Will Low-Income Countries Have to Wait on COVID Vaccines?

M-Foto/Shutterstock.com

The global assessment of purchasing agreements shows that high-income countries, as well as a few middle-income countries flush with manufacturing capacity, have already purchased nearly 3.8 billion doses of the COVID-19 vaccine.

Rich countries are snapping up vaccines even before they’re ready, and it could mean fewer—as well as delays in vaccination—for billions in less wealthy nations, according to a new study.

The global assessment of purchasing agreements shows that high-income countries, as well as a few middle-income countries flush with manufacturing capacity, have already purchased nearly 3.8 billion doses of the COVID-19 vaccine, with options for another five billion.

The analysis shows that many of these countries will be able to vaccinate their entire populations—and some will be able to do so many times over—before billions of people are vaccinated in low-income countries.

“An ambitious effort to create a global system of vaccine equity is being undermined as a handful of countries—including those who made a commitment to equality—secure as many doses as they possibly can,” says Elina Urli Hodges, who leads the Duke University Global Health Innovation Center’s Launch and Scale Speedometer, an initiative that identifies impediments to delivering health innovations to low-income countries.

“Countries are hedging bets by making direct deals while also participating in multilateral platforms, which drives inequality and threatens to prolong a global pandemic,” Urli Hodges says.

While other assessments have warned of potential inequalities in vaccine access, the new analysis is the first to carefully quantify the amount of vaccine doses that are being claimed by country-level agreements and how this could delay access to COVID-19 protection across large regions—including sub-Saharan Africa—until almost the middle of the decade.

Long Wait for COVID-19 Vaccine

The Launch and Scale analysis revealed that while it will likely take three to four years to manufacture enough vaccines to cover the world’s population, nearly four billion doses of COVID-19 vaccine candidates are already part of bilateral advance purchasing deals involving mainly high-income countries, vaccine developers, and global vaccine manufacturers. Another five billion doses are the subject of negotiations among these same parties that have yet to be finalized.

Meanwhile, the study found that only enough doses to cover 250 million people have been confirmed as purchased thus far by COVAX, a global effort involving both wealthy and poor countries that has promised equal access to COVID-19 vaccines globally, regardless of income levels.

In fact, the data reveal that several COVAX signatories, including the United Kingdom (UK), the European Union (EU), and Canada, are effectively undermining the pact by negotiating “side deals” for large vaccine shipments that will “result in a smaller piece of the pie available for equitable global allocation.” Yet the analysis shows that not a single low-income country has made a direct agreement to purchase vaccines, suggesting that low-income countries will be limited to the COVAX pact to secure vaccines.

For example, the researchers found that Ethiopia, Africa’s second largest country, is counting on COVAX for enough vaccines to cover 20% of its population and has no avenues to secure additional doses.

Overall, the research points to a dismal conclusion: that most people in low-income countries will be waiting until 2024 for COVID-19 vaccinations if high-income countries keep engaging in what some are calling “vaccinationalism.”

For example, there are estimates that to meet its goals of vaccinating at least 20% of member countries, COVAX would need at least 1.14 billion doses of a single-dose vaccine and twice that amount for a two-dose regimen. Currently, most COVID-19 vaccine candidates require two doses.

“There are negotiations underway in which vaccine-rich countries would allocate doses purchased through advance market commitments to the COVAX effort after they have vaccinated a certain portion of their populations,” says Andrea Taylor, who led the analysis for the Launch and Scale initiative. “But there’s no requirement, and arguably little incentive to do so.”

Hedging Bets to Get COVID-19 Vaccines

Taylor and colleagues conducted the assessment by reviewing available evidence from public sources through October 8, 2020, combined with interviews with global and regional vaccine experts, as well as ministry of health officials in select countries. The analysis looked at advance market commitments (AMCs) for COVID-19 vaccines in order to better understand their overall volume and ultimate destination.

The insights that emerged show that COVAX members Canada and the UK have already pre-purchased more than enough vaccines to cover their entire populations. The EU has secured the rights to 400 million doses for member countries, with future agreements under discussion, potentially raising that number to almost two billion.

The United States, which is not part of COVAX, already has agreements to purchase enough doses to cover 230% of its population and could eventually control 1.8 billion doses—about a quarter of the world’s near-term supply.

None of the vaccine candidates yet have regulatory approval, however, so countries are hedging bets by purchasing multiple candidates and some portion of these doses may never materialize. The UK, for example, has made AMCs with five different vaccine candidates, using four different vaccine technologies.

Among middle-income countries, the Launch and Scale data show that Brazil and India—each of which have large vaccine manufacturing infrastructure—already have secured the rights to enough vaccines to cover about half of their populations and are negotiating additional deals. It also shows that some countries, such as Peru, are using their status as the site of COVID-19 vaccine trials to secure AMCs for vaccines—though Peru is also participating in COVAX to help cover its needs.

Root for the Problem

According to the analysis, the root problem is that finite global manufacturing capacity is colliding with wealth disparities and self-interest in which low-income countries can’t compete.

“High-income countries are making deals with major vaccine developers who are in turn reserving the lion’s share of the world’s manufacturing capacity to meet those commitments,” Taylor says.

“We’re rapidly reaching the point where soon, even countries that have the finances to shop for vaccines will find there is no manufacturing capacity available to fill their needs. Even with new investments to build or retrofit additional facilities, there is a limit to how much global vaccine manufacturing capacity can expand in the next few years,” says Taylor.

For example, the study reveals that a pair of vaccine candidates—one from the Oxford University/Astra-Zeneca (AZ) vaccine partnership and another from the American vaccine developer Novavax—are the subject of agreements with global manufacturers to produce 3.73 billion doses. And about 3 billion of those doses would come from the Serum Institute of India.

Meanwhile, both vaccine candidates are the subject of large pre-purchasing commitments from high- or middle-income countries. The Oxford/AZ vaccine candidate leads the pack for AMCs at more than two billion doses, though that includes between 300 and 500 million doses for COVAX. In response to this climate, COVAX has moved quickly to reserve manufacturing capacity in Spain and Korea for more than a billion doses of one or more vaccines that have yet to be selected.

Distribution Challenges

Taylor says the vaccine outlook for low-income countries could be even bleaker when considering that the vast majority of low-income countries need vaccines that do not require extreme cold storage. That means only certain candidates in development will be suitable.

For example, one of the leading vaccine candidates in late-stage trials—a formulation from Pfizer—requires storage at temperatures ranging from -60 to -80 degrees Celsius, or about -76 to -112 degrees Fahrenheit.

Meanwhile, a vaccine candidate from Johnson & Johnson, while it has to be shipped frozen, can be stored at typical refrigeration temperatures for several months and only requires one dose, two factors that will ease distribution challenges in low-income countries. But the new analysis reveals that the US, UK, EU, and Canada have already negotiated large pre-purchasing agreements for the Johnson & Johnson vaccine candidate, potentially shutting out low-income countries.

Taylor notes that other challenges that disproportionately impact low-income countries include the need to have supplies like syringes shipped and available in time for the arrival of vaccines. Also, she says that while there have been major advances in developing a better infrastructure in low-income countries for childhood vaccinations, COVID-19 will require vaccination campaigns targeting adults and especially older adults.

“There are significant challenges and they can be overcome,” says Taylor.

But, she adds, “Without knowing if they will have access to vaccines or the number of doses or type of cold storage needed for vaccines they may get, it is difficult for countries to move aggressively to prepare.”

This article was originally published in Futurity. It has been republished under the Attribution 4.0 International license.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.