23 January, 2021

Blog

The Great Vaccine Rollout & The Global Pecking Order

By Rajan Philips

Rajan Philips

Last Tuesday Britain became the first country to administer the first multi-nationally developed Pfizer-BioNTech coronavirus vaccine. 800,000  doses of the vaccine are being distributed among the Isle’s four nations in the first stage of the British rollout. Canada is starting its Covid-19 vaccination this week with 250,000 doses of the same vaccine; another 20 million doses are arriving next year along with over 350 million other vaccines. While welcoming the arrival of the Pfizer vaccine as “the beginning of the end of the epidemic in the UK,” Prof. Stephen Powis, medical director of the National Health Services England, has also cautioned that getting to the end itself is going to be a “marathon [and] not a sprint.” Britain has ordered 40 million doses so far and it will cover 20 million people with two shots each, 21 days apart. There are still 47 million to account for. It is a long haul.  

In the US, Donald Trump is not happy that Britain got the vaccine before the US and he is even madder that he will not be able to claim credit for vaccination in America as much of it will happen after he leaves office. In any event, many of his supporters may refuse to take the vaccine because it is not mentioned in the US Constitution! Under its military “Operation Warp Speed” vaccination program, the US has issued purchase orders for 800 million doses from the world’s six leading vaccine contenders, although there is some controversy about the timing of vaccine deliveries. Last Tuesday, Trump issued a meaningless executive order that all vaccines procured by the US must be delivered to the US first before vaccines are supplied to other countries. 

On Friday, the Pfizer vaccine was given ‘emergency use authorization’ by the US Food and Drug Administration (FDA), amidst controversy that the FDA was under pressure from the White House to expedite the authorization. Friday was also a record black day, with the highest daily numbers of infections, hospitalization, and deaths. More than 3,300 deaths were reported on a single day even as the vaccine rollout was getting underway.       

Russia meanwhile got ahead of both the UK and the US, launching three days before UK its nostalgically named Sputnik V vaccine in Moscow which accounts for about a quarter of Russia’s infections. In a new development last week, Russia’s Gamaleya Institute and AstraZeneca have agreed to carryout clinical trials in Russia to assess if their two vaccines, Sputnik V and Oxford-AstraZeneca, could be successfully combined – with a single shot of each instead of two jabs with the same, to ensure greater protection, a procedure known as “heterologous prime-boost.” 

For several months, China has been conducting mass trials involving millions of recipients for two of its five vaccines in development, Sinovac and Sinopharm. Beijing is yet to announce its internal vaccination program proper, but has already shipped 1.2 million doses of Sinovac to Indonesia, a nation of 274 million people. India has the world’s single largest vaccine manufacturer in the Serum Institute established in 1966, in Pune. The Institute has an annual production capacity of 500 million doses, and has production contracts with the Oxford-AstraZeneca vaccine as well as the Novavax vaccine. The first 100 million doses of Serum’s production are earmarked for use in India, while the rest will be open for distribution among developing countries. 

The vaccine rollout I have described here is hardly global in that it is tilted entirely in favour of wealthy countries, and excludes much of the rest of the world, with the exception of the two giant outliers – China and India. This global vaccine anomaly is being exposed and criticized by the People’s Vaccine Alliance that includes well known civil society organizations such as Oxfam, Amnesty International, Frontline AIDS, and Global Justice Now. The Alliance has pointed out that wealthy countries representing only 14 per cent of the world’s population have so far reserved 53 per cent of the most promising vaccines, and thereby limited the ability of the world’s nearly 70 poor countries to vaccinate only 10% of their populations for all of 2021. 

A majority of the developing countries are consigned to getting their supply from the pool of vaccines provided by the Covid-19 Vaccine Global Access (COVAX) facility, the global set up by the WHO to ensure “rapid, fair and equitable access to Covid-19 vaccines worldwide.” It is a partnership of high-income countries and lower-income countries involving 60% of the world’s population, with the former providing for the supply of vaccines to the latter. The expectations are that the WHO will supply 20% of a developing country’s population at no cost. But the reserved quantities for COVAX, according to the People’s Vaccine Alliance, now amount to a single dose for about three people in developing countries, or 16% of the population. Even that may not be fully available in 2021. The root of this problem is too much reliance on donor charity and too little desire to tackle the structural aspects of the anomaly.    

