Uganda, for example, has announced a deal for millions of vaccines from AstraZeneca, at a price of $7 a dose – more than three times what the EU paid for the same jab. Including transport fees, it will cost $17 to fully vaccinate one Ugandan. Campaigners and scientists warn that we are on course for a “vaccine apartheid” in which people living in the global south are inoculated years after those in the West.
Without equal access to vaccines, there are fears many lower-income countries will not have enough stock to inoculate key populations, including healthcare workers, in 2021. On the ground, health workers are struggling.
Modelling by Northeastern University indicates that if the first 2 billion doses of Covid-19 vaccines were distributed proportionally by national population, worldwide deaths would fall by 61 per cent.
But if the doses are monopolised by 47 of the world’s richest countries, the death numbers would fall by only 33 per cent.
Dr Mogha Kamal-Yanni, global health policy consultant at the People’s Vaccine Alliance, told the Bureau: “We’re all fighting for pieces of a small pie. Why not increase the size of the pie so everyone can get a fair slice?”
Low-and-middle-income countries have made deals directly with pharmaceutical companies, but have so far secured only 32 per cent of the world’s supply to cover 84 per cent of the world’s population.
Fatima Hassan, the founder of South Africa’s Health Justice Initiative, explained, “If even in South Africa we can’t get even half of our population vaccinated soon, I can’t even imagine how Zimbabwe, Lesotho, Namibia and the rest of Africa will cope. If this is going to continue for another three years, we’re not going to get any kind of continental or global immunity.”
Public Citizen, a US think tank, has found that just 2 per cent of Pfizer/BioNTech’s global supply has been granted to Covax.
Last year people familiar with Moderna’s plans believed the US company intended to prioritise high income nations. In January, the South African government said Moderna has no intention of registering its vaccine in the country.
AstraZeneca has licensed 10 other companies in the UK, India, Brazil, Japan, South Korea, China, Australia, Spain, Mexico and Argentina to make its product, on top of its own factories in the UK and Europe but most of these companies have been limited to make the vaccine only for a specific geographic area.
In India, where much of the world’s pharmaceutical manufacturing takes place, the Serum Institute is producing the largest shipments of both AstraZeneca and Novavax’s vaccines. However, because it has a non-commercial license for the AstraZeneca jab, the Serum Institute can export its own version – Covishield – to 92 of the world’s poorest countries. Unlike AstraZeneca, the Serum Institute has not promised to keep to cost price, and is charging India $3 per dose, South Africa and Brazil $5, and Uganda $7, where the EU only paid AstraZeneca $2.
Many public health experts and campaigners are calling on pharmaceutical companies to waive patents to allow more factories to make vaccines. Within two months of declaring the pandemic, WHO had set up a mechanism for sharing intellectual property and data. Membership was voluntary. Not a single pharmaceutical company has participated.
“The problem is GAVI [the international vaccine alliance] has never worked in a situation where they’re competing with rich countries for vaccines,” said Prabhala. “They’ve never been in a situation where they are trying to supply highly, highly sought after vaccines to countries in developing countries and in the West.”
The WHO has asked manufacturers to prioritise supplying Covax and urged countries ordering doses beyond their needs to donate – but that looks increasingly politically unpalatable.
Some campaigners believe the WHO is foolish to think asking countries to donate is a good solution. “I think it’s honestly the most ridiculous, most unworkable … most problematic solution I’ve ever seen,” said Prabhala. “I just don’t understand how anyone in this moment could justify donating vaccines that they have, and getting away with it.”
Scientists are also concerned that allowing the virus to thrive unabated in some countries could lead to greater risk for all. “The more circulation there is, the more opportunity there is for the virus to mutate,” said Dr Marie-Paule Kieny, avirologist and director of research at Inserm. Mutated variants could result in more direct deaths in under-vaccinated countries, and may potentially make vaccines less effective over time.
“The mutations mean now rich countries realise they can’t just vaccinate their own people.” Kamal-Yanni said.
Even if wealthy countries vaccinated their populations, they could still lose around $119 billion a year if the poorest countries are denied a supply, RAND’s modelling showed.