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Senam Agbesi tried to make the most of the confinement in London.
"I had a lot of Zoom encounters and took a lot of walks," he says.
Agbesi, 34, is manager of the National Health Service, and believes that he will possibly be vaccinated this month, as he is going to start working in a position where he will have to make frequent visits to hospitals.
Despite the good news about her vaccination, she is concerned about her father, Yao, who lives in the Ghanaian city of Accra.
Yao is 65 years old and suffers from sickle cell disease, a condition that increases the risk of suffering a severe form of COVID-19 if she contracts the disease.
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A close family friend recently died of the virus, and Agbesi would like her father to be more careful.
“Think of him as invincible.
In the morning he takes a cup of ginger and lime juice infusion and thinks he is surrounded by an invisible fortress, ”he jokes.
Yao has not been advised that he is to be vaccinated, nor has he seen any specific information in the media about the arrival date of the vials.
Forecasts indicate that the majority of the Ghanaian population will not be vaccinated until 2023, and other countries in sub-Saharan Africa will wait until 2024.
Poor countries will not only be forced to wait, but many are already being charged much higher prices per dose.
Uganda, for example, has announced an agreement to purchase millions of AstraZeneca vaccines at $ 7 a dose, more than three times what the European Union has paid for the same injection.
Including transportation fees, administering the entire vaccine to a Ugandan will cost $ 17.
Activists and scientists warn that we are heading for a "
vaccine
apartheid
" in which people in the global South will receive the injection years after those in the West.
This inequality will have important consequences.
Projections from Northeastern University in Boston and others indicate that if the first 2 billion doses of covid-19 vaccines were distributed in proportion to the population of countries, global mortality could be reduced by 61%.
On the other hand, if the 47 richest countries in the world monopolize the doses, there will only be 33% fewer deaths.
As the European Union discussed last week with AstraZeneca to secure more vaccines, the leaders mechanically repeated the mantra "no one is safe until we all are."
The uneven distribution on a global scale will be detrimental to all of us, as it will leave reservoirs of the virus scattered across the planet, from which new and perhaps more dangerous variants will emerge and spread.
Distracted by the infighting and protectionism of the West, we sleepwalking to a world with more cases, more economic chaos and more deaths.
Survival of the fastest
In the rush to secure vaccines for their citizens, and before knowing which ones would be most effective, countries quickly closed deals to receive billions of doses.
Some 12.7 billion doses of various coronavirus vaccines have been sold so far, enough to immunize about 6.3 billion people.
(At the moment, all approved vaccines require two injections, but some countries have already ordered a single-dose preparation that has yet to be approved.)
More than half of the doses ‒4,200 million insured, with the option to buy another 2,500 million‒ has been acquired by rich countries, where only 1,200 million people reside.
Canada has purchased enough doses to inoculate each Canadian five times, while those acquired by the United States, United Kingdom, European Union, Australia, New Zealand and Chile are enough to vaccinate their population at least twice, although some of the preparations have not yet been approved.
Low- and middle-income countries have reached agreements with pharmaceutical companies, but so far they have only secured 32% of the supply, with which they have to immunize 84% of the world's population
These huge orders already placed leave fewer doses for the poorest regions and raise questions about whether COVAX, an organization created to ensure that low-income countries have access to vaccines, will be able to achieve its goal of immunizing the most vulnerable in everyone throughout this year.
(COVAX has told the authors of
The Bureau of Investigative Journalism
that it is confident of achieving its purpose and hopes to surpass it.)
Low- and middle-income countries have signed deals directly with pharmaceutical companies, but so far they have only secured 32% of the supply, with which they have to reach 84% of the world's population.
In Israel, the country with the fastest vaccination program in the world, more than a third of the population has received one dose, and more than a fifth have received both.
The Palestinian Territories is still waiting for COVAX vaccines to arrive, although Israel recently announced that it would send 5,000 doses to immunize front-line Palestinian health workers.
“We are facing a crisis of gigantic proportions,” says Fatima Hassan, founder of the South African Health Justice Initiative.
“If even in South Africa we cannot get at least half the population vaccinated soon, I cannot imagine how they will cope in Zimbabwe, Lesotho, Namibia and the rest of Africa.