The Pecking Order

The world’s ten leading Covid-19 vaccine contenders, including the Chinese (Sinovac) and Russian (Gamaleya) manufacturers, have a total capacity to produce eight to nine billion doses a year. The chart below illustrates the current capacity and pre-order of each vaccine candidate. Of the ten contenders, excluding the Chinese and Russian contenders, only three vaccines – Pfizer/BioNTech, Moderna and Oxford/AstraZeneca, are at the point of getting public health authorization in multiple countries. The three have a combined annual capacity under four billion doses. Novavax and Johnson & Johnson are expected to join them in 2021, and raise the capacity to six billion doses. In other words, even in any best-case scenario, it will easily take at least three to four years before a majority of the world’s peoples can receive their two shots of the Covid-19 vaccine. 

pastedGraphic.png

Add to this what might be called the tragedy of the aggregate – in that while the combined global Covid-19 vaccine production capacity might exceed the world’s total demand, not every country, or not individuals within countries, would be equally positioned to receive the new vaccine without too much delay. Within the so-called high-income countries (HICs), the priority for vaccination is being given to the elderly, frontline healthcare workers, people with medical conditions, and those who are in essential services. But there is no reason-based system for distributing vaccines between different countries. The global pecking order privileges those in HICs far above the people in lesser income countries. The two charts below provide a snapshot of the per capita procurement levels (Calling the Shots); and the bulk vaccine orders placed by individual and groups of countries with different vaccine manufacturers.   

pastedGraphic_1.png             pastedGraphic_2.png

As shown in the chart, Canada leads the pack with confirmed orders for just under 10 doses for each of its 37.7 million people. Australia and Britain are procuring just over five does per head, while every other country or region is under 3 doses per head. At the bottom of the chart is COVAX, with a single dose for about three people. The bulk order chart shows 2.4 billion doses reserved for developing countries, whose estimated population, excluding China, is 3.6 billion people. Almost all of the reserved developing country supply will come from India’s Serum Institute and the Oxford/AstraZeneca and Novavax vaccines, which are considerably cheaper than Pfizer/BioNTech and Moderna. 

On the supply side, “all of Moderna’s doses and 96 percent of Pfizer/BioNTech’s doses are contracted to HICs. In contrast, 64 % of Oxford/AstraZeneca’s doses are pledged to  people in developing countries. But their supply can “only reach 18 per cent of the world’s population next year at most.” As well, Oxford/AstraZeneca’s deals are mostly with big developing countries like China and India, while the majority of developing countries are left to depend entirely on the COVAX facility. 

Vaccines as global Public Good

This global pecking order and the disparity between countries are inevitable to some extent, but the question is what efforts are being made by national and international leaders and agencies to mitigate this seemingly natural gap. The signs of mitigation are not as encouraging as the rhetoric of global reset and assertions of global solidarity. The same wealthy countries that have ratcheted up vaccine procurement, are also opposing the waiver of the World Trade Organization’s rules for protecting intellectual-property rights, that is required to facilitate the production of Covid-19 vaccines in developing countries. 

Led by South Africa and India, ninety-nine WTO members have called for a temporary waiver of WTO rules. The People’s Vaccine Alliance supports the waiver request, but it is being flatly rejected by the HICs, including the UK, the USA, Canada, Norway, and the EU. The HICs, which are under pressure by the pharmaceutical industry, are unsupportive of structural changes, and would rather prefer a charitable avenue like COVAX. The UK is the largest funder of COVAX, and is keener about urging for more donations than supporting any rules waiver. WTO decisions are normally reached through consensus, and so a majority vote will be meaningless if the HICs are not willing to compromise.

To address, these disparities, the People’s Vaccine Alliance “is calling on all pharmaceutical corporations working on Covid-19 vaccines to openly share their technology and  intellectual property through the World Health Organization Covid-19 Technology Access Pool, so that billions more doses can be manufactured and safe and effective vaccines can be available to all who need them.” In addition, the Alliance is calling for Covid-19 vaccines to be made as “a global public good—free of charge to the public, fairly distributed and based on need.” A first step would be “to support South Africa and India’s proposal to the World Trade Organisation Council to waive intellectual property rights for Covid-19 vaccines, tests and treatments until everyone is protected.”

