Equity

Is vaccine tourism ethical?

j.harris — Fri, 28 May 2021 19:29:25 +0000

Is vaccine tourism ethical? j.harris Fri, 05/28/2021 - 19:29

INSIGHTS

Is vaccine tourism ethical?

Author: Blen Biru

According to Our World in Data, 1.78B people are fully vaccinated against COVID-19 across the world. About 16% of the fully vaccinated (289M people) live in the US, which has a very high rate of vaccination, especially compared to neighboring countries in Latin America. The abundance of available vaccines in the US has attracted foreign travelers from South America and other parts of the world looking to get vaccinated, referred to as vaccine tourism. An estimated 70,000 people from Peru alone have traveled abroad in search of COVID-19 vaccination.

Vaccine tourism in the US is becoming more prevalent with Houston, Dallas, Miami, and Las Vegas being the most visited destinations. States such as New York are also promoting vaccine administration in popular tourist destinations. This presents an opportunity for travel agencies to promote tour packages to wealthier countries such as US and UK, complete with vaccination.

In Europe, Serbia had excess doses of supply which attracted individuals from neighboring countries: Macedonia, Montenegro, Bulgaria, and Albania although it has temporarily suspended access to foreigners as of April 09, 21 to prioritize Serbian citizens.

The primary reason for vaccine tourism is the delayed vaccine distribution in the travelers’ home countries. Many countries around the world still face dire shortages of vaccine, and some have none at all.

People are also traveling in order to get access to the vaccine of their choice, particularly those in LMICs, where mRNA based vaccines (such as Pfizer-BioNTech and Moderna) are not readily available,

The legality of vaccine tourism seems to be ambiguous. In the US, the CDC has stated that there are no citizenship or residency requirements to receive COVID-19 vaccine, which is largely to ensure that requirements for identification do not hamper vaccine uptake, particularly for marginalized communities in the US.

While the policy is designed to promote vaccine equity within the US, vaccine tourism certainly does not; the wealthiest people in poorer countries are able to get access to vaccines first because they can afford to travel. Some argue that countries like the US would do better to donate excess doses instead of giving access to wealthy foreigners who may not necessarily be at risk. That way, the recipient governments would be able to allocate the donated vaccines to highest priority populations – a way that might promote equity.

On the flip side, allowing foreigners access to vaccines might help reduce the healthcare system burden in their home countries and could increase the number of vaccinated people contributing to herd immunity (Though it’s also worth noting that people might increase their chances of infection when traveling, seeking vaccinations). Further, the administrative burden (and chilling effect for undocumented populations) of requiring proof of residency would likely be untenable for local vaccination sites in the US.

These factors should be taken into consideration when assessing vaccine tourism. However, the ultimate solution to vaccination and achieving herd immunity across the world is equitable distribution of vaccines. In addition to bilateral purchases, donations and supply for the COVAX facility play a huge role in ensuring access everywhere and the vaccine tourism numbers clearly show that we have not yet succeeded.

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

Samsung is officially chosen as Korea’s fill and finish manufacturing partner for Moderna.

J&J suspended in Belgium for under age 41s due to adverse effect associated death.

WHO requested more data on Sinovac prior to approving a second Chinese vaccine for an emergency-use listing (EUL).

Per the IMF, a $50 billion investment by rich countries to vaccinate people in poor countries would end the pandemic earlier and result in a $9 trillion in additional economic growth.

India has restricted purchases and agreements only to the government; private sectors are not allowed to sign contracts anymore. State governments are also not able to negotiate with pharmaceutical companies such as Moderna and Pfizer.

Medicago released promising mid-term results and is hoping for Q3 authorization in Canada.

Sanofi-GSK released promising Phase 2 results and have launched Phase 3 trials, which will test efficacy against the South African variant, as well as the original strain. Production of the vaccine candidate is expected to begin “within weeks.”

CureVac expects EU authorization in June.

“Sputnik Light,” the 1-dose version of Sputnik V, expects to file for emergency use authorization in India in June and is being fast tracked for approval.

