Vaccines against Covid-19, a business for the rich?

No vaccine against Covid-19 is yet available but future stocks are already empty or almost empty. The United States, China, the United Kingdom and the European Union have paid to reserve more than two billion doses of vaccines, calculated the scientific journal Nature, Monday, August 24. Enough to arrange the business of pharmaceutical companies - Sanofi, AstraZeneca, or Pfizer -, but much less of poor and developing countries.

The United States is leading the way and has already spent about six billion dollars to secure nearly one billion doses of six vaccines in development. Washington even posed options to be able to order an additional billion. In relation to its population, the United Kingdom has struck the hardest, reserving 335 million doses, or five per capita. The European Union and Japan are not left out, each having ordered hundreds of millions of doses.

Optimistic pharmaceutical companies

"What is happening - that is to say, a group of countries buying all the way - is worrying, because the production capacities are not infinite", underlines to Reuters Thomas Bollyky, director of the Global Health program at the Council on Foreign Relations, an American think tank.

Listening to the pharmaceutical groups, however, there is still room. If the ten vaccines currently tested on humans were to demonstrate their effectiveness, there could be up to 10 billion doses available by the end of 2021, according to official projections from the various laboratories. Developing countries would then still have enough to market to meet the needs of their populations.

But experts warn against the optimism of vaccine makers. Airfinity, a British medical data analysis firm, estimates that there should not be more than one billion doses of vaccine by the end of 2021. The Coalition for Innovations in Epidemic Preparedness (Cepi, a foundation international organization to fight epidemics) estimates, for its part, that laboratories should be able to produce between two and four billion doses of vaccine before the end of next year. 

Projections established based on past experiences, during previous epidemics, and on current production infrastructure.

The story repeats itself

So there are only a few crumbs left for the developing countries. This is hardly surprising: history repeats itself from one health crisis to another. Antiretroviral treatments to treat HIV patients, introduced in 1996, have for more than five years been reserved for Western countries. During the influenza A virus epidemic in 2009, the so-called industrialized countries "first made sure that they would have enough vaccines for their population before giving 10% of their stocks to less favored nations", recalls the journal Science in a vitriolic editorial against “nationalism” in terms of vaccines, published on August 14.

Faced with the Covid-19 pandemic, the boss of the WHO, Tedros Adhanom Ghebreyesus, also spoke out against this law of the richest by warning against “health nationalism”. Even if he says he understands “the desire of the leaders to protect their populations in the first place”, he recalls that from an ethical and scientific point of view, the behavior of the so-called industrialized countries does not make sense. 

“This amounts, in effect, to saying that a healthy American teenager living in a well-off neighborhood near state-of-the-art health facilities is going to have priority to be vaccinated over a doctor who works in precarious conditions in a country. poor ”, summarizes Michael Gerson, an adviser to the former American conservative president George W. Bush, in an article published Monday by the Washington Post. The most effective vaccine approach to stem the Covid-19 pandemic consists “in administering treatment first of all to healthcare workers in direct contact with patients, then to populations who do not have access to healthcare facilities and people at risk and, only then, to the rest of the population ”, recalls the scientific journal Nature.

Vaccine diplomacy

The international community believed it had taken the lead this time around to avoid the pitfalls of the past and adopt a more equitable distribution of future vaccines. WHO, in partnership with Gavi (an international vaccine alliance funded by the Bill Gates Foundation), has thus set up a specific mechanism, called COVAX (Covid-19 Vaccine Access), which should, in theory, make it possible to reserve one billion doses of vaccine for poor and middle-income countries. 

But for it to work, rich countries must participate in its financing. It is not won: the United States, Russia and China have already indicated that they will pass their turn, while of the 172 countries that have expressed interest in this initiative, none have yet taken strong commitment to help raise the $ 18 billion needed to purchase and distribute vaccines. “Attempts to convince the richer nations to participate have had little success,” confirms Brook Baker, an expert on access to health care at Northeastern University in Boston, interviewed by Nature.

There is therefore little chance of escaping, once again, a two-speed vaccination. And this is not all bad news for the global fight against the pandemic. This race of rich countries to reserve the lion's share of future vaccines may lead to dangerous vaccine diplomacy, fears Thomas Bollyky of the Council on Foreign Relations. "Some countries, such as China or the United States, will be able to keep doses that they will offer to other nations in exchange for favors or diplomatic support," he told the BBC. 

In addition, the fact that poor countries are likely to be the last served can widen economic inequalities. These nations will, in fact, take longer to come out of the health crisis and will therefore not be able to regain the path of economic growth until well after the industrialized countries. An economic scenario which, given the eagerness of major nations to preempt vaccine stocks, seems to have been decided.

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