Lima, Peru 06.09.2020. To date, the new coronavirus has infected nearly 26 million people and caused 880,000 deaths worldwide. The pandemic remains unstoppable, with some countries facing a second wave. Peru has a total of 683,702 confirmed cases and almost 30 thousand deaths; it also has the highest mortality rate in the world from COVID-19. New measures have been taken by the Peruvian government in recent weeks. Government statements leave one with the feeling that there is nothing left to do but to live with the virus and to wait for the vaccine. However, living with the virus does not mean putting on hold what organizations and experts propose to do to mitigate the damage and reduce deaths from COVID-19: expanding the use of molecular tests as a basis for effective measures to contain the spread of the virus in different populations; strengthen the first level of care; promote and articulate the initiatives that arise from community organizations; also to develop a communication plan that reaches everyone, taking into account the diverse cultures and impacts of the pandemic .
The vaccine is not a reason to not continue actions, and the announcement of its uncertain arrival must not generate illusions and passivity in the different hierarchies of the Government, nor in the population. The vaccine is still a long way off and significantly greater efforts are needed to control the spread of the new coronavirus.
VACCINE FOR COVID-19: A GLOBAL PUBLIC GOOD?
To date there are nine vaccines in the last phase which are testing their effectiveness in a large number of volunteers. It is clearly better if this process is carried out in various countries. They also have to confirm if the candidates are acceptably safe; that is, they do not produce serious secondary reactions. However, when vaccines are applied en masse (to millions of people) and despite the positive findings that can be found in Phase III (in tens of thousands), new adverse reactions may appear that were not detected before. Producers of vaccines, governments, multilateral organizations as WHO, and scientific institutions have to pay attention to these possibilities in order to prevent negative consequences.
There are at least three approaches that countries like Peru are using to access the vaccine: a) the COVAX FACILITY initiative led by WHO, the Global Alliance for Vaccines and Immunization (GAVI) and the Coalition for Epidemic Preparedness Innovations (CEPI ); b) preferential treatment from companies that research vaccines, facilitating the participation of the Peruvian population in PHASE II and III tests; c) Bilateral advance purchase agreements with pharmaceutical companies. In addition, given the announcement that the Astra Zeneca / Oxford University vaccine would be produced by Argentina and Mexico, the Peruvian government is looking at possibilities in order to reach agreements with those particular countries.
The Peruvian government must make the details of the agreements it is carrying out transparent. If the country participates in clinical trials in any of its phases, what are the benefits that it will receive, if it is proven that the vaccine is effective: will there be a preference in the supply of the vaccine? Discounted prices? How is this strategy consistent with the concept of "global public good" defined by the World Health Organization for the vaccine? The third strategy - bilateral purchase agreements - clearly collides with the above-mentioned concept, as those who cannot pay will be left at the end of the line.
In April, the WHO launched the so-called Accelerated Access to Tools to Respond to COVID-19 (ACT-A), which “brings together governments, health organizations, scientists, companies, civil society organizations and philanthropists, who have joined forces to end the pandemic as soon as possible ”. ACT-A seeks funds to contribute to the development and distribution of treatments, diagnostic tests, vaccines, among other purposes. One of the pillars of ACT-A is the COVAX FACILITY whose purpose is to provide vaccines to low- and middle-income countries. To do this, it seeks to obtain contributions in the first 12 months of its creation in the amount of more than 31 billion dollars to be able to meet its goals: 500 million diagnostic tests and 245 million treatments for low and middle-income countries. As for the vaccine, it hopes to have distributed 2 billion doses by the end of 2021.
Apart from donations from governments, philanthropic organizations and the like, the COVAX FACILITY also depends on the political will of the countries interested in obtaining vaccines, for which they must commit to support financially to receive benefits. The deadline has been extended until September 18, when the countries must seal their commitment by advancing a percentage of the cost of the vaccines they would need for 20% of their population. In the case of Peru, this means around 6.6 million doses. How much is each dose expected to cost? How are the prices of vaccines calculated?
How is it that the COVAX FACILITY will be able to obtain vaccines to be distributed in many countries of the world? An important part of the funds they collect is going to research companies that develop the vaccines. On the other hand, the COVAX FACILITY has made agreements with the companies that have nine vaccine candidates supported with funds from CEPI, one of the leaders of this initiative. In other words, pharmaceutical companies are not alone in this race; they are supported by public money and philanthropic organizations. COVAX FACILITY, having as one of its leaders the World Health Organization combines two forms of access to the vaccine, one of which erodes the concept of the “global public good”. Of the two billion doses that will be reached by the end of 2021, 50% will be distributed taking into account the epidemiological criteria of the low- and middle-income countries that will receive the vaccines at low prices or at no cost. . And the other 50%? Those one billion doses will be delivered to countries that pay for vaccines without applying any epidemiological criteria and leaving aside the issue of equitable distribution of the vaccine worldwide. ACT-A is expected to create transparent criteria for the allocation of vaccine doses particularly of the 50% that is being offered to countries that can pay.
The commitment of the member countries of the WHO is that the vaccine for COVID 19 is a “global public good”. The call of the World Health Assembly (May 2020) is that “global priority be given to universal, timely and equitable access to all quality, safe, effective and affordable essential health technologies and products, including their components and precursors, which are necessary for the response to the COVID-19 pandemic, as well as its fair distribution, and so that the unjustified obstacles that hinder such access and distribution are quickly eliminated”. Advance purchase contracts in rich and less rich countries are turning this decision into an empty phrase. There has not been a multilateral agreement to agree on criteria that move towards equitable access to the vaccine, taking into account valid epidemiological criteria.
Nor is there a firm agreement of the different actors (governments, pharmaceutical companies, multilateral organizations, philanthropic organizations, civil society organizations and others) to prevent the use of intellectual property protections that can be exercised over vaccines, actions needed to be taken in order to facilitate the vaccine manufacturing as well as immediate distribution by different producers and key actors in order to control the pandemic in the shortest possible time.
(Nota: Traducido por Richard Stern. Agua Buena. San José, Costa Rica)