The European Union continues its court case against AstraZeneca, suing for damages arising from delayed delivery of a vaccine it doesn’t even want or need anymore. As AstraZeneca is the only company so far that has kept a pledge to sell its Covid-19 vaccine at no-profit, and as much of the world is desperately waiting for AstraZeneca doses, we suggest that perhaps the EU could reconsider and let AstraZeneca get on with their work.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

vaccine tourism

Equity

High-income country confirmed dose total:	5.9 billion
Upper-middle-income country total:	1.8 billion
Lower-middle-income country total:	961 million
Low-income country total:	270 million
COVAX total:	2.4 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	11.3 billion doses

The G20 Pledge Drive

j.harris — Fri, 21 May 2021 12:40:58 +0000

The G20 Pledge Drive j.harris Fri, 05/21/2021 - 12:40

INSIGHTS

The G20 Pledge Drive

Author: Andrea Talor

The G20 met today in Rome for a Global Health Summit and vaccine equity was at the top of the agenda. According to Reuters, the resulting “Rome Declaration” calls for voluntary licensing and technology transfers to increase production of Covid-19 vaccines globally. The declaration also reportedly mentioned the important role of the ACT-Accelerator (of which COVAX is one pillar) but did not commit to funding it (the ACT-Accelerator still needs $19 billion to reach its goal).

A flurry pledges were made by G20 members and vaccine makers today in the wake of the summit. The most consequential include:

Pfizer-BioNTech pledged to provide 1 billion of their mRNA vaccine in 2021 to low- and middle-income countries, with another 1 billion to follow in 2022. The doses will be shared with low-income countries “at cost” and with middle-income countries at half the market rate for wealthy countries.
The European Union (EU) pledged to send 100 million doses in 2021, including 30 million each from France and Germany. Germany also pledged another 100 million euros to fund COVAX.
The EU further committed to investing 1 billion euros to build vaccine manufacturing hubs in Africa, to support a distributed network of manufacturing globally and move Africa toward independence in vaccine supply.
Johnson & Johnson finalized their existing MOU to supply 200 million doses of the Janssen vaccine to COVAX in 2021.
China pledged $3 billion in aid to developing countries to support Covid-19 response, as well as recover, over the next three years.

The focus on 2021 vaccine deliveries in tandem with a longer-term plan to develop manufacturing capacity is encouraging. But this is still too little, too late.

Together with several other centers and organizations, we authored an open letter to the US government at the beginning of this week. We proposed five specific actions that the US can take to actively promote vaccine equity in the pandemic:

Designate a leader to coordinate the US global response
Share as many vaccine doses as possible, as quickly as possible
Support expanded manufacturing capacity including short-term increases to serve immediate global needs and longer-term investments in regional manufacturing hubs in low- and middle-income countries
Support vaccine distribution and delivery infrastructure in low-income countries
Lead development and implementation of a 5-year plan to build sustainable long-term manufacturing capacity in Africa, Latin America, and Asia.

The same day, the US pledged to share 80 million doses by the end of June and we expect more will come, as US supply begins to outpace demand.

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

Please see above for news coming out of the G20 summit today.

We have received a number of messages over the past week about GC Pharma and Moderna. GC Pharma, in South Korea, has an agreement to import and distribute 40 million doses of Moderna’s vaccine, which just became the fourth vaccine to be approved in the country. We erroneously indicated that GC Pharma was also contracted to manufacture Moderna’s vaccine, based on early press reports. It now looks nearly certain that Samsung will be chosen as Korea’s manufacturing partner for Moderna. Thank you to everyone who contacted us about this issue. Please keep helping us to correct and fill in gaps in the vaccine manufacturing data.

WHO released a statement this week after expert review of the risk of blood clots from the Janssen (J&J) vaccine, concluding that the benefit of vaccination outweighs the risk of blood clots and recommending that countries conduct risk-benefit analysis that includes mortality from Covid-19 as well as availability of alternate vaccines.

Emergent’s manufacturing site in Baltimore (US) remains closed after a batch of Janssen’s (J&J) vaccine was contaminated with materials from the Oxford-AstraZeneca vaccine. US production of J&J is currently on hold while a US Congressional subcommittee investigates Emergent’s record.

Serum Institute of India released a media statement this week that indicated they are not likely to export doses to COVAX or any countries before the end of 2021.

