a new study shows rich country stores for vaccines against Covid-19 could mean fewer billions of vaccinations in low-income countries

Durham, North Carolina – The information shows that members of a global treaty are promising vaccine taxes among those who undermine the initiative; madness of transactions covers about 8.8 billion doses

A new global review of purchase agreements for COVID-19 vaccines shows that high-income countries, as well as some middle-income countries, have purchased production capacity of nearly 3.8 billion doses, with options for another five billion. The analysis, released today by the Duke Global Health Innovation Center, shows that many of these countries will be able to vaccinate their entire population – and sometimes many times – before vaccinating billions of people in low-income countries.

“An ambitious effort to create a global system of vaccine equality is being undermined as a handful of countries – including those committed to equality – are getting as many doses as they can,” says Elina Urli Hodges, MSPH, what the Centers Start and scale speedometer, an initiative that identifies barriers to delivering health innovations to low-income countries. “Countries hedge bets by entering into direct transactions, while also participating in multilateral platforms, which drive inequality and threaten to prolong a global pandemic.”

While other assessments have warned of potential inequalities in access to vaccines, this new analysis is the first to accurately quantify the amount of vaccine doses required by country agreements and how it could delay access to COVID-19 protection in large regions – South Africa of the Sahara included – until almost the middle of the decade.

The analysis of the launch and scale revealed that although it is likely to take three to four years to produce enough vaccines to cover the world population, nearly four billion doses of COVID-19 vaccine candidates are already part of bilateral pre-sale contracts in which mainly countries with high incomes are involved. , vaccine developers and global vaccine manufacturers. Another five billion doses are subject to negotiations between the same parties that have yet to be completed. Meanwhile, the study found that only enough doses to cover 250 million people had been confirmed so far by COVAX, a global effort involving rich and poor countries, and that equal access to COVID-19 vaccines worldwide was promised, regardless of income levels.

In fact, the data reveals that several COVAX signatories, including the United Kingdom (UK), the European Union (EU) and Canada, are effectively undermining the treaty by negotiating ‘side deals’ for large vaccines that’ piece of pie available for equitable global award. However, the analysis shows that no low-income country has entered into a direct agreement to purchase vaccines, indicating that low-income countries will be limited to the COVAX treaty-safe treaty.

The researchers found, for example, that Ethiopia, the second largest country in Africa, relies on COVAX for enough vaccines to cover 20% of the population, and that it does not have the potential to secure additional doses. But overall, the research points to a sad conclusion: that most people in low-income countries will wait until 2024 for COVID-19 vaccinations if high-income countries continue to participate in what some ‘ call vaccination ‘. For example, it is estimated that COVAX requires at least 1.14 billion doses of single-dose vaccine and twice as much for a two-dose regimen to achieve the goals of vaccinating at least 20% of member states. Currently, most COVID-19 vaccine candidates require two doses.

Finite global manufacturing capacity

“Negotiations are underway in which countries containing vaccines will assign doses purchased through prior market commitments to the COVAX effort after inoculating a certain portion of their population,” said Andrea Taylor, MSW. initiative. “But there is no requirement, and probably little incentive to do so.”

Taylor and her colleagues conducted their assessment by reviewing available evidence from public sources until October 8, 2020, combined with interviews with global and local vaccine experts, as well as Ministry of Health officials in selected countries. The analysis looked at preconditions (AMCs) for COVID-19 vaccines to better understand their total volume and final destination.

The insights that emerged show that COVAX members Canada and the United Kingdom have already purchased more than enough vaccines to cover their entire population. The EU has secured the rights to up to 400 million doses for member states, with future agreements being discussed, which could potentially increase it to almost two billion. The United States (US), which is not part of COVAX, already has agreements to buy enough doses to cover 230% of its population, and could eventually control 1.8 billion doses – about a quarter of the world short-term inventory. However, none of the vaccine candidates have yet received approval from the regulatory organization, and therefore hedge countries commit by acquiring multiple candidates, and a portion of these doses may never materialize. The UK, for example, has created AMCs with five different vaccine candidates, using four different vaccine technologies.

