniors was later approved. On January 28th, the plane with the first shipment of 1.9 million doses landed, and on January 31st, another plane with a second shipment of a further 1.9 million doses was announced, thus advancing that 10 million vaccine doses should be available in the short-term, as established in the contracts signed between the pharmaceutical company and the Chilean government.

Santiago de Chile. (Photo internet reproduction)
Santiago de Chile. (Photo internet reproduction)

The Chilean model

Physician Eduardo Savio, coordinator of the Immunization Committee of the Pan American Association of Infectious Diseases, assured that Chile’s immunization plan against Covid-19 is a model to be followed in the region. “They implemented a comprehensive program, which is very fast-acting and with the guarantee that they are receiving vaccines from suppliers, something that does not happen to just anyone, on time and in the right way.

“This is particularly important because today, more than ever, vaccinating populations quickly is more important than ever. A rapid implementation campaign that can achieve the herd immunity we all seek before the emerging SARS-CoV-2 strains have a chance to invade and begin to compromise the efficacy of vaccines, as has already occurred in South Africa with one of these strains,” he said.

With these data in hand, the Chilean vaccination plan intends to advance quickly. In total, 35 million vaccines have already been reserved by Chile for its population: 10 million from the US-based Pfizer-BioNTech, another 10 million from China’s Sinovac and the remainder from AstraZeneca, Johnson & Johnson and the Covax platform from the W.H.O.

Three new shipments of the Chinese Sinovac vaccine are expected to arrive in the last week of February and early March. This was announced on Thursday by Health Minister Enrique Paris.

“Last night we had a meeting with Sinovac and they assured us three more shipments of 3 million doses each, which means that we will have 9 million new doses. Two more shipments will come in the last week of February and one in the first week of March,” he said.

He also mentioned the delay in the delivery of the Pfizer vaccines, announcing that these shipments are expected to start arriving on February 15th. “We will be replenished with the vaccines that could not be delivered, I estimate that there should be about 400,000 additional doses,” he added.

The arrival of the 4 million AstraZeneca vaccines set in a pre-contract signed last November is also expected for April. While 7.6 million doses of the Covax vaccine are expected to land that same month, along with another shipment of 4 million vaccine doses from Johnson & Johnson’s Janssen.

With the above, health authorities are not ruling out that in the very near future negotiations will begin with Novavax, a North American laboratory linked to India’s Serum Institute, with which Chile has already had earlier contacts for the supply of more vaccines against the coronavirus. An agreement with the Russian laboratory which developed the Sputnik V vaccine has also been officially announced recently.

The calendar

The mass vaccination schedule began last February 3rd. At the time, seniors aged over 90 were vaccinated. From then on, the age range was gradually reduced. On Friday, February 12th, those over 71 years of age were immunized. The process began very early with the vaccination of President Sebastián Piñera himself.

The process proposes to continue lowering the age range until reaching 65 year-olds on February 19th. On the same day, a new phase begins, which covers staff with essential tasks of direct citizen assistance, pharmacy employees, laboratory technicians, Law Enforcement and Security Forces and Armed Forces personnel deployed in the coronavirus action plan and staff who perform critical government tasks.

From February 22nd on, vaccination of the group with co-morbidities is scheduled to begin in parallel to the vaccination of people aged 60 and over. The process is expected to be completed on February 26th, with people aged up to 55. Next on the list are teachers and kindergartner workers; people who work in ONEMI, CONAF and Firefighters; staff who perform essential tasks in basic supply companies; people who work in transport companies, ports, airports; workers in the transport of essential products: food, medical supplies and medicines; prison guards and prisoners. The plan calls for the vaccination of 80% of the population by June 2021 at the latest.

Chile has already officially immunized 1,550,594 people against Covid-19, according to data provided by the Department of Statistics and Information (DEIS) up to 5 PM on Thursday, February 11th. In one day, 221,459 people were immunized. At this rate, by the start of next week more than 2 million people will have been immunized.

The plan is encouraging officials, who have even proposed to go further by delivering vaccines to more locations, preparing stadiums and vehicles to travel through the neighborhoods, taking the vaccine wherever it is needed. This is a successful process with transparent and detailed information, but which also considers other aspects that are part of highly confidential information, such as public spending and investment associated with negotiations, travel, agreements and contracts with Chile’s vaccine suppliers.

However, at present, this does not seem to be a matter for questioning, when what matters most is to urgently advance towards the long-awaited immunity, whose path does not seem to be utopia for Chile.

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