The UAE announced they will provide booster shots (or third doses, depending on what you want to call them) of Sinopharm six months after the second dose.

This opinion piece by Prashant Yadav in the New York Times explains how we became so dependent on India to make vaccines and what we can do about it now.

Hungary has opted out of future EU vaccine purchases, including the latest purchase of up to 1.8 billion doses of Pfizer-BioNTech vaccine. The Hungarian government reported that they were confident in their current supply.

India and Pfizer have come to an impasse over Pfizer’s indemnity clause stalling negotiations for vaccine purchase. Pfizer’s indemnity requirements have been the subject of frustration among other country leaders earlier this year and caused some countries to walk away.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

G20

Vaccines

Equity

High-income country confirmed dose total:	5.93 billion
Upper-middle-income country total:	1.82 billion
Lower-middle-income country total:	959.6 million
Low-income country total:	270.2 million
COVAX total:	1.96 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	10.9 billion doses

Three reflections from a wild week

j.harris — Mon, 03 May 2021 18:58:13 +0000

Three reflections from a wild week j.harris Mon, 05/03/2021 - 18:58

INSIGHTS

Three reflections from a wild week

Author: Andrea Taylor

There is a lot of ground to cover this week. The pandemic continues to rage throughout the world, with countries in South Asia and Latin America battling the worst surges. India has set new world records for daily infections and deaths, while eschewing a nation-wide lockdown and struggling to implement a mass vaccination campaign with limited supply.

Meanwhile, high-income countries are planning for the vaccination of children and annual boosters for the entire population. The inequities in global access to Covid-19 vaccines are starker now than ever before and the consequences of the unequal rollout across the world are beginning to be felt in terms of preventable deaths, dangerous variants, and economic loss.

We published three opinion pieces recently, in which we reflect on these developments and the implications for global equity, and provide recommendations for leaders.

In Politico Magazine, we write about why and how the US should actively support Covid-19 vaccination in other countries. As of this week, 70% of vaccinations have taken place in the US, EU, China, and India, and we face a long wait before most of the world will have enough doses to approach herd immunity. Based on analysis of our data on vaccine purchases and manufacturing, we recommend that excess does be shared immediately, rather than being stored for later use, as the global need is urgent now and speed counts. We also make the case that the US can and should lead efforts to fund development of manufacturing hubs in Africa and Asia, to improve global access to safe and effective vaccines.

In The Hill, we explore how the communication and messaging from leaders in the US and EU about potential risks from Covid-19 vaccines can have unintended and dangerous impacts in other parts of the world. We note that the risk-benefit ratio is very different for countries where Janssen (J&J) and Oxford-AstraZeneca vaccine make up the bulk of supply than for countries like the US, which have enough vaccine doses from other makers to cover the entire population. Clear communication about the factors leading to regulatory pauses or restrictions can help leaders in other countries to put these risks into perspective and help to inform their own risk-benefit calculations.

In the MIT Technology Review, we write about the factors contributing to India’s current crisis and what is needed now. While India’s export restrictions on Covid-19 vaccines are important and understandable, the country will not be able to vaccinate its way out of this surge. India urgently needs to implement national public health measures to reduce spread of the virus and buy time to manufacture and administer vaccines. International support, in the form of oxygen, medication, testing kits, and masks are also desperately needed. (The MIT Technology Review requires a subscription, but non-subscribers can read up to three articles free.)

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

US will divert supplies ordered for its own vaccine manufacturing to India, to support production at the Serum Institute. This is a great start towards equity, but there is more that the US can do (see our comments above for our take on what can and should be done).

US, EU, UK, and Russia send help to India including oxygen, ventilatiors and medication to address the Covid-19 crisis, as India registered more than 300,000 new cases daily this week.

South American countries are also seeing record-high death rates and last week accounted for 38% of Covid-19 deaths worldwide but only represent 8% of the world’s population, according to the New York Times.

Israel, which has vaccinated 62% of their population, purchased more Pfizer-BioNTech and Moderna doses this week but is still not providing vaccines to Palestinians, including those living in the West Bank.

