Covid-19 has raffled the feathers of all countries across the globe, creating a health crisis in a manner many, especially the developing world, never imagined.
With many developed countries worst hit by the pandemic, many in Africa, too, are being hit hard as the second wave of Covid-19 sweeps across the continent.
If there is a health God out there, he or she must indeed be angry and the Covid-19 wave is a strong message for serious disaster preparedness and management in future.
It is no secret that developed countries have a bigger financial muscle to purchase Covid-19 vaccines in plenty, putting less income countries under intense pressure to access them.
The issue of equitable access thus becomes an issue.
What has been done so far so that low income countries and the poorest countries who cannot purchase vaccines for their populations can do so?
Speaking during an HIV Research for Prevention (HIVR4P) Virtual Journalist Fellows Session titled: “Covid vaccines and treatments” last Tuesday executive director of the Wits Reproductive Health and HIV Institute, University of Witwatersrand and professor in the Department of Obstetrics and Gynaecology, Helen Rees, said equitable vaccine access is critical hence the COVAX facility which has 190 plus countries, from the biggest superpowers to poorest small income countries who will have vaccines purchased for them through donors, bilateral agreements etc.
She said the whole idea of COVAX is to try to level the playing field so that every country, before anyone gets more, has 20 percent of their population covered.
COVAX is the global initiative to ensure rapid and equitable access to Covid-19 vaccines for all countries, regardless of income level.
However, she noted there has been over purchasing of vaccines by richer countries pointing out that some of that was with good intentions.
“If we take Canada for example, they did not know which of the vaccines were going to work so they invested upfront in a number of vaccines in anticipation that at least one of them would work. Then we found out that a number worked, meaning there was a massive oversupply in their country,” said Prof Rees.
She said Canada was now doing bilateral negotiations with COVAX.
“Some countries have stuck their heels in and said its us first,” said Prof Rees. “We are going to see a situation which started with a statement from the US saying we are going to vaccinate everyone first, while Africa has nothing.
“The tragic irony for us in the global health is we are going to be vaccinating people with a very low risk profile throughout rich countries when we still have very small amounts of vaccines for the poorest countries of the world, including the African region.”
Prof Rees revealed that COVAX was pushing very hard, but the African Union had also come out with strong statements that they wanted to see 60 percent of all African countries populations protected with vaccination.
“AU is pushing very hard with vaccine developers to try to get access to the vaccines through COVAX and their own negotiations,” she said. “As global citizens we have to keep raising our voices to say it does not make sense in terms of epidemiology to try to protect one ring fenced country perfectly while we have a continent that hardly has any.”
Professor of Mucosal Infection and Immunity at Imperial College, London Robin Shattock said global access involves critical drivers.
These include production capacity and which vaccines can be produced in scale.
He said the other driver is cost, with huge differences in the price between vaccines.
“The third aspect is stability,” said Prof Shattock. “We know some of the vaccines have to be kept frozen and are completely inappropriate for countries that do not have a high level of freezer capacity.
“Its likely that there may well be trade-offs between choosing vaccines that may be most efficacious versus those that are available, cheaper and easier to introduce in a timely fashion.
“I think we will be struggling with such discussions in the year to come.”
Despite the challenges, a lot of work is taking place on the ground and the health gods seem to be forgiving.
On Friday, COVAX, announced the signing of an advance purchase agreement with Pfizer for up to 40 million doses of the Pfizer-BioNTech vaccine candidate, which has already received WHO emergency use listing.
In a statement, Gavi, the Vaccine Alliance, said the rollout will commence with the successful negotiation and execution of supply agreements.
In further support of its mission to expedite early availability of vaccines to lower-income countries and help bring a rapid end to the acute stage of the Covid-19 pandemic, COVAX also confirmed Friday that it will exercise an option — via an existing agreement with Serum Institute of India (SII) — to receive its first 100 million doses of the AstraZeneca/Oxford University-developed vaccine manufactured by SII.
Of these first 100 million doses, the majority are earmarked for delivery in the first quarter of the year, pending
WHO Emergency Use Listing.
The WHO review process, which is currently underway, follows approval for restricted use in emergency situations by the Drugs Controller General of India earlier this month, and is a critical aspect of ensuring that any vaccine procured through COVAX is fully quality assured for international use.
According to the latest WHO update, a decision on this vaccine candidate is anticipated by the middle of February.
COVAX also anticipates that, via an existing agreement with AstraZeneca, at least 50 million further doses of the AstraZeneca/Oxford vaccine will be available for delivery to COVAX participants in Q1 2021, pending emergency use listing by WHO of the COVAX-specific manufacturing network for these doses.
A decision on this candidate is also anticipated by WHO in February.
“Today marks another milestone for COVAX: pending regulatory approval for the AstraZeneca/Oxford candidate and pending the successful conclusion of the supply agreement for the Pfizer-BioNTech vaccine, we anticipate being able to begin deliveries of life-saving Covid-19 vaccines by the end of February,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, which leads COVAX procurement and delivery.
“This is not just significant for COVAX, it is a major step forward for equitable access to vaccines, and an essential part of the global effort to beat this pandemic. We will only be safe anywhere if we are safe everywhere.”
Preparations, led by WHO, Unicef and Gavi, are already well under way for COVAX to deliver vaccines to economies eligible for support via the COVAX AMC, with Gavi making US$150 million available from its core funding as initial, catalytic support for preparedness and delivery.
“The urgent and equitable rollout of vaccines is not just a moral imperative, it’s also a health security, strategic and economic imperative,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation.
“This agreement with Pfizer will help to enable COVAX to save lives, stabilise health systems and drive the global economic recovery.”
Building on the work of the past months supporting country readiness efforts, a “Country Readiness Portal” will be launched by WHO this month, which will allow AMC participants to submit final national deployment and vaccination plans (NDVPs).
This is a vital step before allocations can be made, to ensure that delivered doses are able to be effectively deployed and to identify where, if necessary, further support is needed.
“These purchase agreements open the door for these lifesaving vaccines to become available to people in the most vulnerable countries,” said Unicef Executive Director Henrietta Fore.
“But at the same time we are securing vaccines we must also ensure that countries are ready to receive them, deploy them, and build trust in them.”
The COVAX Facility intends to provide all 190 participating economies with an indicative allocation of doses by the end of this month.
This indicative allocation will provide interim guidance to participants — offering a minimum planning scenario to enable preparations for the final allocation of the number of doses each participant will receive in the first rounds of vaccine distribution.