By Sohan Rao
University of Pittsburgh
The COVID-19 pandemic is without doubt the most devastating public health crisis since the H1N1 outbreak in 2009. Yet, despite the exponential growth in healthcare technology and access, we remain in the shadow of certain social disparitiestied to race and income we ought to have eliminated by now. Specifically, issues with the equitable distribution of critical pandemic vaccines pose as much of a challenge now as they did 11 years ago with the Swine Flu.
In early 2010, during the massive global rollout of the H1N1 vaccine, the World Health Organization (WHO) itself criticized the large advanced orders placed by developed nations and neglect of vaccine demand in developing countries. The WHO attempted to negotiate with manufacturers and first-world nations to reserve some vaccine supply for the developing world and partnered with the United Nations (UN) to collect monetary donations as well. However, success was limited and developed nations saw an excess of vaccine supply, even after the end of the pandemic, while developing countries struggled with their limited resources. The WHO committed to a goal of supplying only 10% of the populations of 95 developing nations with the H1N1 vaccine, amounting to 200 million total doses .To put this in perspective, in 2009 the United States alone advance ordered 250 million units of the vaccineenough to vaccinate about 81% of its population , . Despite many proposed actions having targeted this inequity over the years, the COVID-19 pandemic once again places it under the spotlight and highlights the demand for a more innovative solution.
Unfortunately, this disparity in vaccine distribution boils down to governing principles that are too often socioeconomically discriminating. Governments themselves don’t possess the infrastructure necessary to develop and manufacture vaccines and instead resort to funding private pharmaceutical companies to do so. This renders potential vaccines as make-or-break business opportunities, where private corporations construct distribution and pricing plans based largely on financial incentives. Specifically, the risks and resources involved in developing such vaccines so rapidly promote high prices and limited access. However, unlike with the relatively small scale H1N1 outbreak, it is clear that financially targeting vaccines to those wealthy enough to purchase them won’t end the current Coronavirus pandemic. Experts contend that at least 70% of the globe must be vaccinated to achieve herd immunity and effectively halt the spread of the virus.How, then, have nations addressed these issues? What is being done to ensure that COVID-19 vaccines will be distributed evenly across the world both at reasonable costs, to both the disadvantaged and advantaged, and without financially hurting pharmaceutical developers?
An interesting initiative that has gained significant traction is the Gavi Covax Advanced Market Commitment (Covax AMC). The goal of the Covax AMC is first to construct a coalition of nations willing to aid in the equitable distribution of future COVID-19 vaccines. It’s focused on raising $2 billion from participating countries around to world to immunize health care workers and high-risk individuals in developing nations. Furthermore, the Covax AMC hopes to provide volume guarantees to all nations for multiple vaccine candidates before they are licensed, similar to what the United States did in 2009 with H1N1. To accomplish this, Gavi has preordered large, set amounts of vaccines from different pharmaceutical companies that the WHO can later decide where to administer. This incentivizes pharmaceutical companies to invest in manufacturing, increasing supply availability and reducing prices as well as the amount of time it takes for vaccines to become available. In effect, this strategy promotes abundant vaccination resources for all nations while de-risking the costs, for pharmaceutical companies, of investing in manufacturing large amounts of product when the outcomes of the vaccines are yet to be known .As of August 24th, 2020, 172 nations are participating in the Covax alliance.
The Gavi model has proved successful before with the Pneumococcal vaccine (PCV AMC). This alliance helped vaccinate 225 million children across 60 low and lower-middle income countries against the leading cause of childhood pneumonia. Launched in 2009, it now ships over 160 million doses of PCV to developing countries annually . However, despite this success, the Covax AMC model faces a much more significant challenge and needs to address certain underlying issues.
A major obstacle for the Covax AMC is deciding which vaccine candidates to invest in. Do they concentrate their funding on a select few or a wide distribution? The scale of the
Coronavirus pandemic has spurred waves of vaccine development in comparison to the PCV, and there are many promising candidates. However, none are proven. The main strategy of the Covax AMC is to invest in vaccine candidates ahead of time, a principle that in effect locks the coalition into their vaccine selections. If vaccine candidates show impactful variations in efficacy after phase 3 trials or some perhaps have dangerous side effects, this could reduce supplies to developing nations and pose a large financial risk for Gavi. The situation would revert to that seen in the H1N1 pandemic where the Covax AMC would lose investments and vaccine supplies while wealthy nations could forfeit the alliance and revert to their own national funding to quickly order functional vaccines. Vaccine supplies would then again prove limited to developing nations.