Bharat Biotech in India reports that it will double manufacturing capacity to 20 million doses per month by June and then will reach 60 to 70 million doses per month by August.

Brazilian health regulators unanimously voted to not approve the Sputnik V vaccine, citing a lack of data on safety, quality, and effectiveness. Regulators in the Czech Republic made a similar announcement this week, saying they had not received enough documentation properly assess the vaccine. Russia has denied both claims and plans to sue Brazil’s regulator.

Pfizer is shipping doses produced in the US to Mexico, the first such global export from the company’s US production. More shipments abroad are expected to follow, as US manufacturing plants expect to have excess capacity by mid-year.

Mexico announced its Birmex firm will provide fill-finish capacity for Sputnik V, using active ingredient produced in Russia. Mexican officials hope this will speed up production and delivery of their order, which has been repeatedly delayed.

Moderna is expanding manufacturing plans in the US and Europe to increase production capacity. The company now expects to produce 800 million to 1 billion doses in 2021 and to further increase capacity up to 3 billion doses in 2022.

The WHO has approved the Moderna vaccine for Emergency Use Listing (EUL), which makes it eligible for distribution through COVAX. Decisions on Sinopharm (Beijing) and Sinovac are expected within the next week.

France is the first country to donate vaccine doses through the COVAX dose-sharing scheme, pledging 500,000 doses by mid-June. France intends to donate at least 5% of their total supply to COVAX through 2021. New Zealand and Spain have also signaled that they will donate doses through COVAX.

The EU is taking legal action against AstraZeneca for “not respecting” terms of their contract.

A new report from the IQVIA Institute for Human Data Science forecasts that global spending on Covid-19 vaccines will exceed $150 billion by 2025, including $53 billion in 2021.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

High-income country confirmed dose total:	4.9 billion
Upper-middle-income country total:	1.5 billion
Lower-middle-income country total:	713 million
Low-income country total:	770 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	9 billion doses

What have we learned in one year of COVAX?

j.harris — Fri, 23 Apr 2021 21:56:33 +0000

What have we learned in one year of COVAX? j.harris Fri, 04/23/2021 - 21:56

INSIGHTS

What have we learned in one year of COVAX?

Author: Andrea Taylor

Launched as a global cross-organization collaboration only one month after the pandemic was declared, COVAX was built to facilitate global equity in the pandemic response. As COVAX passes the one-year mark this month, there are some early lessons and insights that can inform its further development and help us prepare for future crises.

In terms of numbers, COVAX is short of the mark. Photo ops of government officials on the tarmac to meet planes full of doses and declarations of the numbers of countries reached can paint an optimistic picture. But the truth is that COVAX has delivered 43 million doses to 119 countries. This is only 2% of the way towards the 2 billion dose goal for 2021 and about 70 COVAX-participating countries have not yet received any doses (though some of these countries have waived their doses).

As Dr. Tedros wrote in the New York Times this week, we are nowhere near the 20% mark, and with significant supply constraints set to continue through the second quarter of 2021, this is not likely to change soon. COVAX is also However, it is not all bad news. COVAX has supported manufacturing deals and bulk purchases that would not have been feasible without its pooled procurement approach. And while distribution of vaccines is coming in more of a trickle than a wave, it is still getting doses to some of the most remote and poorest regions of the world. One year in, we can look back and begin to see what has worked and what needs rethinking.

Iterating in the midst of a crisis is difficult

COVAX was pulled together by a group of people who foresaw the dangers of inequitable access to vaccines in a pandemic, part of the ACT Accelerator that also focused on access to diagnostics and therapeutics. But at the time it was launched, the shape and timeline of the pandemic were unknown, the symptoms and impact of Covid-19 were still not well understood, and no one yet knew if or which vaccine would work. There was not the luxury of time to wait for these answers before designing and market testing an equity solution.

It is a difficult thing to build the car while you are driving it. The designers of COVAX and the partners who have steered its implementation have had to iterate as they go along, adding this, removing that. They have navigated the same dynamic landscape as national leaders, responding to changes in disease patterns, infection rates, vaccine trial results, manufacturing supply. But they’ve had to do all of this while keeping the world’s leaders engaged, maintaining a vision and strategy that would hold both wealthy and poor countries and everyone in between. It is worth keeping in mind the sheer difficulty of this task. To large degree, COVAX was down to grit and persistence.

