The COVID-19 epidemic has swept the world for nearly a year. Recently, the United Kingdom and the United States have successively approved several coronavirus vaccines to be launched, which has brought significant benefits to the return of normal to the global economy, but it is far from the time to cheer for victory.
The COVID-19 vaccine is a long and complex process from procurement to production to vaccination. It is not only affected by the economic strength of the purchaser, but also by political factors. Coupled with the uncertainty caused by the mutation of the novel coronavirus, this process is like a 12-dimens. ional chess).
On December 8, the British National Health Service (NHS) began to inject vaccines jointly developed by Pfizer-BioNTech, starting a rare public health action in the history of modern medicine. The British will become the first group in the world to be vaccinated against the novel coronavirus after a complete three-phase clinical trial.
The United States also began vaccination in mid-December. As of December 23, 1 million people had been vaccinated against the novel coronavirus. Although it is still far from the 20 million people planned by the end of 2020, it is only a matter of time before the United States can achieve universal vaccination in the face of sufficient supplies. (If factors such as anti-vaccine campaigns are not taken into account).
Britain and the United States are the most abundant in ordering of coronavirus vaccines in the world, in addition to the European Union and Canada.
According to the Duke Global Health Innovation Center, the authoritative source of information in the field of vaccine protocols, the four countries or regions not only have large orders but also have a large number of orders, covering most pharmaceutical companies.
Table 1: Purchases of COVID-19 vaccine in the European Union, the United States, the United Kingdom and Canada
Based on the above data, U.S. media analysis said that if the vaccines purchased can be delivered in full, the EU can vaccinate its people twice, Britain and the United States can vaccinate the people four times, and Canada can vaccinate the people six times. In contrast, low-income countries, which may have access to up to 20% of the population by the end of 2021.
Data from Duke University Weekly confirms this analysis. As of December 18, 2020, the number of coronavirus vaccines subscribed worldwide was 7.7 billion, including 4 billion doses in developed countries, 1.1 billion in upper middle-income countries, 1.8 billion doses in low- and middle-income countries and 0 in low-income countries.
The price of vaccines hides secrets.
Although it is not yet possible to prove that the coronavirus vaccine will ensure an end to the pandemic, high-income countries have made a full bet and actively hoarding even if an absolute majority of vaccines have been obtained.
On December 23, the U.S. pharmaceutical giant Pfizer revealed that it would supply an additional 100 million doses of coronavirus vaccine to the U.S. government under a new agreement between the company and the Trump administration.
Pfizer and its German partner BioNTech said that this will bring their total dose to 200 million doses to the United States, and the U.S. government has the option to buy 400 million additional doses. “The new procurement agreement gives Americans more confidence to vaccinate every American in need by June 2021,” said Secretary of Health and Human Services, Alex Azar, in a statement.
“When desperately needed goods appear on the market, we’ll buy as much as we can because we are afraid that every country is like a drowning person to grab a lifebuoy, and every vaccine is a lifebuoy.” Julia Barnes-Weise explained the rush to the reporter of Finance. Barnes-Weiser has senior experience in the pharmaceutical industry and is familiar with issues related to vaccine supply agreements.
She is currently the executive director of the Global Alliance for Health Innovation (GHIAA) and a senior consultant to the Alliance for Epidemic Prevention and Innovation (CEPI), a funding agency for COVID-19 vaccine research and development.
At present, there are two main types of agreements on the novel coronavirus vaccine.
The first is the bilateral agreement signed between countries and regions (such as the European Union) and pharmaceutical companies, and the second is the agreements signed between multilateral cooperation mechanisms and pharmaceutical companies.
Different subjects of the agreement also reflect the difference in the way to obtain vaccines. In the current situation of tight supply, the two models do not fully achieve good interaction and cooperation, but are in a tense state of competition.
So far, most pre-purchased vaccines have been procured through bilateral agreements in high-income countries. Regarding what the agreement may contain, Barnes-Weiser said that the details of these bilateral agreements are almost undisclosed, but generally speaking, they include price and time frames and exemptions from liability if the vaccines cause any damage to the human body, because these vaccines were not authorized to be authorized at the time of signing the agreement.
