[Ip-health] New York Times: For Covid-19 Vaccines, Some Are Too Rich — and Too Poor

Thiru Balasubramaniam thiru at keionline.org
Tue Dec 29 00:32:36 PST 2020


For Covid-19 Vaccines, Some Are Too Rich — and Too Poor

Global inequality is shaping which countries get vaccines first. In South
Africa, people’s best chance for vaccines anytime soon is to join an
experimental trial.

By Matt Apuzzo and Selam Gebrekidan

Dec. 28, 2020

CAPE TOWN — A few months from now, a factory in South Africa is expected to
begin churning out a million doses of Covid-19 vaccine each day in the
African country hardest-hit by the pandemic.

But those vials will probably be shipped to a distribution center in Europe
and then rushed to Western countries that have pre-ordered them by the
hundreds of millions. None have been set aside for South Africa.

The country, which will help manufacture the vaccine and whose citizens
have enrolled in clinical trials, does not expect to see the first trickle
of doses until around the middle of next year. By then, the United States,
Britain and Canada may already have vaccinated more than 100 million people.

The first year of the Covid-19 pandemic revealed that a country’s wealth
would not spare it from the virus. Overconfidence, poor planning and
ignored warnings felled some of the world’s richest nations. But now, money
is translating into undeniable advantages.

Over the past few months, rich nations like the United States and Britain
have cut deals with multiple drug manufacturers and secured enough doses to
vaccinate their citizens multiple times over. China and Russia have
conducted their own trials and begun mass vaccination programs.

Yet countries like South Africa are in a singular bind because they cannot
hold out hope for charity. Although its government is nearly insolvent and
half of its citizens live in poverty, South Africa is considered too rich
to qualify for cut-rate vaccines from international aid organizations.

“Where you’re not rich enough but you’re not poor enough, you’re stuck,”
said Salim Abdool Karim, an epidemiologist who leads the country’s
coronavirus advisory council.

Poor and middle-income nations, largely unable to compete in the open
market, rely on a complex vaccine sharing scheme called Covax. A
collaboration of international health organizations, Covax was designed to
avoid the inequities of a free-market free-for-all. But its deals come with
strings attached, and health advocates are questioning its transparency and

By the middle of next year, South African officials hope to secure their
first vaccine doses under Covax, even as they negotiate to buy supplemental
supplies from drug manufacturers. But in a country where luxury estates are
walled off from sprawling squatter villages, many expect the newest
vaccines to remain a privilege for residents who can pay out of pocket or
through supplemental insurance — a program that disproportionately benefits
white people.

“You’ll be able to stride into your local private pharmacy and pay a couple
hundred rand (about $15) and say, ‘Hit me baby,’” said Francois Venter, a
researcher at the University of the Witwatersrand in Johannesburg.


In the 1990s, when antiretroviral drugs to treat H.I.V. were developed,
South Africans volunteered for clinical trials, knowing that they could
never afford the medicine otherwise. “If you had money, you were able to
buy it. If you didn’t, you died,” Dr. Venter said. “It’s going to be the
same thing again.”

Covax was set up to prevent that. It came together with money and support
from the World Health Organization, the Coalition for Epidemic Preparedness
Innovations and GAVI, the Vaccine Alliance. Countries, even those that
cannot hope to compete on the open market, can buy into Covax and receive
vaccines. Poor countries pay nothing.

Secret Deals

South African medical advisers say the Covax system is vital but also
deeply frustrating. Governments must pay up front without knowing what
vaccine they will receive or getting any guarantees on when the doses will
arrive. Covax estimates the price per dose but offers little recourse if
the cost is ultimately much higher. Countries must assume all of the risk
if the vaccine fails or if anything goes wrong.

During a recent call with reporters, Covax officials called their vaccine
sharing program “the only global solution to this pandemic.”

“We still need more doses and, yes, we still need more money, but we have a
clear pathway to securing the initial two billion doses and then beyond
that,” said Seth Berkley, the chief executive of Gavi, the Vaccine Alliance.