Nationalism will win, so let’s plan for it

COVAX was premised on an all-for-one-and-one-for-all approach to defeating the pandemic. It was a way to invest together in a portfolio of vaccines and therapeutics and then ensure that the successful ones were shared out equally, regardless of country wealth or geopolitics. We know from economic and epidemiolocal modeling that this would have led to the best outcomes for everyone and was our best hope for ending the pandemic quickly. But we also know from experience that the world doesn’t really work this way. And COVAX used a traditional donor-aid model to drive an all-in-this-together program, leading to, as the Lancet put it this week, “a funding shortfall and a system not based on solidarity but rather one that reinforces inequities.”

Vaccine purchase decisions are made (for the most part) by national leaders, whose primary responsibility is to protect their own population. If leaders have the opportunity to control the purchase (and production) of vaccines for their country, they will. If they have the opportunity to prioritize their population over others, they will. This is their job.

For future iterations of COVAX, nationalism must be baked into the design from the beginning. COVAX needs to assume that government leaders will prioritize their own, and work with that. Perhaps vaccine makers could commit that 20% of every batch produced goes to supply COVAX, while 80% can go to the wealthy countries first in line. The important thing is to bake it in from the beginning so that it not a choice of “giving up” doses that leaders have to explain to their voting population.

Messaging matters

COVAX can be described in many ways but transparent is not one of them. The risk-averse partnership has consistently kept its cards close to its chest, providing information only in broad strokes and only when absolutely necessary. While we can understand why, we also think this may be a strategic error.

When COVAX does share information, the tone tends to be defensive and protective and the data shared is difficult to parse. The risks and dangers inherent in the COVAX design are not lost on the watching world and simply choosing not to talk about them doesn’t make them disappear. Rather, clear messaging about the benefits of vaccine equity (which are well documented by others), what is needed to get there, and the potential pitfalls on the way could allow COVAX to drive and shape the story. Unfortunately, opaque supply updates built on data that cannot be externally validated undermine, rather than build, confidence.

COVAX is the largest purchaser in the Covid-19 vaccine market and could use its platform and purchasing power to push for more transparency and accountability in Covid-19 vaccine purchases and manufacturing. Making its supply deals public, including prices and delivery schedules, and clearly communicating about the gaps, could drive urgency and more transparency across the board.

Equitable distribution must begin with equitable manufacturing

The location of manufacturing matters and countries with domestic manufacturing of Covid-19 vaccines are better able to ensure supply. While COVAX was quick to secure manufacturing capacity, this is less relevant in the context of export controls. COVAX does not have a country or government and is unable to use policy levers to commandeer manufacturing when the going gets tough.

Ensuring equitable access to vaccines globally means that manufacturing must be global. There are a very limited number of manufacturing partners who could provide the scale of vaccine needed for COVAX and this led to an overreliance on Serum Institute of India (SII). When a second wave of Covid-19 infections hit India and sent it into crisis, export controls cut short the COVAX supply. There was no Plan B and no clear options for making up the shortage in production for countries counting on COVAX.

The world needs more regional manufacturing hubs that can produce vaccine independently and do not require drug substance to be imported from other regions. There is a particularly acute need in Latin America, the African continent, South East Asia, and the Pacific. With more equitably distributed manufacturing, COVAX or a similar future effort could draw on a broad network of manufacturing partners to supply the world and lower-income regions could control their own supply.

The world is better off with COVAX than without it. But one year in, we can see how far we are from the goal and the factors that have prevented success. One of the strengths of COVAX is its ability to iterate and it will continue to do so in a continually changing environment. And importantly, we now have something on which to build and improve for future global crises.

INTERESTING TRENDS

Significant updates, news, and trends we saw last week:

India’s health systems are collapsing from the pressure of a near-vertical rise in infections. With more than 330,000 new cases on Friday, India set a world record for the second day in a row.

In response, India is opening up vaccine eligibility to all adults aged 18 and older, starting May 1. The country is facing a significant vaccine shortage, however, and has declared that domestic manufacturers must sell 50% of their doses to the government but can sell the other 50% on the private market within India. Prices for the private market can be different than the government rate but must be transparent and set in advance.

