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Political leaders across the world have said everybody, everywhere, should be able to get a Covid-19 vaccine when it becomes available. But across Africa, health officials are growing increasingly concerned they won’t be able to afford the potentially life-saving therapies currently under development.
The deals a handful of governments are striking with pharmaceutical companies to secure millions of vaccine doses in advance of licensing approval suggest this pandemic could play out the same, old way the HIV-AIDS and swine flu crises did: rich countries first, the rest later — or maybe never.
“It’s almost like children fighting over food at home and the oldest child who is the strongest taking all the food and saying, ‘Listen, I will keep all this food for myself and I don’t care if my brothers and sisters have eaten or not,’” Chikwe Ihekweazu, chief executive officer at Nigeria’s Centre for Disease Control told POLITICO. He said that distributing vaccines “on a country’s ability to buy” would radically increase global inequity.
Pharmaceutical companies don’t want to be caught in the middle of the global rivalry, said Thomas Cueni, who leads the Geneva-based International Federation of Pharmaceutical Manufacturers and Associations. “Realistically, for everybody to get a vaccine, we might need around 12 to 15 billion doses,” he said. That could be a problem, given that “the five or six biggest vaccine manufacturers produce, in total, less than half of this volume in a year.”
Drugmakers are already working to ramp up their capacity to produce billions of extra doses, before they know if their vaccines would even be effective, Cueni said.
Some of those could be produced in Africa, hopes John Nkengasong, director of the Africa Centers for Disease Control and Prevention, an Addis Ababa-based agency of the African Union.
“We have manufacturing capabilities and capacity across the continent in South Africa, Tunisia, Egypt, Nigeria, Senegal,” he told POLITICO. “We should not just be standby spectators in this setting.”
Doomsday averted…for now
So far, the doomsday scenarios some feared when the pandemic reached Africa have not materialized. Among 1.2 billion people, the continent has reported 750,000 novel coronavirus infections and 13,000 deaths. More than half the infections and deaths are in South Africa. Nkengasong said that’s because countries locked down swiftly after seeing what was happening in China and Europe. But like in many other parts of the world, Africa’s numbers are increasing rapidly. “We see much more community transmission,” Nkengasong said.
Testing remains a challenge on the continent, both in terms of numbers of tests carried out and the speed by which results come back. Some 7.5 million people in Africa have been tested over the last four months, but Nkengasong thinks 13 to 15 million tests are needed each month to gain a better understanding of the virus’ spread. It can take between one to two weeks to get the results, increasing the likelihood that those who test positive will infect others.
How to avoid history repeating itself
Africa’s CDC, created in the wake of the Ebola outbreak in Western Africa between 2014 and 2016, has been instrumental in getting countries on the continent to cooperate during the coronavirus pandemic.
The next crucial step is a united front on vaccine access. African Union health ministers endorsed a strategy in June, working through the COVAX Facility, a GAVI Alliance-backed scheme to strike deals with manufacturers for vaccine doses. For rich countries, COVAX acts as insurance if their preferred vaccine never makes it to market, while for poor countries, it’s usually their only option. Seth Berkley, chief executive of the GAVI vaccine alliance, promotes COVAX as the “only truly global solution” for vaccine distribution.
At least 136 countries are interested in taking part in the scheme. Even if successful, COVAX would make available only 2 billion vaccine doses to participating countries by the end of 2021, well short of the doses needed to vaccinate everyone whose governments joined the scheme.
AstraZeneca, which is developing a vaccine with Oxford University, has committed to supply 300 million doses to COVAX. The drugmaker has already signed a deal with four European countries — France, Germany, Italy and the Netherlands — to supply them with 400 million vaccine doses at cost, if it proves effective.
Pfizer and BioNTech, which have struck deals with the U.S. and U.K. government, have expressed interest in supplying COVAX, as well, a Pfizer spokesperson said.
Both COVAX and pharma companies say they want to avoid a repeat of the swine flu pandemic a decade ago. Then, “a few countries cornered the vaccine market, leaving the vast majority of the global population with no vaccine at all until the outbreak was effectively over,” GAVI’s Berkley, the Coalition for Epidemic Preparedness Innovations’ Richard Hatchett and the WHO’s Soumya Swaminathan wrote in mid-July.
“The solution is likely going to be a mix of bilateral and global agreements,” IPFMA’s Cueni said.
COVID VACCINE RACE LATEST
By the numbers – 27: The number of vaccine candidates now in human trials.
The race is getting hotter: The world may have its first approved coronavirus vaccine in a few weeks time — from Russia. The vaccine could get the green light as early as Aug. 10, even though it has not yet been tested for efficacy and safety in thousands of people, which is typically a prerequisite for approval. Those tests will take place in parallel with the vaccination of health care workers, CNN reported. More than 60 percent of American voters are willing to accept delays to a vaccine if that ensures its safety, according to a POLITICO/Morning Consult poll out Wednesday. North Korea says it’s also in the vaccine race, though the claim is raising concerns that the project is really an effort to boost its biological weapons game.
Price tensions emerge: U.S. biotech firm Moderna, which has received almost $1 billion from the American government to develop its vaccine against coronavirus, plans to charge rich countries about $50 to $60 a dose, the Financial Times reported. The European Union is negotiating with drugmakers to pay less than $40 per shot, an unnamed EU official told Reuters. Berkley, chief executive of the GAVI vaccine alliance, said, “The truth is nobody has an idea what the price is going to be, because we have no idea which vaccine is going to work.”
Pharma execs cashing in via stock valuation: Executives and board members at pharma companies working on coronavirus vaccines have cashed in on big stock valuations, even though their product may never make it to market, the New York Times reported.
What happens after a vaccine is approved: Coming up with a vaccine that is safe and wins official approval is only half the battle. Then comes the issue of distribution, which poses challenges because of the massive supply needed and the trouble of shipping doses around the world.
Side effects: People also have to be prepared to accept some short-term discomfort after receiving the vaccine, which could include headache, sore arms, fatigue, chills, and fever. Such side effects are being seen across a number of different vaccines, made in different ways, STAT reported.
GLOBAL HEALTH SNAPSHOTS
Never dying alone: Hospitals in Chile have set up special units to avoid one of the most heartbreaking aspects of the pandemic: people dying alone in the hospital.
Nearly no place untouched: People traveling by small boat have spread the virus along the length of the Amazon River, making it as likely for people in some remote areas of Brazil to catch the virus as those in New York City. On the other side of the Atlantic Ocean, a cancer researcher is still trying to understand how an Italian island has been spared from the coronavirus outbreak.
Who you gonna call? Covid-busters! Volunteers have propped up Kyrgyzstan’s health system amid the pandemic.
— Ryan Heath contributed reporting