The low-cost vaccine agreement signed between the European Union and AstraZeneca contains a certain degree of exemption. In addition, the agreement may be limited to sales in one region and country, rather than resale to other regions and countries. The number of additional vaccines purchased will also be mentioned, and may be purchased at the same price and a delivery date will be specified.
The non-disclosure of the vaccine agreement has both political and economic considerations, which has caused some controversy. In December 2020, Eva De Bleeker, Belgium’s Secretary of State for the government budget, angrily announced the price of the European Union’s vaccine purchase on Twitter during a verbal battle with the opposition party, which was subsequently deleted.
Her spokesperson apologized that technically these prices should not be released, so the tweet was deleted. In response, a spokesman for the European Commission said that everything about vaccines and prices is included in confidentiality clauses, which is in the interest of society and the parties under negotiation.
The most sensitive part of the vaccine agreement is the price, and even rich countries are competing and playing games. De Brick’s move caused controversy precisely because his announced EU purchase price is lower than that of the United States and Canada.
According to analysis by Bernstein Research, an independent asset research company, the EU paid 24% less than the price of the Pfizer vaccine in the United States. The EU has provided substantial funding for BioNTech, which has developed a vaccine in cooperation with Pfizer. Similarly, the United States pays $4/date for AstraZeneca vaccine, compared with $2.18 per dose in the European Union.
“The non-disclosure of vaccine agreement is largely because countries do not want each other to know the purchase price of vaccines, and pharmaceutical companies do not want to let the outside world know that the price of vaccines depends on the influence of both negotiating parties (leverage).
For example, some countries pre-funded research, while some countries have less bargaining power… Pharmaceuticals Enterprises give preferential terms to some countries, but do not want to give them to other countries. Barnes-Weiser explained to the reporter of Caijing.
Not only is the price issue sensitive in bilateral vaccine agreements, but also in multilateral agreements, because the price of a vaccine subsidized by international multilateral organizations will be very different from the domestic price, or even 10 to 20 times, but the public is not aware of the mechanism of operation, and only sees the result of the price difference. , which may stimulate dissatisfaction with the government.
Funding R&D rich countries to seize the opportunity
In the signing of bilateral agreements, the influence of the negotiating parties largely determines the purchase price and quantity of a country or region. The funding a nation has paid in vaccine development is an important sign of influence.
For example, the United States has provided billions of dollars for the development and production of five promising coronavirus vaccines to push these vaccines forward at an extraordinary speed and scale, but this support is conditional that Americans will give priority to obtaining the United States. These vaccines are produced locally.
Countries with strong payment ability can take the lead in ordering vaccines. In order of the risk of failure of vaccine research and development, they choose to bet on many kinds of vaccines in advance, as shown in the above-mentioned form.
These countries and regions also chose to expand the scope of transactions and add options to buy more vaccines, which further weakens the purchasing power of low-income countries.
Although Pfizer vaccine has entered the United Kingdom, Canada and the United States, it is not clear when it will enter other countries. Even middle-income countries like Mexico can only expect to get the first vaccines in the next 12 months under the agreement, not to mention low-income countries that cannot afford to buy them.
“This is a matter of money. Those countries that cannot advance the cost of vaccines, those countries that cannot fund vaccine research and development funds cannot get vaccine agreements like high-income countries.
But not every country has a big wallet. The United States can fund multiple vaccine research and development, and can also order multiple vaccines from other countries. Low-income countries can’t afford to get the coronavirus vaccine for the whole population.” Barnes-Weiser said.
Although the bilateral agreement enabled rich countries to obtain most of the coronavirus vaccines, and similar situation occurred when the influenza A (H1N1) outbreak occurred in 2009, it should not be a result of exaggerating irrational hatred of rich countries and demonizing the bilateral agreement on vaccines.
“We need to recognize that the bilateral model is not all negative in any case,” Krishna Udayakumar, director of the Center for Global Health Innovation at Duke University, told Caijing. The large funding of vaccine development and pre-orders by the bilateral and private sectors has enabled the world to accelerate vaccine development on a large scale and obtain multiple effective vaccines in a record short time.
