We frequently see scorecards of how each country is faring with COVID-19 vaccinations, with high-income countries competing to claim the top spot. But how often do we look at countries with little to no access?
As of Oct. 27, 63.5 per cent of people living in high-income countries have been vaccinated with at least one dose of a COVID-19 vaccine versus fewer than five per cent of those living in low-income countries. High-income countries have had to increase their health-care spending by only 0.8 per cent to cover the cost of vaccinating 70 per cent of their populations, whereas low-income countries would need to increase their health-care spending by a whopping 56.6 per cent to do the same.
To address this inequity, COVAX was developed as a short-term global solution to ensure that people in all corners of the world get timely access to COVID-19 vaccines, combining the efforts of 190 countries. The idea behind COVAX is that wealthy countries purchase a portion of their vaccines through the COVAX Facility, the vaccine procurement platform that monitors COVID-19 vaccine development and incentivizes manufacturers to expand production capacity ahead of regulatory approval. In addition, the wealthy countries would donate funds to the COVAX Advance Market Commitment (AMC) to procure vaccines for 92 low- and middle-income countries. The group purchasing power would allow COVAX to negotiate cost-effective deals with various vaccine makers. AMC funds the COVAX Facility.
Canada is one of the wealthy countries participating in COVAX. So far, we have committed to donating 50 million doses from our own contracts as well as donating $500 million, covering the purchase of 87 million more doses but are not expected to meet this target until the end of 2022. We also will be donating 18 million doses of the AstraZeneca and 10 million doses of the Johnson and Johnson vaccine now that mRNA vaccines are considered preferential.
As of Oct. 31, of the 1.3 billion doses wealthy countries have pledged to donate, only 356 million doses have been provided to COVAX. COVAX AMC is also far from reaching its target of $3.2 billion for 2021. Canada, appallingly, has only donated about 3.5 million doses so far – 2.7 million to COVAX and another 750,000 that were not part of the COVAX umbrella via bilateral agreements with countries in Latin America and the Caribbean.
Last week, GAVI and UNICEF launched a public plea: “We urgently need countries to deliver these doses to help protect people and health systems.” Clearly, the system is not working.
While COVAX attempts to meet the short-term need, a longer-term strategy to encourage and support domestic vaccine production in low- and middle-income countries is necessary. Pharmaceutical manufacturers that own most of the approved COVID-19 vaccines, many of which have received a large amount of public funding dollars, not only have a monopoly on their production but benefit from a lack of transparency on bilateral agreements, confidential price discounts and vaccine nationalism. This only further exacerbates the striking difference between the Haves and the Have Nots.
In October 2020, India and South Africa jointly proposed at the World Trade Organization (WTO) that intellectual property rights pertaining to patents and copyright should be temporarily suspended during the acute phase of the pandemic. This initiative is called the Trade-Related Aspects of Intellectual Property Rights or TRIPS waiver, which in fact is not new but critical now to help toward rapid and equitable access of COVID-19 related medicines and vaccines. Many countries, including Canada, have either refused to sign the waiver or have remained silent.
In addition, in May 2020, the WHO launched the COVID-19 Technology Access Pool (C-TAP) to share intellectual property and know-how through pooling of technology, data and information via voluntary, non-exclusive and transparent agreements for COVID-19 therapeutics, diagnostics and vaccines. More than a year later, none of the manufacturers producing vaccines or any of the new COVID-19 therapeutics have signed on.
Despite appeals from the WHO, Canada has made direct deals with the Serum Institute of India, essentially the primary supplier for COVAX, potentially purchasing supplies intended for COVAX. It has made several bilateral trade deals with manufacturers, again something the WHO discourages. Canada also withdrew vaccines from COVAX for its own domestic use and has not vocally supported the TRIPS waiver.
Recent data shows rich countries have given out more boosters in the last three months than poor countries have given total doses all year. Many countries have begun giving boosters to their entire populations. It is a travesty that in many countries, health-care workers and high-risk groups have not yet received a single dose of the vaccine while we have already boosted entire populations at low risk of severe illness with two doses.
As the Omicron variant is showing us, we aren’t safe until we’re all safe.
Canada currently expects an abundance of COVID-19 vaccines to be delivered by the end of 2021 – sufficient to provide boosters for all those who need one, as well as to vaccinate children under the ages of 12 and those still needing first and second doses. In addition, Canada expects to receive another 35 million doses of the Pfizer COVID-19 vaccine in 2022, with options to purchase up to 30 million more; and 20 million doses of the Moderna vaccine, with options for up to 15 million more.
So, to advance global vaccine equity in the coming months, Canada should:
1: Only provide COVID-19 vaccine boosters to the populations that we know would concretely benefit from them, specifically in terms of efficacy and based on clear evidence;
2: Donate the bulk of the vaccines that are expected to be delivered in 2022 to COVAX;
3: Support COVAX by following WHO’s call to refrain from making bilateral deals with vaccine manufacturers and delay further withdrawal of doses for domestic use from COVAX;
4: Advocate for the sharing of raw materials and lifting bans globally on the export of materials necessary for vaccine production;
5: Urge manufacturers of therapeutics and vaccines to share manufacturing processes and technical know-how through the C-TAP;
6: Lastly, but most importantly, join the U.S. in signing the TRIPS waiver set forth by the WTO.
As the Omicron variant is showing us, we aren’t safe until we’re all safe. High rates of transmission result in new mutations and variants. This tends to occur in countries with uncontrolled spread due to a lack of access to vaccines. Newer variants have generally resulted in higher transmissibility or virulence, and often also enhanced immune-evasion capabilities; this can subsequently impact the effectiveness of our vaccines.
Global access to vaccines – with urgency – is not just the right thing to do but, in fact, is the only way we can get out of the pandemic once and for all.