Among the middle-income countries, the launch and scale data show that Brazil and India, each with a large infrastructure, have already secured the rights to enough vaccines to cover about half of their population and negotiate additional transactions. It also shows that some countries, such as Peru, use their status as the site of COVID-19 vaccine trials to secure AMCs for vaccines – although Peru also participates in COVAX to meet its needs.
According to the analysis, the root problem is that finite global manufacturing capacity conflicts with wealth disparities and self-interest to create a zero-sum game where low-income countries simply cannot compete.

“High-income countries are engaged in large-scale vaccine developers who in turn retain most of the world’s manufacturing capacity to meet these obligations,” Taylor said. “We are rapidly reaching the point that soon even in countries that have the money to buy vaccines, they will find that there is no manufacturing capacity available to meet their needs. Even with new investments to build or supplement additional facilities, there is a limit to how much global vaccine manufacturing capacity can expand in the next few years. ‘

The study reveals, for example, that some vaccine candidates – one from the University of Oxford / Astra-Zeneca (AZ) and another from the US vaccine developer Novavax – are subject to agreements with global manufacturers to increase doses of 3.73 billion liver. About 3 billion of the doses come from the Serum Vaccine Institute of India. Meanwhile, both vaccine candidates are subject to major pre-purchase commitments from high- or middle-income countries. The Oxford / AZ vaccine candidate leads the package for AMCs in more than two billion doses, although it includes between 300 and 500 million doses for COVAX. In response to this climate, COVAX has moved rapidly to maintain production capacity in Spain and Korea for more than a billion doses of one or more vaccines yet to be selected.

Distribution Challenges

Taylor said the outlook for vaccines for low-income countries could be even darker than captured in advanced purchasing data, given that the vast majority of low-income countries need vaccines that do not require extreme cooling. not – and that means only certain candidates in development will be suitable.

For example, one of the leading vaccine candidates in late-stage trials – a Pfizer formulation – requires storage at temperatures ranging from 60 to 80 degrees Celsius, or about 76 to 112 degrees Fahrenheit. Meanwhile, a Johnson & Johnson vaccine candidate, although sent to be frozen, can be stored for a few months at typical refrigeration temperatures and requires only one dose, two factors that will ease distribution challenges in low-income countries. But the analysis of the launch and scale showed that the US, UK, EU and Canada have already negotiated major bargaining agreements for the Johnson & Johnson vaccine candidate, which could include low-income countries.

Taylor noted that other challenges affecting low-income countries excessively include the need to have supplies such as syringes shipped and made available in a timely manner for the arrival of vaccines. She also noted that although there has been great progress in developing a better infrastructure in low-income countries for vaccinations in children, COVID-19 needs vaccination campaigns aimed at adults and especially older adults.

“There are big challenges and it can be overcome,” Taylor said. “But without knowing if they have access to vaccines or the amount of doses or the type of cold storage needed for vaccines they can get, it is difficult for countries to aggressively prepare.”


About the launch and scale speedometer
The Launch and Scale Speedometer aims to systematically analyze the factors that support or hinder the setting and scale of interventions, including but not limited to drugs, diagnostics and devices to address critical global health challenges. In addition to the quantitative and qualitative research on specific health interventions, the speedometer research will also focus on the introduction and scaling up of interventions in India and Ethiopia. The Launch and Scale Speedometer is led by the Duke Global Health Innovation Center. Find out more: https://launchandscalefaster.org/about

About the Duke Global Health Innovation Center
The Duke Global Health Innovation Center’s mission is to study and support the scale and adaptation of innovations and related policy reforms to address critical health challenges worldwide. GHIC links global health, health policy and health innovation efforts at Duke University. The GHIC shares knowledge and resources through peer-reviewed manuscripts, white papers, knowledge products, webinar series, podcasts, personal workshops, and virtual forums. Our organization is also active in training next-generation physicians and health professionals through postdoctoral fellowships, one-on-one mentorship, internships, health education courses, and fieldwork opportunities. Find out more: https://dukeghic.org/


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