It is indeed a pity that there should be so much global disparity in the production and distribution of Covid-19 vaccines, when all the scientific work and breakthroughs that created them have involved unprecedented international collaboration at every level. In 1955, when Dr. Jonas Salk at the University of Pittsburgh developed his successful vaccine against polio, the then generational scourge in the US and elsewhere, he was hailed as a “miracle worker,” but he declined to patent the polio vaccine, or to profit from it. He would rather let it be free for maximum global distribution. When asked, “Who owns this patent?”, Dr. Salk famously replied, “Well, the people I would say. There is no patent. Could you patent the sun?” Dr. Jonas Salk chose to walk away from a $7 billion worth patent and let his vaccine be a global public good. Why cannot Covid-19 vaccines be similarly another global public good? 

Print Friendly, PDF & Email

Latest comments

  • 9
    2

    Well there’s no reason to panic. The few vaccines that come to this land can be given to those who trust scientific facts. As for the moda sb’s who believe in water snakes, clay pots and delusional unproven theories of how Corona virus can contaminate ground water that is 100s of feet below the earth when a body is only buried under 6ft and also those moda sinhala buddhists who think that corona virus can grow in a body that is deceased when the corona virus needs a living host to grow. For these moda sinhala people, they can have their ‘pani beema’ and what other nonsense unemployed carpenters and cattle monks will come up with in their temples. And don’t worry, the absolute moda health ministry is there with their stamp of approval for these hocus pocus games being played to fool the masses.
    .

    • 1
      7

      The Modayas SBs are the ones who think depending on what you do to a lifeless rotting body defines the afterlife.

      • 7
        0

        Sorry, MSB are quite accommodating as to burial or cremation but it is another religious group which thinks so, and again I have quarrel with that as well, as it is a matter of “faith”, as faith cannot be a matter of argument.

        • 3
          0

          So sorry – Should read “again I have NO quarrel with that as well.”
          Profuse Apologies.

  • 1
    5

    It is unfortunate that the income issue is a problem. but to be honest it may be a blessing in disguise. (not for the dead of course)

    I have very little trust in Pfizer Moderna vaccines in fact any of them given everything is rushed. and in fact there were some very respected virologists who disagreed with the FDA approval who are not getting any publicity here in the US. True safety information is not known. and in my case, I distrust any medicine where these profiteering companies and countries push.

    I am not sure if people remember 1976 the swine flu debacle.

    It may be a good idea to wait a bit before injecting garbage into our bodies.

  • 4
    1

    I find it difficult to believe this to be true.
    .
    Won’t there be an effort to pirate? Obviously, I wouldn’t know how to set about doing this, but it gets done so often.
    .
    I’m using pirated Windows 7 right now, but I use Open Office instead of MS Office. I find that even “respectable” computer users (those of upper-middle-class origins) have not thought of using Open Source software.
    .
    Medicine may be different, but will it be all that different?

    • 5
      1

      The way things are going, Gota’s Generals may bungle even any pirating.
      .
      Why is it that so few appear to have looked at this article which may be on its last day of comment acceptance?
      .
      https://www.colombotelegraph.com/index.php/corona-are-we-paying-a-big-price-for-being-dishonest/
      .
      I don’t understand why readers appear to focus on articles which allow them to bring in comments which allow the Sinhalese, Tamil and Muslim communities against one another.

      • 2
        10

        is it necessary for you to post other people’s articles in your comments. don’t you have an original thought in your head! you think people here can’t read ? They are not all your students you know eskole mahattaaya.

        • 9
          0

          Dear a14455,
          “don’t you have an original thought in your head!”
          This question begs the answer that all knowledge is “original thinking” ? Yes it is someones first and passed on to others by some form of publishing. Then someone picks it up and passed on. Because not everyone has such “original” inspiration. So let us share what each knows. If you know already discard but some may add second hand “thoughts” to one’s armoury. Better be grateful.