If this continues for another three years, we will not get continental or global immunity. "
Demand exceeds supply
This frenzy of vaccine hoarding is because the supply is finite.
Once the vaccine is developed, pharmaceutical companies have to modify the product so that it can be manufactured on an industrial scale, before transferring the technology to licensed factories around the world.
AstraZeneca, the company behind the adenovirus-based vaccine created together with the University of Oxford, has licensed its product to 10 other companies from the United Kingdom, India, Brazil, Japan, South Korea, China, Australia, Spain, Mexico and Argentina, which join their own factories in the United Kingdom and Europe.
While most of these companies are only allowed to produce the vaccine for a certain geographic area, this is at least a global manufacturing attempt.
Activists have criticized other pharmaceutical giants for failing to license more manufacturers around the world.
Many of them have focused more on supplying Western countries.
The American Public Citizen Foundation has discovered that Pfizer / BioNTech has guaranteed only 2% of its world production to COVAX, while last year those who knew about Moderna's plans thought that the American company intended to give priority to high-income countries. .
In January, the South African government made it public that Moderna did not intend to register its vaccine in the country.
The Pfizer and Moderna vaccines are also much more expensive.
Although many of the acquisition deals have been kept secret, information leaked by a senior Belgian official revealed that the European Union paid between $ 2 and $ 18 per dose, and that Pfizer and Moderna messenger RNA preparations were the most expensive. , with a price tag of more than $ 14, far more than low-income countries can afford.
Pfizer stated that it had "reserved doses to supply low- and middle-income countries at a non-profit price."
In Uganda, at least one Chinese company has been authorized to import doses to immunize its Chinese workers and their families before the Ugandans
AstraZeneca has promised that its vaccine will be available in perpetuity at cost price in the Global South (in Western countries there is a time limit not yet specified for this price).
However, some poor countries have already paid more for the vaccine marketed under another name.
In India, where much of the world's pharmaceutical production is located, the Serum Institute is manufacturing the largest shipments of AstraZeneca and Novavax vaccines.
However, since you have a non-commercial license for the AstraZeneca preparation, you can export your own ‒Covishield‒ version to 92 of the poorest countries in the world.
Unlike AstraZeneca, the Serum Institute has not promised to maintain the cost price, charging India three dollars a dose, South Africa and Brazil five dollars, and Uganda seven, while the European Union paid AstraZeneca only two dollars.
Neither AstraZeneca nor the Serum Institute responded to a request for comment.
Many countries, particularly in Latin America, Asia and the Middle East, have turned to Russian and Chinese vaccines, which have yet to be approved by what the World Health Organization calls a strict regulator.
According to the manufacturer's website, more than 50 countries have ordered the Russian Sputnik V vaccine.
China has administered at least 30 million doses of its vaccine to its citizens, and Turkey and Indonesia have started doing so.
Last June, Chinese President Xi Jinping promised African countries that they would "be among the first to benefit" from Chinese vaccines, but it is unclear if any have reached them.
In Uganda, at least one Chinese company has been authorized to import doses to immunize its Chinese workers and their families before the Ugandans.
Since inadequate supply is the cause of delays and inequity, many activists and public health experts have called on pharmaceutical companies to waive patents in order to allow more factories to produce vaccines.
Within two months of the pandemic being declared, WHO created a mechanism to share intellectual property and data.
Membership was voluntary.
Not a single pharmaceutical company has participated in it.
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Clash between the north and the south over the covid-19 patents
In October 2020, a group of countries, led by India and South Africa, asked the World Trade Organization to temporarily suspend intellectual property rights on covid-19 vaccines and drugs, which would mean that any manufacturer of generics could start producing them.
While the WHO supports the initiative, countries such as the United States, Canada, Australia, the European Union and the United Kingdom have sided with pharmaceutical companies to oppose it.
However, as a result of the recent dispute over delays in the supply of AstraZeneca in Europe, even the Council of the European Union is debating the waiver of intellectual property rights.
“We all fight for a piece of a small cake.