The European Medicines Agency (EMA) found a possible link between a very rare blood clotting disorder and the Janssen (J&J) vaccine, similar to that identified with the Oxford-AstraZeneca vaccine, but stressed that “the vaccine’s benefits in preventing Covid-19 outweigh the risks of these very rare side effects.”

Dr Tedros offered a scathing indictment of the choices wealthy countries have made in the pandemic in a NYT opinion article, and called on rich countries to support COVAX financially, to donate vaccine doses, and to share manufacturing expertise to allow production to scale up globally.

Japan will host the next fundraising summit for COVAX in June, bringing together leaders from the US, Japan, and European countries.

New Zealand, France, and Spain announced plans this week to donate excess vaccine doses through the COVAX Facility.

The ACT Accelerator released a report in honor of its first anniversary: ACT Now, ACT Together: 2021 Impact Report.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

High-income country confirmed dose total:	4.7 billion
Upper-middle-income country total:	1.5 billion
Lower-middle-income country total:	732 million
Low-income country total:	770 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	8.9 billion doses

COVID-19 vaccines are flowing into the private sector. What does this mean for equity?

j.harris — Tue, 09 Mar 2021 04:46:06 +0000

COVID-19 vaccines are flowing into the private sector. What does this mean for equity? j.harris Tue, 03/09/2021 - 04:46

Weekly Insights and Interesting Trends

COVID-19 vaccines are flowing into the private sector. What does this mean for equity?

While the vast majority of Covid-19 purchases have been through the public sector, we have also seen some private sector deals. This appears to be increasing recently, as governments are partnering with private sector health providers to widen the reach of their vaccine rollouts.

Back in 2020, the Russian Direct Investment Fund (RDIF) was selling Sputnik V to private companies and setting up private distributers in countries including Egypt, India, and Mexico. At the time, there was very little private sector involvement with any other vaccine and most developers pledged that they would work only with governments during the pandemic.

We are seeing an uptick of private sector involvement now, often at the invitation of governments, as countries struggle to ensure both supply and distribution. This makes sense particularly in countries where a large proportion of health care is provided in the private sector. Private sector involvement is a wide tent, however, and there are at least three key variables:

Who purchases the vaccine – private company or government?
Who pays for the vaccine – purchaser or end user? and
Who decides the priority groups and schedule for recipients?

The third variable holds the most risk of inequity at the country level.

For example, private companies could deliver government-purchased vaccine following the government’s priority schedule. This is a pragmatic move, leveraging all available health care providers and locations and is happening in many countries, both rich and poor, as vaccines are rolled out through local pharmacies and private care providers.

Or private companies could purchase their own vaccine and provide it to end users willing to pay. Where vaccines are sold directly to the public through private sector pharmacy chains or provided by employers, it can reduce the cost burden for governments that have not been able yet to purchase enough vaccine for their population. This may be on balance a positive trend in countries such as India, that have wide income disparity, where a large wealthy population can (and will) pay for a vaccine, ensuring that limited government funds support those in most need.

As in the case of India and Indonesia, private employers could purchase the vaccine and provide it to their employees free of charge. (In Indonesia, these doses must be acquired through the government and also be separate from the doses intended for the public sector campaign.) In the Philippines, more than 30 companies came together to purchase vaccine doses and promised to donate half to the government, while using half to cover their employees.

All of these options can relieve pressure on overburdened public health systems. But if people willing to pay are able to get vaccinated ahead of the priority schedule set by the government, countries risk creating a two-track vaccine rollout. Rich people will be vaccinated before poor people and may have access to different vaccines. It may also drive up prices for vaccines as a commercial product, tempt manufacturers to prioritize higher-paying private sector purchasers, and lead to an increase in fraud and black market activity.

While there is a critical and positive role for the private sector in the equitable distribution of vaccines at the national level in many countries, the key risk is when these companies work outside of the government priority schedule. Vulnerable populations around the world need to receive the vaccine on the same timescale to ensure the best results for everyone; the same is true at the country level. Public health priorities should continue to guide vaccine rollout, regardless of which sector administers the doses.