A more long-term issue is determining whether Covid-19 fits the Pneumococcal model Gavi has developed for continued shipment of vaccines years from the start. There is a possibility for companies to invest in developing seasonal Coronavirus vaccines to prevent another pandemic. If they do so, Gavi would have to outline plans to continue funding vaccine orders. Furthermore, seasonal Coronavirus vaccines may prove less necessary than, for example, the PCV (Coronaviruses tend to cause mild illnesses) and it may not be feasible for Gavi to continue the Covax AMC. In this situation, access to seasonal Coronavirus vaccines in third world countries would diminish, as lower demand would raise prices. This may leave the developing world more susceptible to a new Coronavirus pandemic or epidemic, as the inaccessible seasonal vaccines may offer partial immunity against new highly virulent or deadly strains to wealthy, developed nations only.
The Gavi Covax initiative is a unique effort that showcases the benefits of all nations, rich and poor, working collectively to eradicate a common threat. However, unlike past epidemics and pandemics, the scale and timetable of the COVID-19 outbreak introduces many economic and technological risk factors and uncertainties. While the current pandemic has clearly fostered efforts to promote health equity with respect to vaccine access, can we really expect to share our resources and developments to third world nations if we ourselves are uncertain of our own future? At the end of the day, luck is still involved. Our vaccines still need to work. If the Covax alliance succeeds, the Gavi model may hold the key to future healthcare investments in developing nations. However, if it fails, we could see rising disparity on a devastating scale.
- Fidler, D. P. (2010). Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1. PLoS Medicine,7(5). doi:10.1371/journal.pmed.1000247
- Roos, R. (2010, June 24). WHO: Donated H1N1 vaccine supplied to 56 countries. Retrieved September 10, 2020, from https://www.cidrap.umn.edu/news-perspective/2010/06/who-donated-h1n1-vaccine-supplied-56-countries
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- Emanuel, T. (n.d.). A Comprehensive COVID-19 Vaccine Plan. Retrieved September 10, 2020, from https://www.americanprogress.org/issues/healthcare/reports/2020/07/28/488196/comprehensive-covid-19-vaccine-plan/
- Gavi launches innovative financing mechanism for access to COVID-19 vaccines. (n.d.). Retrieved September 10, 2020, from https://www.gavi.org/news/media-room/gavi-launches-innovative-financing-mechanism-access-covid-19-vaccines
- Countries come together to back COVAX Facility. (n.d.). Retrieved September 10, 2020, from https://www.gavi.org/
Chuo Kikuu cha Sohang Rao cha Pittsburgh, Marekani, kimesema janga la COVID-19 ni janga kubwa zaidi la afya ya umma tangu kuenea kwa virusi vya corona mwaka 2009. Hata hivyo, licha ya ukuaji wa kasi katika teknolojia ya huduma za afya na upatikanaji, bado tuko katika kivuli cha tofauti fulani za kijamii kwa jamii na mapato ambayo tunapaswa kuwa tumeondoa sasa. "Hata hivyo, ""matatizo ya usambazaji wa chanjo za janga muhimu ni changamoto kubwa sasa kama ilivyokuwa miaka 11 iliyopita na homa ya nguruwe.""" Katika mwaka wa 2010, wakati wa kuanzishwa kwa chanjo ya H1N1, Shirika la Afya Duniani (WHO) lilishutumu maagizo makubwa ya nchi zilizoendelea na kutojali mahitaji ya chanjo katika nchi zinazoendelea. WHO ilijaribu kujadili na wazalishaji na mataifa ya ulimwengu wa kwanza kuhifadhi baadhi ya usambazaji wa chanjo kwa ulimwengu unaositawi na kushirikiana na Umoja wa Mataifa (UN) kukusanya michango ya fedha pia. Hata hivyo, mafanikio yalikuwa madogo na nchi zilizoendelea ziliona ziada ya usambazaji wa chanjo, hata baada ya mwisho wa janga hilo, wakati nchi