Still, Mr. Berkley and other officials declined to reveal their
arrangements with drug companies, describing them as company secrets. They
also did not make public the deals they have struck with individual

“They’re agreeing to buy something with public money, and we won’t have any
influence on pricing,” said Fatima Hassan, a human rights lawyer. “Covax is
saying the pricing is fair, but we don’t know. Where’s the transparency?”

Those trade-offs might be palatable for countries receiving the medicine
nearly free. But South Africa is paying about $140 million for its Covax
doses to vaccinate roughly 10 percent of its population, including health
care workers and some high-risk people. The government hopes to cover the
country’s remaining 50 million people through private deals with drug

Globally, the process is secretive, with governments not disclosing the
prices they are paying for vaccines. When a Belgian minister recently
published the European Union’s price list, she revealed that prices vary
depending on who’s doing the buying.

Many South Africans are deeply skeptical of pharmaceutical companies and
wary of rampant government corruption. The health minister, Zweli Mkhize,
said in a recent call with reporters that it was essential that rich
countries not hoard vaccines, but otherwise the government has said little
about its plans.

Outraged, health advocates have threatened to sue the country’s government
to make the plans public.

Ultimately, though, money is the great differentiator. From the outset,
South Africa’s government knew it could not afford to order doses before
they were tested and approved, as wealthy countries did.

“While these countries have gone on a shopping spree, we haven’t even
started window shopping,” Ames Dhai, a bioethics professor and member of
the government’s vaccine advisory panel, told doctors on a recent webinar.


Abdool Karim, the head of the country’s coronavirus council, said the
country needed to be judicious in choosing a vaccine that best fits the
needs of South Africa. Rushing to buy the Pfizer vaccine, for example,
which requires shipping and storage at ultracold temperatures, made no
sense when cheaper, simpler and more manageable medicines were on the
horizon, he said.

But because South Africa did not pre-order doses from private companies,
the country may have to watch its own domestic drug maker, Aspen
Pharmacare, produce vaccines for other countries before they are available

Under contract with Johnson & Johnson, Aspen is expected to produce
millions of vaccine doses. South African officials have high hopes for the
vaccine, which does not need cold storage and promises to require one
injection rather than two.

“We’ll participate in your trials, we’ll manufacture your vaccines, but we
don’t know if we’ll get access,” Ms. Hassan said.

Johnson & Johnson has promised to sell its vaccines at break-even prices
and provide half a billion doses to Covax to help poor countries. Aspen’s
chief executive, Stephen Saad, said he was proud of that commitment. But he
acknowledged that there is no guarantee for South Africa.

“It’s J & J’s decision as to where the product goes,” he said.

South Africa, which is now past a million Covid-19 cases, is facing its
second wave. Public health officials are particularly worried about a new
mutation that they believe may have made the virus more contagious.

In poor and working-class townships, the greater fear is of a new lockdown.
The government’s earlier aggressive lockdown devastated the economy and
confined many people to tin shacks built an arm’s length apart, with a
dozen families sharing an outhouse and many more sharing a water tap.

“It’s impossible to have social distancing here,” said Mr. Mzwamadoda, who
was selected for the drug trial.

He is counting on the vaccine, hoping he got the actual medicine and not a
placebo. “I want my life back,” he said.

Mr. Mzwamadoda woke up the day after his injection feeling well. He talked
it over with his wife, and they decided that she would walk to Dr. Gill’s
clinic and enroll that weekend.

A few days later, though, Dr. Gill got word that Johnson & Johnson did not
need any new test subjects at her location.

Data was pouring in. A good outcome, but that meant that when people began
lining up at the gates early the next morning, she had to turn them away.

Matt Apuzzo is a two-time Pulitzer Prize-winning reporter based in
Brussels. He has covered law enforcement and security matters for more than
a decade and is the co-author of the book “Enemies Within.” @mattapuzzo

Selam Gebrekidan is an investigative reporter for The New York Times based
in London. She previously was a data and enterprise reporter for Reuters
where she wrote about migration to Europe and the war in Yemen, among other
stories. She has also covered U.S. oil markets.

Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International
41 22 791 6727
thiru at keionline.org

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