Interesting Trends

Significant updates, news, and trends we saw last week:

COVAX has delivered more than 12 million doses to 21 countries over the past two weeks: Ghana, Ivory Coast, South Korea, Nigeria, Angola, Cambodia, Democratic Republic of the Congo, the Gambia, Rwanda, Kenya, Senegal, Lesotho, Sudan, the Philippines, Indonesia, Fiji, Moldova, Uganda, Mali, Malawi, and Afghanistan. COVAX also this week published projected allocations by country through May.

Bharat Biotech released interim Phase 3 results, demonstrating 81% efficacy.

Sinovac’s vaccine (Coronavac) demonstrated 83% efficacy in phase 3 trials in Turkey. This data release follows phase 3 data announcements from Sinopharm (Wuhan) and CanSino last week.

Good news in real world data from the UK suggesting that the first dose of the Pfizer-BioNTech and Oxford-AstraZeneca vaccines prevents symptomatic cases among the elderly.

The European Medicines Agency has begun a rolling review of the Sputnik V vaccine. The vaccine has racked up a slate of approvals recently, including in Democratic Republic of the Congo, Iraq, and Sri Lanka.

Novartis will manufacture drug substance for CureVac’s mRNA vaccine in their Austrian facility. Novartis is also helping to produce the Pfizer-BioNTech vaccine in their Switzerland facility.

Merck will partner with J&J to produce the Janssen vaccine in the US.

Canada approved the Janssen (J&J) vaccine but may not receive its ordered doses before September.

The US government projects it will have enough doses in hand by May to cover the adult population.

France and Germany have only distributed a fraction of their Oxford-AstraZeneca doses. Meanwhile, the EU is offering an additional 100,000 vaccine doses each to Austria, Czech Republic, and Slovakia to combat rising Covid-19 cases. Italy and Germany are following in France and Spain’s footsteps, hoping to conserve vaccine by giving only a single dose to people confirmed to have already had Covid-19.

Italy invoked the EU export controls to block shipment of 250,000 doses of the Oxford-AstraZeneca vaccine to Australia, highlighting the vulnerability of global supply contracts. Australia is domestically manufacturing the vast majority of its Oxford-AstraZeneca order, however, so the export block is more of a diplomatic than supply issue.

On the topic of export controls, the CEO of the Serum Institute of India said this week that US export controls on raw materials such as bags and filters are a limiting factor for global manufacture of Covid-19 vaccines.

Pfizer’s opaque distribution strategy is motivated by order size, timing of deal, relationship between country and company leaders, data sharing agreements, and profit opportunity according to in-depth article in Bloomberg this week.

Chile donated 20,000 doses to Ecuador in one of the first donations we’ve seen among Latin American countries.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

Data Updates

High-income country confirmed dose total:	4.6 billion
Upper-middle-income country total:	1.3 billion
Lower-middle-income country total:	608 million
Low-income country total:	670 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	8.3 billion doses*

*Change from March 9, 2021 reported total of 14.7 billion, which included potential dose purchases

Today, we celebrate: This week's good news for global equity

j.harris — Tue, 02 Mar 2021 00:35:58 +0000

Today, we celebrate: This week's good news for global equity j.harris Tue, 03/02/2021 - 00:35

Weekly Insights and Interesting Trends

Today, we celebrate: This week’s good news for global equity

There were two significant developments this week that are great news for Covid-19 vaccine equity. To be clear, the picture is still bleak: rich countries hold more than half of the vaccine purchased and don’t want to share until they’ve had their fill. More than 100 countries have not administered their first vaccinations, even while coverage passed 90% in Israel, 60% in the UAE, and 30% in the UK. But there are also things worth celebrating.

The first COVAX delivery landed in Accra, Ghana this past week, with 600,000 doses of the Oxford-AstraZeneca vaccine from the Serum Institute of India. This was quickly followed by a COVAX delivery of 500,000 doses in Abidjan, Ivory Coast. Together, these deliveries can cover 550,000 people. Outside of Morocco (which launched an enviable immunization campaign this past month), only 260,000 people across the entire continent of Africa have received a vaccine (this is roughly 6 in 100,000 people). (According to Our World in Data, which is tracking vaccination rates around the world, updated daily.) In this context, delivery of 1.1 million doses is a significant event, and worthy of taking a moment to cheer.