          • 0
            5

            may be you are one of this guy’s students .lol I don’t blame you then.

            • 6
              0

              Regret – you are mistaken.
              From earlier comments, one may realise it is the other way round.
              SM could well have been my student if you consider our ages.

      • 6
        0

        Dear SM,
        Leaving aside your first sentence as speculation or sarcasm, I would fully agree with the rest.
        I brought this up when articles by Dr Saumya Liyanage and Dr Charles Sarwan appeared and very few commented. In fact I invited two regulars directly to comment on the second article above, but no takers.
        ……………..”I don’t understand why readers appear to focus on articles which allow them to bring in comments which allow the Sinhalese, Tamil and Muslim communities against one another”……………..
        To understand, you must realise how fractured our Society is. Divided we fall – as is happening now, Not only are we divided now as Sinhalese, Tamil and Muslim communities but even politically and railing against each other but not pausing to think Sri Lankan to get together. Also the Diaspora of both communities adds fuel from afar. to perpetuate these differences.
        …………….”articles which allow them” ………… and for this the CT moderator can do more.

      • 3
        0

        I see no reason to strive for “originality”.
        .
        When you give yourself the sort of pseudonym that you have, it doesn’t stay in the mind of the reader. I now see that you have made two comments on Dr Janapriya’s article. It may be that you are piqued that I hadn’t noticed.
        .
        If you were to start writing things in a less sniggering way, you may be read with understanding, and you may actually influence decision-making. As it is, you are just a troll.

        • 0
          0

          Dear SM,
          ……….”When you give yourself the sort of pseudonym that you have”……..
          May I kindly know to whom you say that ? Is it to a14455 or myself.
          Thanks
          Cheers

    • 4
      0

      S.M,
      “I’m using pirated Windows 7 right now, but I use Open Office instead of MS Office. “
      I do too, but I haven’t published my NIC number…….
      Do you know Microsoft has local agents who sue people using pirate Windows?

      • 3
        0

        Dear oc,
        .
        We are discussing CORONA vaccines, but the analogy in terms of systems for computers may be useful in understanding the issues.
        .
        Whilst Apple and Microsoft may each claim that their operating system is the more user friendly, it is said that Linux is not. We are mere users, not professionals, and it is not for us to strive for ultimate solutions. Given the confusing array of innovations and the opacity of profit-seeking vendors, I feel that our just throwing some ideas in (provided they are not cranky) may be useful.
        .
        https://en.wikipedia.org/wiki/Free_and_open-source_software
        .
        Far too much in education is tied up with politics. My own confusion may be reflected in this article that I posted hurriedly before the Presidential elections 13 months ago:
        .
        https://www.colombotelegraph.com/index.php/two-categories-of-presidential-candidates/
        .
        I speak there of a sixteen-year-old girl being who hadn’t seen a pen-drive, being given a state-of-the-art computer with Ubuntu installed. No follow-up by the government.

      • 3
        0

        PART TWO
        .
        The background of that girl is such that she has no access to professional advice, but this is a conscientious and bright young girl who would benefit from balanced views being presented. However, part of the problem is how conservative our society is. I have yet to see this girl!
        .
        To get back to Open Office, and Libre Office, these work well, and are legal. Sure, Bill Gates may prefer that they don’t exist, but I don’t see him bothering with individuals using them in conjunction with pirated copies of his Windows.
        .
        A quite new lap-top with Windows 8.1 installed was given us by my sister in Sydney who thought that they had upgraded to Windows 10. They hadn’t. However, they had paid the relatively high annual fee for Office 365. I pulled it out and installed Libre Office, which is working satisfactorily, with updates coming in. Worth exploring, oc.
        .
        What bearing does that have on the COVID vaccine? the superstitions floating around are obvious. However, intelligent discussion of the sort generated by this Rajan Phillips article is very necessary to win the co-opetation of the public in fighting this pandemic. For this to happen, only the TRUTH, as w know it, should be disseminated.

        • 1
          3

          I am not sure why you compare computers to the human body. It’s apples and lobsters.

          and this kid you are talking about is probably better off learning from youtube rather than from the instruction from a teacher who knows no better.