zinazoendelea zilipambana na rasilimali zao ndogo. WHO imeweka lengo la kutoa chanjo ya H1N1 kwa asilimia 10 tu ya idadi ya watu katika nchi 95 zinazoendelea, na kwa jumla inawakilisha dozi milioni 200 za chanjo hiyo. Licha ya hatua nyingi zilizopendekezwa zilizolenga ukosefu huu wa usawa kwa miaka, janga la COVID-19 kwa mara nyingine tena linaweka chini ya mwangaza na linaangazia mahitaji ya suluhisho la ubunifu zaidi. Kwa bahati mbaya, tofauti hii katika usambazaji wa chanjo huishia kwenye kanuni za utawala ambazo mara nyingi ni za ubaguzi wa kijamii na kiuchumi. Serikali zenyewe hazina miundombinu muhimu ya kuendeleza na kutengeneza chanjo na badala yake zinatumia fedha kwa makampuni ya kibinafsi ya dawa kufanya hivyo. Hii inatoa chanjo za uwezekano kama fursa za biashara za kufanya au kuvunja, ambapo mashirika ya kibinafsi hujenga mipango ya usambazaji na bei kulingana na motisha za kifedha. Hasa, hatari na rasilimali zinazohusika katika kuendeleza chanjo hizo kwa kasi sana huendeleza bei ya juu na upatikanaji mdogo. Hata hivyo, tofauti na mlipuko mdogo wa H1N1, ni wazi kwamba kulenga chanjo kwa wale matajiri vya kutosha kuzinunua hakutaishia janga la sasa la coronavirus. Wataalamu wanasema angalau asilimia 70 ya watu duniani wanahitaji chanjo ili kuimarisha kinga ya kundi na kuzuia kuenea kwa virusi hivyo, lakini ni vipi mataifa yamepambana na tatizo hilo? """Ni nini kinachofanywa kuhakikisha kwamba chanjo za COVID-19 zitasambazwa kwa usawa ulimwenguni kote kwa gharama za busara, kwa walio chini na walio na faida, na bila kuumiza kifedha watengenezaji wa dawa?" Mfumo wa kwanza wa kuimarisha ushirikiano wa GAVI na Covax ni Mkataba wa Soko la Juu (AMC). Lengo la Covax AMC ni kwanza kujenga muungano wa mataifa tayari kusaidia katika usambazaji wa usawa wa chanjo za COVID-19 za baadaye. Lengo la mradi huo ni kukusanya dola bilioni mbili kutoka nchi zinazoshiriki na kuandaa chanjo kwa wafanyakazi wa afya na watu walio katika hatari kubwa katika nchi zinazoendelea. Kwa kuongezea, Covax AMC inatarajia kutoa dhamana ya kiasi kwa mataifa yote kwa wagombea wengi wa chanjo kabla ya kuidhinishwa, sawa na kile Marekani ilichofanya mnamo 2009 na H1N1. Kwa ajili ya hili, Gavi imeagiza kiasi kikubwa cha chanjo kutoka kwa makampuni tofauti ya dawa ambayo WHO inaweza kuamua baadaye ni wapi kuitumia. Hii inawasaidia makampuni ya dawa kuwekeza katika utengenezaji, kuongeza upatikanaji wa usambazaji na kupunguza bei na kiasi cha muda unachohitajiwa kwa chanjo kuwa inapatikana. """Mkakati huu unakuza rasilimali nyingi za chanjo kwa mataifa yote wakati wa kupunguza gharama kwa makampuni ya dawa ya kuwekeza katika utengenezaji wa bidhaa nyingi wakati matokeo ya chanjo bado hayajulikani,"" alisema Rais Obama katika taarifa yake ya kwanza ya wiki hii." Mfano wa Gavi umethibitika kuwa na mafanikio kabla na chanjo ya Pneumococcal (PCV AMC). Mkataba huo ulisaidia chanjo ya watoto milioni 225 katika nchi 60 zenye mapato ya chini na ya kati dhidi ya kisababishi kikuu cha ugonjwa wa mapafu wa watoto. Tangu kuanzishwa kwake mwaka 2009, shirika hilo limesafirisha dozi zaidi ya milioni 160 za virusi vya corona kwa nchi zinazoendelea kila mwaka. Hata hivyo, licha ya mafanikio haya, mfano wa Covax AMC unakabiliwa na changamoto kubwa zaidi na unahitaji kushughulikia masuala fulani ya msingi. Kizuizi kikubwa kwa Covax AMC ni kuamua ni wagombea gani wa chanjo wa kuwekeza. Je, wanakusanya fedha zao kwa watu wachache waliochaguliwa au kwa watu wengi? """Ukubwa wa janga la coronavirus umesababisha mawimbi ya maendeleo ya chanjo ikilinganishwa na PCV, na kuna wagombea wengi wenye kuahidi." Hata hivyo, hakuna lolote ambalo limethibitishwa. Mkakati mkuu wa Covax AMC ni kuwekeza katika wagombea wa chanjo kabla ya wakati, kanuni ambayo kwa kweli inazuia muungano katika uteuzi wao wa