Why not increase the size of the pie so that everyone can get their fair share? ”Mogha Kamal-Yanni, global health policy adviser for the People's Vaccine Alliance, asked the Office of Journalism research.
Pfizer stated to the Office that those asking for the suspension of intellectual property "do not take into account the specific circumstances of each situation, each product and each country."
He added: "Long after the pandemic has passed, intellectual property will continue to play a critical role in ensuring that the world is prepared to provide innovative solutions to future global health crises, as well as other urgent medical needs."
Critical voices from the pharmaceutical industry argue that there is no capacity to produce surpluses due to a lack of both approved factories and trained technicians, so suspending patents would not increase supply.
Count on COVAX
Due to difficulties in guaranteeing the supply of vaccines, many poor countries will depend on COVAX, an organization created in April 2020 to facilitate "innovative and equitable access to covid diagnosis, treatments and vaccines."
The fund is coordinated by WHO, the Coalition for Epidemic Preparedness Innovations (CEPI), and Gavi, the Alliance for Vaccination.
COVAX Coverage: Countries Eligible for COVAX Subsidized Vaccines (Red), COVAX Donor Countries (Blue), None (Gray), Non-Binding Agreement to Fund COVAX (Yellow).
COVAX is aiming to deliver 2 billion doses worldwide by the end of 2021, including at least 1.3 billion for 92 low- and middle-income countries.
This would be enough to inoculate 20% of the population of each country - priority would be given to health workers, the elderly and people with previous pathologies - although this objective has been criticized as insufficient to fight the pandemic .
COVAX has negotiated advance agreements for these 2 billion doses.
However, Duke University analysts believe that doses can only be delivered this year, as planned, if the Serum Institute can produce the 900 million ordered as "options", something they consider unlikely given the capacity publicly declared by the company and the orders placed.
Analysts estimate that COVAX will rather deliver between 650 and 950 million doses spread across 145 countries, including some with confirmed agreements to receive enough vaccines to immunize their populations multiple times.
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Goal: 2 billion vaccines against covid-19 for the whole world
"The problem is that Gavi has never worked in a situation of competition for vaccines with rich countries," observes Achal Prabhala of AccessIBSA.
"It has never been in a situation where it tried to provide vaccines in high demand to developing countries and Western countries."
It is understood that COVAX relies on a legally binding agreement with the Serum Institute to deliver all of its optional doses, and that its figures do not include those donated by other countries.
Although many countries eligible to receive the alliance's vaccines have already reached other agreements to obtain more than sufficient doses, the uncertainty about the delays means that rich countries, including Canada and New Zealand, have chosen to receive the COVAX vaccines. in the first wave, rather than waiting for the poorest countries to get theirs first.
The organization states: “Nothing like COVAX has been tried until now, but we know what would happen without it.
As we saw in the 2009 H1N1 pandemic, countries that cannot pay would run out of vaccines for a year or more than wealthier countries.
We are currently on the right track to reduce this gap to a couple of months ”.
In January, Cyril Ramaphosa, president of the African Union, announced a deal for 270 million vaccines from various suppliers, hinting that the continent would not depend solely on COVAX.
A fairer way?
Experts differ on solutions to the vaccine supply crisis.
The WHO has asked manufacturers to prioritize sourcing COVAX, and has urged countries that have requested more doses than necessary to donate, although this seems increasingly politically unacceptable given the delays. in the deliveries that are taking place.
Until recently, COVAX had not established a donation mechanism and, for now, only Norway, which has recorded fewer than 600 deaths from covid-19, has agreed to donate doses at the same time as it carries out its national vaccination program.
Canada will contribute up to C $ 5 million to the facility, but cannot commit to setting a date to start delivering vials.
1. Percentage of the population that a country can vaccinate with the acquired doses.
2. Percentage of the population that a country can vaccinate with the acquired and approved doses.
Apart from this system, there are independent donation attempts.
The European Union has backtracked on its previous proposals to donate to COVAX on a regular basis, agreeing to send vaccines to immunize healthcare professionals in Africa and the western Balkans.
Australia and New Zealand have similar plans to sell or donate to neighboring Pacific countries, Southeast Asia, and the Polynesian Islands.