    • 5
      0

      Dear SM:
      Pirating isn’t impossible; surely will be capital and time intensive even for a company that already has a footing in vaccine manufacturing. Non-vaccine industry players are unlikely to venture in because of the expertise, time and resources that are required.

      Amazed these companies actually came up with effective vaccines in such a short period of time. Undoubtedly, they’d already been working for many years on vaccines for the other corona viruses (e.g. MERS in 2012, SARS in 2002) but without such urgency. The accumulated scientific knowledge would’ve gone a long way towards the speed of discovery of a vaccine for covid-19 and certainly not without good fortune.

      Waiving WTO rules will financially benefit companies which never invested in R&D for covid-virology/vaccination over the years.
      The first-line of resolution should be to make ways for the intellectual property owners to serve all parts of the world; will likely need to form partnerships in those countries to manufacture and supply the vaccine.

      Vaccines are administered to healthy people to prevent them from getting sick; the vaccine itself shouldn’t possess health risks or be lethal.
      Better not hope for pirated versions or waivers to fast track!

  • 7
    0

    Dear Mr. Philips, in answer to that final question :
    “When Dr. Jonas Salk at the University of Pittsburgh developed his successful vaccine against polio, ……. he declined to patent the polio vaccine, or to profit from it. ……….Dr. Jonas Salk chose to walk away from a $7 billion worth patent and let his vaccine be a global public good. Why cannot Covid-19 vaccines be similarly another global public good?”
    I can think of two reasons, arguably of course.
    1. That was in 1954 +/- and just after the war and there was a feeling of get togetherness. Social values were different.
    2. Now the expense of research and development of any new medicine or vaccine is a huge cost after paying researchers, getting very special lab facilities and equipment. So discoverers are given a patent for a limited number of years to recoup their outlay and of course some profit as well, to research further on other medicines. Inventions may qualify for a patent much longer.

    • 5
      2

      AN ADDENDUM TO ABOVE.
      Another similar situation of current medical practice for “public good.”……
      The Doctors and Hospitals ask for the last cent on even the dying or ‘no hope’ patients. Now it is an ADVANCE PAYMENT Rs.50,000/- to cover hospital and doctors fee, even before touching the patient and diagnosis.
      There have been cases of withholding the “dead” till bill is paid.
      The days of the much maligned Vedas of yore who gave medicine free or to pay when you get the harvest, are gone.
      I say again. “Social values were/are different.”.

  • 1
    4

    sitrep24
    Muslims don’t need a vaccine.
    Praying to Allah ( PBUH) will immunise them all.
    The loudspeaker must be turned upside towards heaven so that Allah (PBUH) can hear rather than blasting our ears.
    (Mr sitrep24, what comes to our mind whenever we hear your loudspeaker is incompatible with CT editorial policy)
    .
    Don’t think of procreation and business deals while praying.
    .
    In our case clay statues don’t seem to respond to Covid 19.

    Soma

  • 1
    5

    Much of the discussion of the vaccine is based on the impression that the Corona virus is among the deadliest of viruses. It is rarely noted that COVID-19 is another flu, not the deadliest but the fastest spreading.
    The speed with which Big Pharma raced to market the product is stunning. Many of the standard procedures before adopting the vaccine for public use have been bypassed. (The politics of the race for the vaccine is another matter which I will not go into here.)
    There are flu vaccines commonly used in cold climates during winter. But their administration has been selective and targeting vulnerable sections of the population.
    The death to detection ratio varies widely with region and country. Both infection rate and death rate are substantially low in Cuba, Venezuela and Nicaragua than in their neighbours with more right of centre regimes.
    There is insufficient data on the age groups and health record of the dead. Such information will help governments to advise people on preventive measures and have a reliable strategy to deal with the infected with serious symptoms.
    Another question is whether the virus will last another year or two, and if after that a new flu virus crops up, with there be a search for another vaccine?

Leave A Comment

Comments should not exceed 200 words. Embedding external links and writing in capital letters are discouraged. Commenting is automatically disabled after 7 days and approval may take up to 24 hours. Please read our Comments Policy for further details. Your email address will not be published.