Pearls and Irritations

To bring the COVID-19 pandemic under control, vaccination rates in the most vulnerable countries need to increase.

Obstacles to global COVID-19 vaccination have left more than a billion people unprotected against the infection in mostly low-and middle-income countries (LMICs). More deadly new variants of COVID-19 will almost certainly emerge from raging infections in these large unvaccinated populations. Ensuring that vaccinations reach the most vulnerable has to become a top priority in bringing the pandemic under control.

There are four global strategies that would accelerate the implementation of COVID-19 vaccination in LMICs.

1. Strengthening COVAX through regional partnerships

The COVAX scheme established by the World Health Organization (WHO) has constantly been undermined since the start of the pandemic by vaccine nationalism and its reliance on a small number of wealthier countries to supply the program. This has made the scheme largely dependent on bi-lateral relationships between states and led to discrepancies in access to vaccines in some regions particularly in South-East Asia and Central Africa. LMICs could use regional partnerships such as ASEAN (Association of Southeast Asian Nations) and ECOWAS (Economic Community of West African States) to improve access and using existing relationships to exert pressure on wealthier countries to better resource COVAX. At the most basic level LMICs acting within these regional partnerships have greater influence. Negotiations could be facilitated by the United Nations with the help of the European Union and other organisations such as the Gates Foundation to pressure donor countries. A quick direct transfer of vaccine doses from COVAX to regional partnerships is needed. Australia’s own contribution to COVAX has been appalling. Australia has pledged to donate more than 60 million doses to COVAX and at time of writing has failed to deliver a single dose to the program — preferring instead to provide vaccine doses bilaterally based on political rather than public health considerations.

2. Producing generic versions of existing COVID-19 vaccines

The Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) deals with aspects of intellectual property rights that directly affect the ability of generic versions of COVID-19 vaccines to be produced and distributed more easily to LMICs. The agreement can be modified to include provisions that can see intellectual property protections supplanted in the event of an emergency, however, despite the crisis created by the COVID-19 pandemic negotiations to open up vaccine patents have stagnated. The production of generic versions of existing vaccines would substantially increase the global supply and discourage the continued hoarding of vaccines by wealthier countries. HIV deaths have been reduced by 64 per cent since the peak in 2004 and by 47 per cent since 2010 after Highly Active Antiretroviral Therapy (HAART) use was rapidly expanded. This only became possible after the extremely stringent rules relating to intellectual property rights were negotiated and access to essential medicines by LMICs could then be achieved. The Clinton Foundation played a critical role in these negotiations. The cost of the treatment fell and the supply of raw materials to make the drugs was consolidated allowing low-and-middle-income countries to establish collective pricing mechanisms. The reduced cost to acquiring the raw materials along with the sheer demand created allowed for a significant reduction in prices and for the production of generic versions of HAART treatment as pharmaceutical companies allowed greater access to patents as margins decreased. The consolidation of both the supply and demand of COVID-19 vaccines has the potential to allow for the production of generic versions of these vaccines and significant reductions in their overall cost.

3. Improving cold storage of vaccines via establishing hubs in central locations across continents

The Pfizer vaccine has been recommended by multiple public health agencies around the world as the safest and most effective option for younger populations, making it ideally suited for LMICs. Despite the suitability of the Pfizer vaccine for younger populations the fact that it needs to be stored at -90C to -60C for long periods has added another level of complexity to the deployment of this vaccine globally. The establishment of cold storage hubs in central locations across continents has the potential to increase the availably of the Pfizer vaccine, allow the global vaccination to contact more people in difficult to reach locations and increase the accessibility of other vaccines and medicines requiring cold storage. This could be achieved by establishing central vaccine hubs with cold storage capacity in central locations in Africa and South East Asia that service a number of smaller facilities. Multiple hubs could also be established in some countries where transport is extremely difficult and could cause delays in the delivery of vaccines. For example, in the Democratic Republic of the Congo vaccine hubs could be established in both the capital city of Kinshasa and the eastern city of Goma that would be directly serviced by a central facility in Kigali run by WHO as a part of the COVAX program.

4. International agreement to stop the stockpiling of COVID-19 vaccines

Vaccine nationalism — countries prioritising their own access to vaccines at the expense of the rest of the world — has been the biggest factor limiting vaccination in low-and-middle-income countries. An international agreement brokered through the United Nations General Assembly by LMICs should limit states from stockpiling vaccines above 10 per cent of their total national population. This would both increase the global supply of vaccines and encourage states to use vaccines already stockpiled. Compassion as well as enlightened self-interest requires Australia to press other high-income countries to assist with the urgent achievement of vaccination rates in LMICs equivalent to the rates already achieved in rich countries.

The COVID-19 pandemic represents a critical and ongoing threat to the health and economic well-being of all countries. A dramatic correction of the major structural problems of vaccine deployment would have huge benefits that would help bring the pandemic under reasonable control. The infrastructure implemented to improve global COVID-19 vaccinations would also help the world to better prepare for future pandemics and the fight against all endemic diseases.

Share and Enjoy !

SHARE TWEET SHARE COPY EMAIL PRINT