COVAX has notably gotten off to a slow start, taking longer to secure deals than many of the countries that funded it. The COVAX collaboration prioritized value, while countries like the US and UK prioritized speed. COVAX’s slow and steady approach to building supply chains (through investment in R&D and manufacturing contracts) and closing purchase deals may start to pay off now as they begin shipping millions of doses around the world. We are still not confident in their supply projections for 2021 (which depend on exercising 900 million optioned doses from Serum Institute), but the arrival of the first shipment is cause for celebration and helps build momentum in a positive direction. COVAX expects to deliver another 11 million doses this coming week.

In other good news, the Janssen (J&J) vaccine received emergency use authorization in the US this weekend and will be rolled out immediately, with 20 million doses being delivered to the US this month. The vaccine is under rolling review in several more countries and, importantly, the company has filed for emergency use listing (EUL) with the WHO, required for COVAX distribution. Janssen has committed (through a memorandum of understanding) 200 million doses to COVAX in 2021, with 300 million more to follow in 2022.

As the first single-shot Covid-19 vaccine to hit the market, Janssen’s vaccine is a game changer for vaccine implementation. Like Oxford-AstraZeneca, the Janssen vaccine can be stored for up to three months at standard refrigeration temperatures but, at one dose per person, only needs half the hours from providers to administer. This will be welcome news in countries with care provider shortages (much of the world) and with large rural and remote populations. Halving the number of injections needed to reach last-mile populations is no small thing.

If there were one vaccine we wanted to prioritize for manufacturing and distribution to LMICs, this is the one. At least until the heat-stable nasal spray vaccines make it to market and change the game again.

Interesting Trends
Significant updates, news, and trends we saw last week:

The first COVAX deliveries landed in Ghana and Ivory Coast this week. Both countries launched their vaccination campaigns today (March 1).

The Janssen/J&J single-dose vaccine received emergency use approval in the US on Saturday. Janssen has also filed for emergency use authorization with the EU and emergency use listing with the WHO and is under rolling review in other countries.

Vaccine purchases (across all income categories) have slowed down over the past few weeks. The rate of purchases may continue to slow, with numbers holding relatively steady, while countries wait for deliveries so that they can being to administer doses they have ordered.

Vaccine campaigns launched last week in Afghanistan, Australia, Bolivia, Gaza, Hong Kong Malaysia, Mongolia, San Marino, Senegal, South Korea, and Ukraine.

The African Export-Import Bank approved $2 billion in funds to help African countries secure vaccines.

Vaccine scandals continue to unfold in Latin America. Following resignations of government officials in Peru and Argentina last month, Ecuador’s Health Minister has resigned after admitting that he helped his mother and others jump the queue. Nurses in Brazil have been accused of injecting people with empty syringes and embezzling the vaccine.

Sinopharm released Phase 3 data for their Wuhan-developed vaccine, reporting 72.5% efficacy, and have applied for authorization for general use in China (their Beijing-developed vaccine is already approved and being administered in China and other countries).

CanSino also released early analysis of Phase 3 data, reporting 65% efficacy, and applied for general use authorization in China (CanSino’s vaccine is already approved for use in the Chinese military and has received emergency use in several other countries). The vaccine is a single-shot vaccine that can be stored at standard refrigeration temperatures, though CanSino is also testing a double dose regime.

The FDA has approved Pfizer’s request for a change to the storage requirements for the Pfizer-BioNTech vaccine, stating that it can be kept in standard freezer up to two weeks.

For more information on our research on Covid-19 vaccine supply, please see https://launchandscalefaster.org/COVID-19.

Weekly COVID Vaccine Research Update

Data Updates

High-income country confirmed dose total:	4.6 billion
Upper-middle-income country total:	1.3 billion
Lower-middle-income country total:	597 million
Low-income country total:	670 million
COVAX total:	1.12 billion
Total worldwide confirmed purchases of Covid-19 vaccines:	8.2 billion doses