According to the
Times,
UK Health Secretary Matt Hancock acknowledged that the 400 million doses requested by his department "exceeded the needs of the British population", and stated that the Government would be generous while continuing to comply. your vaccination program.
Some activists believe that the WHO is naïve if it believes that asking countries to donate is a good solution.
"Honestly, I think it is the most ridiculous, unworkable ... and problematic solution I have ever seen," Prabhala ditch.
"I do not understand how at this moment someone could justify the donation of their vaccines without that having consequences."
A deadly and destructive delay
Without equal access to vaccines, it is feared that many low-income countries will not have sufficient reserves to immunize key segments of the population, including health care workers, in 2021. On the ground, health workers are making a big difference. effort.
"The situation is very tense," says Ireen Mutombwa, coordinator of national disaster management for the South African Red Cross.
"Everyone's life is in danger, especially when it comes to someone who works with the community."
Scientists are also concerned that allowing the virus to spread unchecked in some countries poses a greater risk to everyone.
"The more it circulates, the more likely it is to mutate," explains Marie-Paule Kieny, a virologist and research director at the French National Institute for Health and Medical Research.
Mutated strains could cause more direct deaths in countries with insufficient immunization coverage and cause vaccines to lose effectiveness over time.
Mutated strains could cause more direct deaths in countries with insufficient immunization coverage and cause vaccines to lose effectiveness over time
The economic cost to the world could be enormous.
A RAND Corporation study estimated that failing to distribute COVID-19 vaccines fairly could cost the global economy up to $ 1.2 trillion a year (another study raises the figure even higher, to seven times that amount).
RAND's simulation shows that, even if rich countries vaccinate their populations, they could still lose around $ 119 billion annually by denying supply to the poor.
"If you ask a random person on the street, you would never think that we could be financially dependent on low-income countries," says Marco Hafner, lead author of the study.
However, since rich countries depend on global trade linkages, the economic slowdown in poor countries caused by restrictions related to the pandemic will have a knock-on effect across the world.
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The price the rich will pay for not vaccinating the poor
"[There are] real financial incentives to give equal access to everyone rather than seeing it as some kind of act of charity," Hafner warns.
"If you compare the costs [of financing COVAX] with the benefits only for rich countries, they are negligible."
"Governments are realizing that the mantra 'no one is safe while we are not all' that they have been repeating while doing the opposite is true, and that they are in danger," sums up Kamal-Yanni.
"Due to mutations, countries are becoming aware that they cannot just vaccinate their own population."
In the UK, Senam Agbesi and her two brothers hope to travel to Ghana for Christmas after they have been vaccinated.
It seems unfair to them that they will probably receive the injection earlier than their father, who is more vulnerable.
"It is very frustrating," laments Agbesi.
“On the news we see the childish fight between the European Union and AstraZeneca.
'I i i'.
It only shows the selfishness of the Western world ”.
How to get first in line
Fund the research needed for an effective vaccine
The United States, the European Union, and the United Kingdom invested billions in the AstraZeneca vaccine, developed by the University of Oxford.
Germany invested $ 445 million in the vaccine created by Pfizer and its German partner BioNTech.
Moderna's vaccine was financed in the United States almost exclusively by the government.
Make your reservations as soon as possible
The United States, the European Union, and the United Kingdom bought billions of doses months before the vaccines were approved by regulators.
"They were not only the first to fund research and development, but also to make the reservations," recalls Achal Prabhala of AccessIBSA.
"It seems logical that they are the first to receive the doses."
Pay more per dose
Israel struck a deal to receive 10 million doses and obtained a promise of a continuous supply from Pfizer in exchange for data from vaccine recipients.
Apparently, the country also paid $ 30 per dose, double the price paid by the European Union.
Be able to make the vaccine yourself
India guaranteed enough vaccines for its 1.4 billion people by taking care of the bulk of world production.
The Serum Institute manufactures most of the AstraZeneca and Novavax vaccines, as well as its own version of the former under the Covishield name.
The Indian generic company Dr Reddy's has also signed an agreement to manufacture and market the Russian Sputnik V vaccine in India.
This article was originally published in English on The Bureau of Investigative Journalism
.
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