These days, emerging countries are receiving their first vaccines against Covid-19. On Thursday, December 31, Mexico is thus administering a first batch ordered from the American-German pharmaceutical duo Pfizer-BioNTech. Very bereaved by the pandemic (more than 122,000 deaths to date), the country has also concluded agreements with the Sino-Canadian project CanSinoBio, for 35 million doses, and with the British AstraZeneca, for 77.4 million doses .
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Mexico is also part of Covax. This international mechanism, created this summer by the World Health Organization, will enable it to acquire 51.6 million additional vaccines. Covax has set itself the goal of providing at least 2 billion doses by the end of 2021, to immunize 20% of the most vulnerable people in 91 poor and middle-income countries. And expects to send the first doses in the next quarter for the countries of the South.
Fifth of the world’s population will not have access to the vaccine for two years
This first step will not prevent a two-speed world. In fact, a fifth of the world’s population may not be vaccinated until 2022 at the earliest, according to a study by the Bloomberg School of Public Health at Johns Hopkins University. Other studies even evoke 2024. This is because half of the eight billion doses ordered – at the rate of two doses per person – have been prepaid by rich countries. The “other” countries – more than four-fifths of the planet’s inhabitants – will share the other half.
But time is running out. Latin America is mired in the pandemic – five of the 13 most affected countries in the world are among them. Africa is discovering it, apart from South Africa, which is already very affected. “We are seeing an increase in cases in the Democratic Republic of the Congo, in cities as well as in more remote areas”, warns in particular Doctor Jean-François Corty, former director of operations at Médecins du monde.
World leaders reiterated that this vaccine should be a “Global public good”. Most countries, except the United States and Russia, have joined Covax, which is negotiating with laboratories for a fair distribution of vaccines. This global purchasing center also benefits from the experience of Gavi, the Global Alliance for Vaccines, created twenty years ago. “Equity in vaccines is part of international solidarity”, confirms Jean-François Corty. “This epidemic shows the inability of States to regulate in the face of the power of the pharmaceutical lobby”, he moderates, however.
“The risk of failure of the Covax program is very high”
Fact, “The risk of failure of the Covax program is very high”, one reads in an internal Gavi report. Countries may refuse to purchase the pre-ordered volumes through Covax if they acquire them by different projects, faster or at better prices. This is what is happening. The European Union prefers to buy its own stocks, so as not to be limited to a supply representing only 20% of its population.
Nathalie Ernoult, advocacy manager for the campaign for access to essential drugs at Médecins sans frontières (MSF), summarizes: “European countries have decided not to join Covax as customers. They have embarked on bilateral agreements with laboratories to make sure they are first served. And they will be. “ She denounces the lack of transparency of signed contracts: “The big winner, for now, is the pharmaceutical industry. She is in a strong position because she knows that the vaccine will allow the economy to restart. “
In addition, European countries seem to pay less for their vaccines than those collected in Covax. “These vaccines are purchased with taxpayer dollars and philanthropists, like the Gates Foundation. However, there is no transparency on the terms of the contracts concluded ”, notes Nathalie Ernoult.
Request for exemption to circumvent patents
It is therefore a solo vaccine race that begins. “The countries of the South have seen that the rich countries have thrown themselves on the masks and the respirators. This created a climate which prompted South Africa and India to request the lifting of patents from the World Trade Organization (WTO) ”, indicates Nathalie Ernoult.
This suspension of intellectual property in the event of a health emergency – a derogation from the Trips agreements of 1995 – was intended in the early 2000s, in particular to allow AIDS patients in poor countries to have access to copies of triple therapies produced. in India, South Africa or Brazil.
In November, the proposal by India and Brazil received the support of around 100 WTO member states. However, it has not been accepted by the United States, the EU, the United Kingdom, Switzerland, Canada, Japan or Australia.
Europe protects patents but gives part of its vaccine orders
Lifting patents on vaccines will not stem the epidemic in the south. “First, messenger RNA vaccines are difficult to develop. Then, for more traditional vaccines, the new producer will have to acquire the know-how and go through clinical trials and checks on the bioequivalence of the generic. That takes time “, explains Jérôme Weinbach, head of the health and social protection division at the French Development Agency (AFD). Clearly, a derogation from the Trips agreements would not allow emerging countries to produce vaccines as of next year.
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The EU prefers to give up purchased doses than to attack the intellectual property of its laboratories. “European countries have ordered many more doses than necessary. Donations are planned for these orders – from 5 to 15% of the quantities depending on the vaccines – to avoid surpluses and supply the poor countries that are members of Covax ”, explains Jérôme Weinbach.
That said, within the French administration, “We are discussing between ministries the possibility of agreeing to lift patents on respiratory devices or drugs” confides, on condition of anonymity, a French official.
Emerging countries are organizing themselves to ensure vaccines
While waiting for a hypothetical victory at the WTO, the South is getting organized. Nathalie Ernoult, at MSF, observes: “Middle-income countries such as Brazil and South Africa have hosted clinical trials on their territory and signed vaccine production agreements with certain pharmaceutical companies wishing to increase their capacity. Their project is to take advantage of part of this capacity for their populations. South Africa, India and Brazil have signed, for example, agreements with AstraZeneca. “
But it takes more than vaccines to tackle the pandemic. We also need tests for diagnoses, infrastructure – such as ventilators – for the treatment of patients, reliable vaccination centers.
“The operational challenge represented by a global vaccination program against Covid-19 will be at least as difficult to meet as the scientific challenge of their development”, says an editorial in the medical journal BMJ (British Medical Journal).
These are all the health systems that must be consolidated
This pandemic highlights the weaknesses of health systems. In the north as in the south. “It is necessary to reconcile this absolute urgency on vaccines with more general objectives of strengthening health systems, in line with the sustainable development objectives set by the UN”, insists Jérôme Weinbach.
Before delivering vaccines under Covax, Gavi requested a vaccine use plan from 91 countries. So far, only a dozen have explained how they will ensure the cold chain and organize vaccinations.
This vaccination campaign is a challenge. Éric Fleutelot, director of the health department of Expertise France, measures the height: “Gavi buys hundreds of millions of doses of vaccines every year for children around the world. But they often concern infants vaccinated via dispensaries where mothers come for postnatal consultation. In the case of Covid, it will be necessary to organize campaigns affecting all age groups. “
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Orders mostly from rich countries
Pre-orders made by States (in millions of doses):
> European Union: 1,965
> Inde: 1,600
> United States: 1,110
> Covax : 700
> Canada : 342
> Great Britain: 357
> Indonesia: 335
> Brazil: 196
> Latin America (excluding Brazil): 150
(No data for China)
Pre-orders recorded by laboratories (in millions of doses):
> AstraZeneca (Sweden and Great Britain) and University of Oxford: 2,572
> Novavax (United States): 1,327
> Pfizer and BioNTech (Germany): 810
> Sanofi-Pasteur (France) and GSK (Great Britain): 732
> Johnson & Johnson (United States): 574
> CureVac (Germany): 405
> Moderna (United States): 490
(No data for Chinese laboratories)
The CEO of AstraZeneca recently claimed to have achieved with his vaccine, developed with the University of Oxford, a “100% protection” against severe forms of Covid-19. This highly anticipated vaccine is inexpensive and does not require as low a temperature as that of Pfizer / BioNTech.
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