As pharmaceutical companies start obtaining emergency use authorizations and manufacturing coronavirus vaccine doses as quickly as they can, wealthy nations are hedging their bets by reserving far more of those vaccine doses than they need. In fact, many of the world's richest countries have enough doses spoken for to inoculate their entire population multiple times over. Meanwhile, many less economically advantaged nations are struggling to secure enough to cover a meaningful fraction of their population within the next few years.
Due to manufacturing limits, it could take many developing countries until 2024 to obtain enough vaccines to immunize their entire populations, reports The New York Times. Meanwhile, the world’s wealthiest countries have already laid claim to more than half of the doses that could make it to market by the end of 2020. This dire situation begs the questions: Are the wealthiest countries going to hoard all the vaccines? And, can anything prevent that from happening?
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In September, a coalition of 156 countries agreed to a COVID-19 vaccine allocation plan, co-led by the World Health Organization, called Covax. The goal is to ensure that vaccines are shared equally between the world’s richest countries and developing nations. The WHO partnered with two nonprofits supported by Bill Gates to secure one billion doses for 92 lower-income countries by the end of 2021. One billion more will go to middle- and high-income nations in the same time frame in an attempt at an early 50/50 split.
“This is a mechanism that enables global coordination of the rollout for the greatest possible impact and will help bring the pandemic under control and ensure the race for vaccines is a collaboration not a contest,” Tedros Adhanom Ghebreyesus, head of the UN health body, said when the deal was announced. He added that the plan would help ensure vaccines for “some people in all countries and not all people in some countries.” Despite this agreement, glaring inequities are already emerging.
The United States, as of now, has secured 100 million doses from Pfizer, with the option of buying up to 500 million more. It also has 200 million pre-ordered from Moderna, with a 300 million dose addition if needed. The U.S. also put a preemptive order on 810 million doses between offerings from AstraZeneca, Johnson & Johnson, Novavas, and Sanofi. In total, that means the U.S. has direct access to as many as 1.5 billion vaccine doses; the entire U.S. population is 331 million. Meanwhile, the European Union has secured 1.3 billion across most of the same companies, for their estimated population of 447.7 million. Additionally, it has the option to purchase 660 million more from German company CurVac if it chooses. Britain laid claim to 357 million doses with the option of 152 million more from Valneva for its population of just under 68 million. Even with these massive purchases, it is uncertain how quickly these countries will be able to vaccinate everyone because there are many vaccines that are not yet ready for distribution.
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Because there is no guarantee that each vaccine will come through as planned, countries are not putting all of their eggs in one basket and instead operating under a “just in case” strategy. Rather than risk a huge setback, wealthy countries would rather overbuy. But the race to buy vaccines has turned into a global scale version of the run on toilet paper many experienced earlier this year.
While some panic purchased enough toilet paper to last them years, others were put in the dire situation of having to rely on the kindness of neighbors to get a roll while they waited for stores to restock their cleared shelves and find ways to limit per customer purchases. According to data collected by Duke University, should all the vaccines come through, the EU could vaccine its entire population twice over, the UK and the U.S. would have four vaccines to every resident, and Canada would have enough to inoculate everyone six times over. So far, none of these countries have come forward to say what they intend to do with the surplus of doses should they have them.
The U.S. began guaranteeing its access to vaccines well before any were developed by providing billions of dollars for the research, development, and manufacturing of five of the most promising COVID-19 immunizations. This support, which sped up the process and broadened the scale of production immensely, came with the condition that Americans would get priority access to vaccines made in the U.S. Other countries that could afford to do so also put money into the efforts. For example, Pfizer’s vaccine, made in conjunction with BioNTech, was funded by $445 million given by the German government.
In an attempt to address vaccine distribution inequities, some pharmaceutical companies are promising a percentage of their products to poor and middle-income countries. AstraZeneca leads this initiative with the promise of over half of its 3.21 billion inventory. Testing as a single dose vaccine, Johnson & Johnson has pledged 500,000 shots to low-income countries.
Time will tell whether wealthy nations will share excess vaccines or whether Corvax is merely a nice theory that does not stand a chance against panic, scarcity, and enough wealth to block out the front of the line.