Multilateral mechanism VS vaccine nationalism
Only by affirming the bilateral mechanism can we better play the complementary functions of the multilateral mechanism in order to achieve equitable vaccination of the global population against the novel coronavirus.
Building on the experience and lessons of the H1N1 pandemic, two nonprofit organizations supported by the World Health Organization (WHO) and the Bill Gates Foundation, the Global Alliance for Vaccines and Immunization (Gavi) and the Alliance for Innovation in Epidemic Preparedness (CEPI), jointly promoted the establishment of the novel coronavirus after the outbreak. Vaccine Assurance Mechanism (COVAX).
Similar to bilateral agreements, COVAX signs agreements with pharmaceutical companies to fund vaccine research and development and purchase vaccines through multilateral mechanisms to obtain vaccines for poor economies.
COVAX supports the development and production of candidate vaccines, including AstraZeneca/Oxford, and obtains hundreds of millions of vaccines through such agreements.
The COVAX mechanism has now ordered 870 million doses of vaccines (as of December 18), according to the Duke University Center for Global Health Innovation. According to the WHO website, 190 economies have joined COVAX, including China.
COVAX is an innovative mechanism that covers everything from vaccine development to vaccine delivery to dose commitment. In this mechanism, CEPI is mainly responsible for research and development, Gavi is mainly responsible for vaccine procurement and coordination, and WHO is mainly responsible for formulating vaccine-related vaccination strategies and distribution principles.
COVAX aims to provide at least 2 billion doses of safe and effective COVID-19 vaccines globally by 2021, 92 of which 92 assisted economies will receive at least 1.3 billion doses of the epidemic through the Advance Market Commitments mechanism.
Seedlings to meet the target of 20% of its population to achieve vaccination by the end of 2021. These 92 economies include not only low-income participants, but also some small island countries. Although they may have higher incomes, they are too small and have no bargaining power in the signing of bilateral vaccine agreements due to their small size and population.
“COVAX represents a promising multilateral platform that will play a central role in the global response to support more equitable global access to and distribution of COVID-19 vaccines, bringing 190 economies together by investing in a large portfolio of candidate vaccines to bring the world’s highest-risk populations to the epidemic by 2021. Miao.” Yudaya Kumar commented.
At the same time, Yodaya Kumar also stressed that the international community needs to significantly increase its financial support for COVAX in order to make it reach the level needed for success.
Whether enough funds can be raised is the key to the success of COVAX. So far, COVAX’s most generous donors are the European Union, the United Kingdom and the Bill Gates Foundation.
The United Kingdom has pledged 700 million US dollars and the European Union has pledged 500 million euros. The Bill Gates Foundation has promised COVAX advance market commitments. The mechanism committed 156 million US dollars.
COVAX does face a funding gap. Zhang Li, director of the Gavi Center for Strategic Innovation and New Investors, said at the recent Global Health and Development Media Seminar held by the Beijing office of the Bill Gates Foundation that the biggest problem facing COVAX’s pre-market commitment mechanism may be funding, because The signing of the agreement needs to be guaranteed by funds.” We set up the COVAX Advance Market Commitment Mechanism in June, when the goal was to raise $2 billion as seed fund by the end of 2020, and $2.4 billion so far.
There is still a gap of about $4.6 billion by the end of 2021 to guarantee the supply of 1 billion doses of vaccine to economies involved in the Advance Market Commitment Facility.” Zhang Li said.
Reuters also revealed that the shortage of funds may lead to the eventual failure of COVAX, because of problems including high vaccine prices, delayed supply and shortage of funds. Not only that, COVAX faces multiple challenges such as failed vaccine trials, difficult distribution and complex supply contracts, making its prospects imperiling.
The article gives an example of saying that under the terms of the COVAX agreement, participants can refuse to buy pre-order vaccines if they prefer other vaccines or obtain them through other agreements (faster or better prices). A Citi report also pointed out that COVAX may also face a loss if countries are unable to pay orders or herd immunity develops too fast, and vaccines are no longer a necessity.
The challenges faced by COVAX, especially the financial problem, have led to a general call for the United States to give more support to this multilateral mechanism.
So far, the tension between the Trump administration and the WHO has kept the United States avoiding COVAX, let alone participate in it.
