As we get closer to the end of 2020, a COVID-19 vaccine for public use may finally see the light of the day. However, concerns about equitable distribution of the vaccine are being raised as richer countries signed contracts for early access. Where do various countries stand in COVID-19 Vaccine Procurement & Distribution strategy? Here is a status check.
The highly contagious COVID-19 pandemic has taken the world by storm. Countries & companies around the world in racing against time to develop a vaccine. According to the WHO’s latest draft landscape of vaccine candidates released on 02 October 2020, there are a total of 193 vaccine candidates of which 42 are in clinical evaluation stage. About 10 of these are in Phase-3 of clinical evaluation, meaning, they are being tested on a large sample of tens of thousands of participants. Some of these 10 candidates can be expected to get approvals for public use.
10 vaccines are in phase-3 of clinical trials
Vaccines being developed by Oxford University and AstraZeneca, Moderna, Pfizer and BioNtech, Janssen Pharmaceutical Companies of Johnson and Johnson, and Gamaleya Research Institute, are a few in this list. (Detailed stage-wise information is available in WHO’s website). Meanwhile, Russia announced in August this year that the world’s first COVID-19 vaccine, named Sputnik V, was approved by the country’s healthcare ministry though WHO said otherwise.
Procurement and distribution will be a challenge once approvals are granted
Numerous ethical challenges and financial risks are at stake for the development of a vaccine. Huge investments and global collaboration across countries gives hope that a vaccine might soon be available. To speed up the vaccine development process, countries are bypassing the usual regulation cycle & giving express approvals because of the emergency. However, development of vaccine & its approval are only the first steps in the fight against the pandemic. Once a vaccine is approved by the specific country regulators, large scale production and distribution follow.
Countries need to devise strategies to ensure equitable distribution of vaccine, since production for the entire world’s population will take a substantial amount of time. For instance, certain sections of the population such as the frontline healthcare workers and those at severe risk with COVID-19 have to be given priority. It is only natural that countries try to procure and purchase vaccines from manufacturers as soon as possible in order to safeguard the health of its citizens. However, there are concerns about rich countries cornering the entire initial production of vaccines leaving poor countries at a great risk.
Since the vaccine trials are still ongoing, relying fully on only one pharmaceutical company for vaccine supply is risky. The clinical trials of the experimental vaccine developed by Oxford University and AstraZenca, being carried out in the UK & other places were suspended for a week in September 2020 following a patient’s illness. Reportedly, Johnson and Johnson has also halted the vaccine trials recently since a participant developed undisclosed illness. Because of such uncertainties in the entire process, countries are sourcing vaccines from multiple sources.
Countries started signing contracts with vaccine manufacturers from as early as May 2020
Many governments across the world have already begun signing contracts with various manufacturers to ensure adequate supplies.
In May 2020, when the COVID-19 cases in the US were mounting, the US government had secured about 300 million doses of the first one billion doses of British company, AstraZeneca’s experimental COVID-19 vaccine. The Department of Health and Human Services has provided $1.2 billion for this purpose. The Trump administration had also announced an agreement with Moderna Inc in August 2020 to manufacture and deliver over 100 million doses of their vaccine candidate. The manufacturing of the vaccine would take parallelly while clinical trials are underway. The US also signed an agreement for delivering 100 million doses of the vaccine with Pfizer. The US government can also acquire an additional 500 million doses as per the agreement.
The European Commission signed its first contract, also with AstraZeneca, on behalf of the European Union’s Member States. As per the contract, all Member States will be able to purchase 300 million doses of the vaccine with an option to purchase further 100 million doses. These are to be distributed on a population-based pro-rata basis. Another contract was signed by the EU with Sanofi-GSK for purchase up to 300 million doses of their vaccine. Recently on 08 October 2020, the European Commission also signed a contract, its third with Janssen Pharmaceutical Companies of Johnson and Johnson allowing member states to purchase vaccines for 200 million people. Talks with CureVac, BioNTech-Pfizer and Moderna have also concluded.
The Australian government has also signed an agreement worth $1.7 billion with pharmaceutical companies to make vaccines available free for all progressively through 2021. University of Oxford and AstraZeneca and the University of Queensland and CSL will provide more than 84.8 million vaccine doses for the Australian population, almost entirely manufactured in Melbourne, as per the agreement. The agreement also includes early access to 3.8 million doses of the University of Oxford vaccine in January and February 2021.
Even New Zealand has signed an agreement to buy 1.5 million doses enough for 7.5 lakh persons from Pfizer and BioNTech provided the vaccine completes all clinical trials and adheres to regulations in New Zealand.
US has released a vaccine distribution strategy
The USA which is one of the worst hit by the virus, has even released an outline of the country’s vaccine distribution strategy. The document released by the Health & Human Services Department touches upon engagement with local partners and other stakeholders. Further, a phased allocation methodology will be followed to deliver vaccines free of cost to all Americans. The vaccine will be delivered under ‘Operation Warp Speed’, a White House initiative to have millions of doses ready to be shipped on receiving necessary approval, as per the strategy document.
WHO has come up with a COVID-19 vaccine allocation plan, known as Covax, in order to ensure equitable access to vaccines, irrespective of a country’s income level. Fair allocations in two phases, first for covering 20% of population, and second for expanding coverage, is how the allocation is set to take place.
India has not yet signed contracts or made budgetary allocations for vaccine
Meanwhile, India’s health minister, Dr. Harsh Vardhan announced on 04 October 2020 that the government has plans to receive and utilize 400-500 million doses of the COVID-19 vaccine when ready, by July 2021. This would cover 200-250 million persons. However, the government is still working on formulating a policy for distribution, he said. However, there has been no formal announcement from the government’s side on what the source of the vaccine will be.
This announcement from the Health Minister comes at a time when countries around the world are racing to procure vaccines and have devised strategies for distribution, as noted in this article. The government has also not made any budgetary allocations for the same. Further, official information about the total expense to be incurred is also not yet available.
The only other information available in the public domain is the agreement between the Serum Institute of India (SII), Gavi, and Bill & Melinda Gates Foundation. The partnership announced in August 2020 aims to accelerate the manufacture and delivery of up to 100 million doses of COVID-19 vaccines for India and low- and middle-income countries (LMICs). What proportion of this will be allocated to India is still not known.
Procurement & Distribution Strategy is the need of the hour
India is now the second worst hit by the pandemic in terms of number of cases, and one among the five countries in the world which has recorded over one lakh deaths due to the virus. As per the WHO’s report, COVISHIELD, based on Oxford/AstraZeneca, is the only vaccine that is currently in phase-3 of clinical trials, being tested in India.
Like the USA, India quickly needs to develop a procurement & distribution for the vaccine once it becomes available for public use. Equitable distribution across states & various sections of society is something that the distribution strategy should take care of.
Featured Image: COVID-19 Vaccine Procurement