How COVAX Lessons Could Help Vaccine Equity

COVAX was supposed to be the elixir of vaccine inequality — it wasn’t. However, lessons can be learned from past global experiences to help move forward.

Most early deaths caused by COVID-19 have occurred in developing economies. The global scale of the pandemic has made it clear where most vaccines are distributed and who bears the disproportionate health burden due to not having access to them. Low-income economies, clearly, had less access to vaccines.

Vaccine makers have been heavily criticized by defenders to prioritize profit over making vaccine access fair by keeping profit margins high, retaining intellectual property and production rights, and prioritizing “those who can pay the most “.

The criticism of “pandemic profit” is particularly directed against manufacturers who use mRNA technology, a relatively new and promising vaccine technology. During this time, the term “vaccine nationalism” has been used to describe how countries – especially developed countries – have saved large quantities of vaccine doses for their own population, limiting access to doses for low-income economies.

For improve international equity in vaccines, the Global COVID-19 Vaccine Access Mechanism (COVAX) was developed, co-led by the World Health Organization (WHO), the Gavi Vaccine Alliance and the Coalition for Preparedness Innovations. epidemics (CEPI). It is designed to be a global pool of funds that serves as procurement mechanism. Supported by donors and high-income economies, the goal is to make COVAX the most attractive customer for vaccines, with the bargaining power to negotiate prices and secure advance purchase agreements with manufacturers.

In reality, COVAX is plagued by complex political power imbalances between countries in need, developed economies and the private sector. For example, the so-called self-funding countries that helped fund COVAX had—in many cases— have already entered into purchase agreements with vaccine manufacturers before COVAX accumulates enough purchasing power to secure large-scale doses for developing economies.

Donor countries fail to honor their promise to “share the dose”, delay their deliveries, reserve donations or donate on a ad hoc base, all caused delays which meant that only a small proportion of promised doses were delivered and many nearly expired doses ended up being dumped as “donations”.

Meanwhile, manufacturers have not donated any promised vaccine doses to COVAX and instead turned to selling doses “at cost” through commercial agreements.

Work is underway to develop the national capacities of developing economies that will reduce dependence on more powerful countries. Technology transfer can play an important role in expanding vaccine manufacturing capacity in developing economies, improving access and reducing donor dependency.

In June 2021, WHO announced a partnership with a South African consortium to establish a multilateral technology transfer center for mRNA vaccines against COVID-19 and other diseases. The consortium, Afrigen Biologics and Vaccines, manufacture mRNA vaccines themselves and train another manufacturer. 10 additional countries will receive WHO technology transfer for mRNA vaccines – Indonesia, Bangladesh, Pakistan, Serbia, Vietnam, Tunisia, Kenya, Egypt, Nigeria and Senegal.

Important elements for the production of vaccines are the transfer of technological know-how and relevant clinical data, the training of human resources and capacity building, and the resolution of the issue of intellectual property rights. Another partner of technology transfer hubs, the Medicines Patent Pool, said that “the technology used in the hub is not covered by patents or that licenses and/or non-enforcement covenants are in place to allow freedom to operate” via “the voluntary participation of intellectual property owners “.

There are always the concern of the experts that the reluctance of mRNA vaccine manufacturers to completely relinquish their intellectual property rights will significantly jeopardize the activities of the hub and its sustainability.

The innovative financing mechanism COVAX tried – and the challenges it faced – raises a crucial question for technology transfer sites in developing economies: how to find and sustain financing.

The methods and materials used in mRNA technology are still relatively expensive, challenging the potential for scalability and profitability. The initial total cost to produce 100 million doses of mRNA vaccines per year is between 127 and 270 million US dollars, according to model.

An example widely cited as a successful example of innovative vaccine financing is the International Finance Facility for Immunization (IFFIm). The establishment issues “vaccination bonds” to investors, primarily based in developed economies, raising the funds to pre-vaccinate children in developing economies with secondary support from government donors.

The IFFIm has helped deliver vaccines to children who otherwise would have missed out, but its model has problems. His complex relationship between the development sector and the private capital market transferred a significant amount of benefits to the private actors involved in the form of costly transaction fees, intermediary fees or interest with financial risks backed by public money .

Health interventions that can save many lives, such as vaccines, must be accessible to everyone when they need them, especially the most vulnerable. Many approaches have been taken to make vaccine equity a reality, from ethical pledge agreements to market- and technology-based solutions.

But the pandemic and issues around access to vaccines show that the right mix is ​​needed to solve a very complicated problem in which political and commercial interests intersect with the need to save as many lives as possible.

Putri Widi Sarasvati is an Indonesian public health specialist and physician currently working as a research intern at the United Nations University-International Institute for Global Health (UNU-IIGH)United Nations Global Health Think Tank.

The author declares no conflict of interest. Originally published under Creative Commons by 360info™.

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