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Editor’s Note: Roberto Izurieta is director of Latin American Projects at George Washington University. He has worked in political campaigns in several countries in Latin America and Spain and was an adviser to Presidents Alejandro Toledo of Peru, Vicente Fox of Mexico and Álvaro Colom of Guatemala. Izurieta is also a contributor to CNN en Español. José Luis Di Fabio is an independent international consultant. He is retired from the Pan American Health Organization / World Health Organization, where he was regional advisor for Vaccines and Biologics, manager of the Technology, Health Care and Research area, among other positions. After his retirement, he has been a consultant on issues related to vaccines, medications and health regulation.
(CNN Spanish) –– With just reason, as in all countries, we hope to have a vaccine to end this pandemic, get out of our quarantine, recover and return to normal. A normality with best practices and information on the challenges we must overcome to lead a healthy life: maintaining social distance to avoid contagion, wearing a mask to protect others, washing our hands frequently to eliminate the virus from our homes and offices . Before the vaccine arrives, we will certainly have treatments available and that is another great hope (there are already some promising treatments, including the use of serum from convalescent patients, an option available to any country). Vaccines, which should arrive in a matter of months, would be the definitive solution to the pandemic, because by vaccinating a large part of the population we create a barrier (“group immunity”) that prevents the virus from continuing to transmit freely. But when vaccines are available, when and how will they reach our poor countries and their most vulnerable inhabitants?
Several manufacturers produce millions of doses of vaccines per year for influenza or influenza and other diseases, but the great challenge is to produce enough vaccines in a short time to effectively combat the pandemic. That is not as easy as it sounds. Technology has its challenges and its times. While we don’t have a coronavirus vaccine yet, there are already some good prospects, primarily in the United States, China, several European countries, Japan, and India. Each one with different types of vaccines and technological platforms. Even a kind of race to obtain it is already perceived, similar to the race to conquer space during the Cold War.
A major concern is that once the vaccine is available, the country where it was discovered and produced decides a kind of nationalization of the formula and that the people who receive the vaccine first are the inhabitants of that country. It is worth remembering that this kind of prioritization was also given in the purchase of masks and diagnostic tests, which were very limited at the beginning of this pandemic. Prioritization will most likely begin in each country by health workers, public safety, and then high-risk individuals. Once this stage is completed, governments will want to satisfy national demand before that vaccine can be exported to other nations (ignoring the demand of the poorest countries and their priority populations; at least while satisfying that national demand). This problem was already clearly seen during the 2009 influenza pandemic with the H1N1 vaccine. Fortunately, several world leaders are collaborating to prevent this from happening this time. The World Health Organization (WHO), BMGF (more popularly known as the Gates Foundation), GAVI, the Vaccine Alliance, and the Coalition for Epidemic Preparedness Innovations (CEPI) are some of the organizations working on global initiatives to encourage sufficient production of covid-19 vaccines and their availability in developing countries. CEPI, a major non-governmental organization primarily funded by the Wellcome Trust, Bill and Melinda Gates Foundation, the European Commission and various governments, is seeking to identify mechanisms and instruments to support the development of global production necessary to combat SARS-CoV-2, and has already supported various industries.
In parallel, leaders of the European Union and other institutions, including Gates and CEPI, have launched the Access to Covid-19 Tools (ACT) Accelerator, a global cooperation platform to accelerate research and development, production, access and distribution of vaccines, treatments and diagnoses in an equitable way. In addition, many plants are being conditioned or built, with enormous public, private and foundation investment, for the production of these vaccines. This is all good news.
Within the global panorama of the actors involved in vaccine development, many associations can be seen, with different modalities of cooperation, including technology transfer, as recently announced by Sinovac Biotech Ltd. (China) and the Butantan Institute in Brazil. An appropriate accompaniment by the national regulatory authorities will from now on allow progress in compliance with good practices and regulatory processes in order to have the corresponding approvals and licenses. The urgency is now; The work of all actors must be coordinated at the global and regional levels, with the support of the Pan American Health Organization (PAHO) in fulfilling its strategic role as established by its mandate.
How many doses of vaccine are needed and when could they reach different countries? The answer is at least 2 billion doses, which should be available in the short term, according to the UN. Given the urgency, the most promising vaccines will be produced in large production units, but if they must first meet the domestic demand of the producing country, production will not do much good to developing countries by not being able to obtain them immediately. For this, several strategies are being developed, such as Gavi Covax AMC (Advanced Market Commitment), which has launched a global initiative to raise US $ 2 billion, enough to finance the immunization of health personnel and other priority groups in the countries to the Gavi arrives. On the other hand, CEPI financing to some producers has been made with the commitment of having several hundred million doses available for low and lower middle income countries.
Another great challenge is to ensure that vaccines reach the intended audience, which would be health workers, high-risk segments and, finally, the general population. This involves the distribution and appropriate conservation media in each country to guarantee its effectiveness.
Therefore, the next objective is free distribution at affordable prices for the least developed countries. For these two steps, some very important organizations are already working. Now, if CoV-2 were to disappear as some prophesy, all that investment, particularly if it includes technology transfer, will not necessarily be lost, since much of the infrastructure built, as well as the technological platforms developed, will be useful for other vaccines or treatments.
How much can this process cost? The main players in the market have not said exactly how much they would charge consumers for the vaccine. However, some have pledged to make no profit in the process, which is meritorious. Others, however, cite prices for other vaccines such as pneumonia as an example (which costs several hundred dollars per patient). So, is it possible to consider that the price range goes from US $ 15 to US $ 500? The huge economic losses on the stock markets with the pandemic can be a reference to increase aid, globally control this pandemic, and avoid others in the future. In several countries, a large part of this sum will be paid by insurance companies, governments –– through social security––, or foundations that also participate. In many others, especially the poorest and those with low and middle incomes, the public health systems will pay for them, already with fairly limited budgets.
In short, no part of the process is easy or cheap, but as a society and with the commitments we are seeing, we have no doubt that we will achieve it together. Because if we have understood something of this pandemic it is that health is a global problem, that it is not solved simply by closing a border and that therefore, it also requires global and solidarity solutions.