Shortage of Covid-19 vaccines in Latin America exposes inequality between rich and poor nations

RIO DE JANEIRO, BRAZIL – Latin America and the Caribbean lack the necessary amount of Covid-19 vaccines. By Friday, March 5th, the region’s countries had received 37 million doses, which are to be distributed among 630 million people.

The figure is only enough to administer fewer than six doses for every 100 inhabitants. Assuming a criterion of 2 doses per person, today the region can immunize 2.8% of its population. By contrast, in the United States, almost 1 in 4 citizens has already been immunized.

The inequalities in global distribution draw a map of the differences between rich and poor countries, as denounced in January by the World Health Organization (W.H.O.).

“Two-thirds of the vaccines were allocated to the 50 most powerful countries, and 0.1% to the 50 poorest countries,” warns Diego Tipping, president of the Argentine Red Cross. Mexico took its demand for greater equity in distribution to the UN Security Council. And it has received the support of Argentina, with which it has committed to manufacture 250 million doses by July in partnership with Oxford University and AstraZeneca pharmaceutical company. However, production has been delayed due to a shortage of packaging. Faced with the emergency, the “every man for himself” has escalated, as could also happen in Europe.

The result is that the total number of doses (37 million) does not reflect the capacity of Latin America and the Caribbean to serve their populations, given that 87% of the doses are in the hands of only 4 countries: Brazil (15 million), Chile (8.6 million), Mexico and Argentina (4 million each).

These four, plus Colombia, comprise the group of the five largest economies in the region. Countries like Cuba (which prepares its own formula) and Honduras have not received a single dose. Others like Paraguay (4,000), Ecuador (73,000), and El Salvador (20,000) have only a few thousand doses. The differences between rich and poor are striking.

The internal pressure suffered by the governments to outbid their neighbors, added to the current constraint in the supply end, has converted the concept of distribution based on solidarity among countries into a mirage. And the procurement model has done the rest. Based on a free market logic, rather than on a global health strategy, countries with fluid commercial ties have been more successful than the rest.

Chile is the best example of this: 30 trade treaties in force and a mature negotiating culture have enabled the Andean country to sign contracts for 60 million doses in three years, of which it has already received almost 9 million to distribute among 16 million inhabitants.

“The internal debates about the vaccine focus on the local level, on comparing where we stand in relation to our neighbor. And we should understand that access to vaccines is not only a humanitarian issue; it also relates to a successful strategy against the pandemic. There is no point in some countries vaccinating their entire population if others can’t even begin, because the virus will continue to spread,” says Argentina’s Tipping.

Most countries in Latin America and the Caribbean now rely on the Covax, the joint WHO/Global Alliance for Vaccines and Immunization (GAVI) mechanism to distribute 281 million doses equitably. Last Monday, the first 117,000 reached Colombia, a country that, like so many others, was left out of the first round of deliveries by private laboratories. The gap opened the way for Russia and China to introduce their own vaccines into the region.

While US Pfizer has fulfilled 1.6% of its contracts with the region and Britain’s AstraZeneca only 0.26%, deliveries of Russia’s Sputnik V vaccine and China’s Sinopharm are around 5% of what was agreed.

“Laboratories like Pfizer and AstraZeneca also had large commitments in Europe and the US, but the Russian and Chinese vaccines did not have these commitments. The Latin American countries that bought from Russia or China got vaccines first, because it is easier to be at the top of those labs’ list than those with commitments to the US and Europe,” explains Colombian Johnattan García Ruiz, a researcher at Dejusticia think tank and professor of Law and Global Health at the University of Los Andes. “It’s one thing to close a deal. It’s another for the lab to deliver.”

Brazil is a good example of issues related to shipments. The region’s largest economy reserved 415 million doses (more than half of them from AstraZeneca), but only received 15 million for a population of 210 million people. “Brazil did not buy the adequate amount in time” says Marcio Sommer Bittencourt, physician and researcher at the University of São Paulo (USP).

Bittencourt attributes the delay to the Bolsonaro government’s malpractice, which “did not accept the companies’ offers made before clinical studies were completed, created legal obstacles, did not facilitate the purchase of vaccines by the states, and did not seek alliances.”

At first glance, Brazil has reserved more vaccines than it needs, but so far it has only managed to vaccinate about 4% of the population, and that’s considering the total number of people who have been administered only one of the two doses of the immunizers. “Obviously, it is more difficult for a poor country to buy vaccines, but Brazil is an intermediate country, like Chile, Morocco and Turkey, which are ahead in vaccination,” he says.

Like Argentina and Mexico, Brazil bet on local production of vaccines in partnership with international laboratories, with the Butantan Institute (for China’s Coronavac) and Fiocruz (in partnership with AstraZeneca and Oxford) in the front line. But the USP researcher laments that the country is not developing its own vaccine against Covid-19, although it possesses the required technology. Gonzalo Vecina, former president of ANVISA, the Brazilian health regulatory agency recalls that Brazil “exports the yellow fever vaccine,” for example.

Last December 23rd, Mexico was the first Latin American country to receive the Covid-19 vaccine; however, like Brazil, it is far behind schedule on vaccinations, due to shortages. The government of Andrés Manuel López Obrador contracted the purchase of over 234 million doses of five different immunizers, but received only 1.7% of the agreed amount. “Mexico did what it could,” says Mauricio Meschoulam, professor at the Universidad Iberoamericana.

Meschoulam explains that the scope for action is very small for low- and middle-income countries, because the determining factor in negotiations with pharmaceutical companies is financing for the development of their vaccines. Thus, rich countries have asked for more vaccines than they need, and laboratories have offered more than they can produce, leaving other nations in limbo.

“We are facing a brutal inequality in vaccine distribution in the world,” Meschoulam says. A reality that has served for governments to justify delays in local campaigns. The Mexican protest at the UN goes along these lines. “The government tries to explain that ‘we are slow on vaccination and we would like to have more vaccines, but look at what is happening in the international context,'” Meschoulam says. The issues are compounded as national purchasing power decreases or as the political situation becomes more fragile. This is the case in Peru, in the hands of a transitional government after the early departure of President Martin Vizcarra, ousted by parliament.

In February Peru received 1 million vials from China’s Sinopharm, a purchase that was tainted by the so-called ‘vacunagate’, a scandal involving over 450 people who irregularly immunized themselves between September and January with doses that the company offered to the Peruvian government in August. The director of the Bartolomé de las Casas Center in Cusco, Carlos Herz, points out that these additional problems are the result of the “fragile institutionality of the state and poor management capacity.”

“The inefficient public structure causes us to have this amount of vaccines, but the particular political interests aggregate a delaying factor. This runs counter to the relationship capacity to buy,” says Herz.

Latin American and Caribbean countries, without exception, must solve the existing bottleneck in the production chain as soon as possible. They have little or no firepower against the largest economies.

Tipping, from the Argentine Red Cross, says the situation is very serious, but there is also an opportunity. “All presidents have an unparalleled responsibility, which is to think of a global strategy against the pandemic without countries looking at themselves and comparing themselves to the one next door,” he says.

Source: El Pais