“Solidarity is the rule of the game to defeat COVID-19” stated Dr Tedros. Indeed, it is clear that no economy can go back to “normal” if the rest of the world is struggling to deal with fast spreading sickness and lockdowns. Thus, sharing tools to prevent, diagnose and treat Covid-19 is critical for all; those who have money to buy these tools and those who do not.
In April 2020 the Access to COVID-19 Tools (ACT) Accelerator was launched by the WHO, the Gates Foundation, Coalition for Epidemic Preparedness Innovations (CEPI), FIND , Gavi, The Global Fund, Unitaid, Wellcome, the World Bank and Global Financing Facility. It was presented as a “ground-breaking global collaboration to accelerate development, production, and equitable access to COVID-19 tests, treatments, and vaccines”.
On the 10th of September, the ACT Accelerators members (including UK, EC, other countries from Europe and developing countries) launched a Facilitation Council. Their statement emphasised their commitments to provide political leadership and support of the investment case of the ACT Accelerator. The third commitment sates that they would “ensure that all countries and populations have early, affordable and equitable access to the new vaccines, therapeutics and diagnostics”.
The WHO set up an Equitable Allocation Framework which analysed the populations that are at high risk of infection and of serious Covid-19 infection. These are health workers, people older than 60 years old and those living with chronic diseases and conditions. The Framework estimates the total number of all these groups to be around 20% of the population in all countries. The Framework recommends prioritising these categories in all countries until there are enough vaccine doses produced for the entire population.
However, the reality is totally different. The notion of the commitment to “ensuring all have equitable access” runs parallel to the reality of rich countries hoarding the most promising vaccines. Currently there are 9 vaccines in phase 3 clinical trials. The US, UK and EU alone secured just under 4 billion doses for their population. The UK has the most vaccine per capita in the world.
Based on announcements of news agencies, governments, and pharmaceutical companies, I calculated the number of doses committed including the options for added doses. I also computed the figure of 20% of the population of the US, UK, and EU based on Worldbank figures for 2019. There was only one deal where the doses where announced for Japan. The result is in the following tables:
Table 1
Mapping these doses against the figures of 20% of the population as recommended by the WHO Equitable Allocation Framework shows significant hoarding, as per the table below:
Table 2:
In fact, the picture is truly shocking if we see the doses painted against rounded figures of 20% of the countries’ population as per the diagram below. It is unclear whether Covax /Astra Zeneca total deals of 1400 doses are for all low income and middle income countries or LICs and LMICs only. Therefore this figure is used twice in the diagram below.
It is important to note that rich countries have secured doses from all promising vaccine, while LMICs* and LICs are dependent on the Astra Zeneca. on 8th of September, the company announced that trials were put on hold due to serious potential side effect in one volunteer. However, on 12 the September, the trial was resumed.
Astra Zeneca has made a deal with Serum from India for the production of one billion doses in 2021. However, Serum declared that 50% of the doses would go to India- leaving 500 million doses for the rest of LMIC and LIC countries. It is also expected that the vaccine requires 2 doses and therefore the number that can be vaccinated by this deal could be only 250 million people.
Clearly the collective figures show that all these doses from all the vaccines would not be available to the countries that secured millions of doses. Some vaccines would fail, others may be more or possibly less effective. However, securing as many doses as possible from as many vaccine suppliers as possible would ensure that rich countries would have access to successful vaccines, while poor countries depend on only one vaccine candidate.
In fact, rich countries hoarding health products during epidemics is not new. In 2009 rich countries scooped all the vaccines of swine fever leaving developing countries to have the vaccine late in the epidemic when it was less effective. hardly anything for the rest of the world. At the beginning of the Covid-19 pandemic rich countries almost emptied the global market of medical supplies including PPE leaving hardly any supplies for developing countries.
Nationalism attitude of hoarding of Covid-19 products is not going to help any nation. Controlling the virus and returning health services and the economy to “normal” requires global access to all health technologies available, especially the waited-for vaccine. Rich countries must contribute the doses they secured to the global system of allocation so that all countries are able to vaccinate the 20% of the population that comprises of all at risk groups. Eventually, as better vaccines and more doses are manufactured, it is hoped that the whole world population can be vaccinated.
*Legend of acronyms:
HICs=High Income Countries
MICs=Middle-Income Countries
UMICs=Upper Middle-Income Countries
LMICs=Lower Middle-Income Countries
LICs= Low Income-Countries