To make matters worse, Trump’s insistence of the concept of “vaccine nationalism” further exacerbates tensions between bilateral and multilateral mechanisms on vaccine procurement and distribution, which is not conducive to the full cooperation of the international community.
Unlike the Trump administration’s “America First” principle, the elected Biden administration adheres to multilateral and internationalist concepts. Biden himself has promised to return to the WHO, which brings positive factors to the outlook of COVAX.
On a positive note, Yodayakumar believes that the Biden administration is likely to join the COVAX platform.
But he also pointed out that the overall tension between bilateral and multilateral access to vaccines will continue, driven by many countries, including the United States.
Regarding the prospect of cooperation between the United States and COVAX, Barnes-Weiser also cautiously believes that the Biden administration does pay more attention to global affairs.
He regards the United States as a globalized country and shuts it off, which will allow the United States and other countries to communicate more in the fight against the epidemic.
But at the same time, because Biden takes over the epidemic mess, he must strike a balance between alleviating the U.S. epidemic, rebuilding the U.S. economy, and playing the role of the leader of the global system, the work he faces is very difficult.
There is still no clear indication of whether Biden’s new U.S. government can join COVAX and provide financial support.
One of the difficulties is that this involves the flow of funds to different countries within the multilateral mechanism, that is, which country contributes to COVAX and which countries the funds are used, in which It contains some traditional bilateral relations mechanisms, so the negotiation process will be difficult and complex.
Far-reaching global immunization
Given the uncertainties and challenges faced by the COVAX mechanism, Yodaya Kumar believes that in addition to direct purchase of COVAX, the international community needs other mechanisms, such as donations from high-income countries for excessive procurement of vaccine doses.
Now Canada and the European Union have a framework of positive signs of donating vaccine doses.
Developed countries in Europe and the United States donated vaccines to low-income countries during the 2009 H1N1 pandemic, because although hoarding large quantities of vaccines can comfort their people, it also burdens these high-income countries with great moral burdens, so donating vaccines is a win-win move.
Not only is it moral pressure, but the donation itself benefits high-income countries, because if low-income countries cannot be helped to mitigate the epidemic, it will not be achieved to curb the spread of the novel coronavirus worldwide.
As Bruce Aylward, senior adviser to the WHO Director General, said, “The worst result may be that we have already provided vaccines to the entire population of [high-income] countries before we can provide vaccines to the most at-risk populations in other countries.”
In addition to donating vaccines, multinational pharmaceutical companies are also required to share technology and intellectual property rights, so that vaccines can be produced globally instead of concentrated in some countries with R&D and production capacity, which can greatly save transportation costs and help the subsequent transportation and implementation of vaccines.
This is a theoretically feasible approach, but whether it can eventually be put into practice depends on the exploration and consultation between governments and multinational enterprises.
“The localization of vaccines will alleviate the situation and achieve greater vaccination coverage. Some large pharmaceutical companies are currently exploring technology transfer with India and other countries to achieve localized mass production of more affordable vaccines, which will benefit low- and middle-income countries.
Achieving vaccine production in many places is also conducive to avoiding vaccine nationalism and preventing a country from monopolizing vaccines from refusing to export. Barnes-Weiser said.
There is still a long way to go to achieve the vaccination of the global population against the novel coronavirus, and some analysts believe that it may not be basically achieved until 2024.
It is full of uncertainty and risks, because we don’t know when the pandemic will end and how many feasible vaccines will be. No one knows whether the coronavirus vaccine will become an annual routine vaccine, or what impact the virus variant will have.
Regarding the future of the coronavirus vaccine, Yodaya Kumar believes that although the vaccine is a key element in the current response to the novel coronavirus, it is not the only factor, or even the dominant factor in most parts of the world, because most low- and middle-income countries cannot achieve the herd immunization needs in more than two years.
Vaccination level. In the face of an uncertain future, we will continue to take the necessary public health response, in the process, vaccines can help shorten the acute phase of the coronavirus pandemic and greatly reduce death and suffering. But if COVID-19 vaccination becomes a seasonal need like the flu, we need to significantly strengthen the relevant infrastructure for vaccine production and delivery.