chanjo. """Ikiwa chanjo zitakuwa na athari kubwa katika ufanisi baada ya majaribio ya awamu ya tatu au baadhi ya athari hatari, hii inaweza kupunguza usambazaji kwa nchi zinazoendelea na kuanzisha hatari kubwa ya kifedha kwa Gavi." Hali hiyo itarudi kwa ile iliyoonekana katika janga la H1N1 ambapo Covax AMC itapoteza uwekezaji na usambazaji wa chanjo wakati mataifa tajiri yanaweza kupoteza muungano na kurudi kwa ufadhili wao wa kitaifa ili kuagiza chanjo za kazi haraka. Kisha tena ugavi wa chanjo ungepatikana tu katika nchi zinazoendelea. "Swali la muda mrefu zaidi ni kuamua ikiwa COVID-19 inafaa mfano wa Pneumococcal ambao Gavi imebuni kwa usafirishaji wa chanjo ya kuendelea miaka kadhaa tangu mwanzo.""" Kuna uwezekano kwa makampuni kuwekeza katika kuendeleza chanjo za msimu za Coronavirus ili kuzuia janga jingine. Ikiwa watafanya hivyo, Gavi ingekuwa na kuelezea mipango ya kuendelea kufadhili maagizo ya chanjo. Kwa kuongezea, chanjo za msimu za coronavirus zinaweza kuthibitika kuwa hazihitajiwa sana kuliko, kwa mfano, PCV (Coronavirus huwa na kusababisha magonjwa ya upole) na inaweza kuwa haiwezekani kwa Gavi kuendelea na Covax AMC. Katika hali hii, upatikanaji wa chanjo za msimu za coronavirus katika nchi za ulimwengu wa tatu utapungua, kwani mahitaji ya chini yataongeza bei. Hii inaweza kuacha ulimwengu unaositawi zaidi kwa janga au janga jipya la coronavirus, kwani chanjo za msimu zisizoweza kufikiwa zinaweza kutoa kinga ya sehemu dhidi ya aina mpya za virusi au hatari kwa nchi tajiri, zilizoendelea tu. """GAVI Covax ni mpango wa kipekee ambao unaonyesha faida za mataifa yote, matajiri na maskini, kufanya kazi kwa pamoja ili kuondoa tishio la kawaida." Hata hivyo, tofauti na magonjwa ya zamani, kiwango na ratiba ya kuzuka kwa COVID-19 inaanzisha sababu nyingi za kiuchumi na kiteknolojia za hatari na kutokuwa na uhakika. """Wakati janga la sasa limekuwa wazi kuimarisha juhudi za kukuza usawa wa afya kuhusiana na upatikanaji wa chanjo, tunaweza kweli kutarajia kushiriki rasilimali zetu na maendeleo kwa mataifa ya ulimwengu wa tatu ikiwa sisi wenyewe hatujui wakati ujao wetu?" Mwishowe, bado kuna bahati. Chanjo zetu bado zinahitaji kufanya kazi. Ikiwa muungano wa Covax utafanikiwa, mfano wa Gavi unaweza kuwa ufunguo wa uwekezaji wa afya wa baadaye katika nchi zinazoendelea. Hata hivyo, ikishindwa, tunaweza kuona ongezeko la utofauti kwa kiwango cha kuangamiza. - Fidler, D. P. (2010). """Ufikiaji wa usawa wa chanjo za homa: diplomasia ya afya ya ulimwengu na utata unaozunguka homa ya ndege H5N1 na homa ya homa ya janga H1N1.""" PloS Medicine, 7 (5) (Jarida la Utafiti la Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti wa Utafiti). WHO: Chanjo ya H1N1 imetoa kwa nchi 56 "Kama ilivyoelezwa katika taarifa ya wiki ya leo, ""H1N1: H1N1 Influenza: Just the Facts: Vaccine Essentials"" ilitolewa na shirika la WHO." (Mwanzo 23; Novemba 23) "Kutoka kwa ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020"" na ""Mwanzoni mwa 2020.""" (2011). "Kutoka kwa ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho ya Uhai"" na ""Makumbusho wa Uhai"" na ""Makumbusho wa Uhai"" na ""Makumbusho wa Uhai""" Washington, D.C. - U.S. Usimamizi wa Biashara, Uchumi na Takwimu, Ofisi ya sensa ya Marekani. - Emanuel, T. (n.d.). Mpango wa chanjo kamili ya COVID-19 "Kama ilivyoelezwa katika taarifa ya GAVI iliyochapishwa Septemba 10, 2020, kutoka https: www.americanprogress.org, ""GAVI inazindua utaratibu wa kifedha wa ubunifu kwa upatikanaji wa chanjo za COVID-19." (N.d.). "Kama ilivyoelezwa katika taarifa ya wiki hii, ""Gavid-launched innovative financing mechanism access covid-19 vaccines: countries come together to back COVAX facility"" (Vaccin za COVID-19: nchi zinaungana kuunga mkono kituo cha COVAX)." (N.d.). Imechapishwa Septemba 10, 2020 na https: www.gmail.com