US Urged To Loan From AstraZeneca Hoard As Health Workers Die In Africa & Assist Technology Transfer To Stop Pandemic Fast
The US has enough doses to vaccinate its entire population twice over and have enough left to fully vaccinate 1.3 billion people outside the USA by the end of 2021. It’s not going to run out of doses. As most of you will know, Biden has committed now to roll out 200 million doses to the USA in his first 100 days in office. The USA is making huge steps forward with its own population.
However at the same time 20 countries have not yet been offered any early doses yet; they are ready to roll out the vaccine but COVAX hasn’t yet been able to offer them doses. The USA has been one of the main donors to public health care in sub Saharan Africa, donating $100 billion in 20 years and helping to train 300,000 health workers in the last 20 years. Yet right now, while doctors whose training they helped fund are dying in these countries, the US hoards a stockpile of tens of millions of unused AstraZeneca doses that won’t be approved until some time in April. This is not rational, to train these health workers then sit on a stockpile of unused vaccines while they die of COVID.
Skip to next section: Released into the public domain to the fullest extent possible from the UK
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The USA has already loaned 4 million doses to Mexico and to Canada. There is no problem with the USA loaning the doses if it makes this decision. The doses are just sitting on shelves in the USA unused and won’t be used until some time in April and quite possibly never as the USA is likely to prefer to use the Pfizer and Moderna vaccines as these are even more effective than AstraZeneca especially for some of the variants.
The USA will have no problems vaccinating every adult by the summer. The COVAX alliance meanwhile are desperately short of vaccines and can only vaccinate 3.3% of the rest of the world by summer 2021. That figure is from the WHO
The WHO is asking for a loan of 10 million of AstraZeneca doses from any country with an excess, or able to spare them, to send 500,000 vaccines to each of 20 countries with weak economies that are ready and waiting for their first vaccine.
The business is just as good for the drug companies if the US loan their AstraZeneca doses which are already paid for, and sitting on the shelves in the US. It is not logical, ethical or rational for the USA to hoard these doses. It is understandable that this is a politically tough domestic decision for the US, the optics to be seen to give away dose, even doses it isn’t using and may never use, when so many of its citizens are calling out to be vaccinated fast. The US government needs support of its own citizens and its lawmakers, asking it to do this, But it’s not impossible, as we’ll see, India gives away half its own early doses, while France gives away 5% and is urging other countries to do the same. Russia and China are also giving away early doses and the USA have already loaned 4 million doses to Mexico and Canada.
Here is Biden’s announcement of its new goal for 200 million shots in the USA in his first 100 days in office.
Today, President Biden announced a new vaccination goal: 200 million shots in his first 100 days in office.
Our Administration is committed to getting America vaccinated as quickly as possible so we can finally turn the page on COVID-19. pic.twitter.com/SPNVWch1hC
— The White House (@WhiteHouse) March 25, 2021
You can hear Biden make this pledge here:
The US has a stockpile of 10s of million AstraZeneca vaccines for approval a few weeks from now.
By the time it completes approval of AstraZeneca a few weeks from now, experts in the US say it may not even need them, but it has kept a stockpile “just in case” – mainly in case there are problems with its Pfizer / Moderna / Johnson and Johnson supplies to achieve its ambitious target.
The United States may only briefly, or never, need the AstraZeneca doses if they are cleared for emergency use.
“If we have a surplus, we’re going to share it with the rest of the world,” Mr. Biden told reporters on Wednesday, speaking generally about the U.S. vaccine supply. “We’re going to start off making sure Americans are taken care of first.”
The White House did not respond to a request for comment.
The administration’s hesitation is at least partly related to uncertainties with vaccine supply before a benchmark of late May laid down by President Biden when he promised enough vaccine doses to cover every adult in the United States. Vaccine production is notoriously complex and delicate, and problems like mold growth can interrupt a plant’s progress.
. The U.S. Is Sitting on Tens of Millions of Vaccine Doses the World Needs (New York Times)
The WHO are asking countries with hoards of vaccines to swap position in the queue with them. The WHO will give their batches which are further down in the queue to the USA in return for the USA giving an equivalent number of doses from its hoard right now.
In Dr Tedros’s call for action on Friday, he explains that 177 countries and economies have started vaccination (61 of those due to COVAX). He says that COVAX will supply their first doses to 16 more in the next 15 days. That leaves 20 countries with no vaccines yet, ready to distribute them, but COVAX doesn’t have the doses yet to give them to them.
At half a million doses for each of the 20 countries that haven’t yet had any vaccinations, only 10 million more doses will be enough to start vaccination in all those countries in the next 15 days.
COVAX needs 10 million doses immediately as an urgent stop-gap measure so these 20 countries can start vaccinating their health workers and older people within the next two weeks.
So today I’m asking countries with doses of vaccines that have WHO Emergency Use Listing to donate as many doses as they can to help us meet that target.
The world is currently using over 13 million vaccine doses every day.
Less than one day of the world’s doses could vaccinate all the doctors and more in the 20 countries not yet able to get early doses.
So Dr Tedros is asking for the equivalent for a loan of less than one day’s worth of world vaccinations to go to the 20 countries that haven’t yet been able to start vaccination.
France is going to donate 5% of its vaccine doses to poorer countries and is asking the EU, UK and USA to do the same.
India donates half of its own doses to neighbouring countries like Bangladesh and Sri Lanka
The US has already loaned 2.5 million doses of AstraZeneca to Mexico and 1.5 million to Canada. Press Briefing by Press Secretary Jen Psaki and Secretary of Housing and Urban Development Marcia L. Fudge, March 18, 2021 | The White House I.e. it’s going to give them some of their doses, in return for a promise to give doses back to the US later on when (or if rather) the US needs them.
This is enough to vaccinate 2% more of Mexico’s population (currently at 5%).
This donation of unused doses is going to make a huge difference to deaths in Mexico at these early stages when it is still vaccinating its elderly and vulnerable and frontline workers.
However the USA has many more to spare.
The USA could supply the WHO’s request all by itself by loaning 10 million more of its stockpiled unused doses of AstraZeneca to COVAX, to swap position in the queue of its batches with COVAX. It would still have tens of millions of doses in its stockpile after doing that (the exact figures don’t seem to be available).
It’s the same for technology transfer which I explain later in this article. The vaccines were publicly funded, and the vaccine manufacturers took no financial risk. If the vaccines had failed they would still come up positive on the ledger, and billions of dollars of vaccine would have needed to be disposed of.
AstraZeneca are already doing technology transfer. and so are Novavax (for when their vaccine is approved). This empowers the rest of the world to make the doses, end the pandemic fast.
It makes no difference to profits of the companies in the wealthier countries. Although AstraZeneca provides its vaccine at cost even in the wealthier countries, vaccine companies that wish to export their technology wouldn’t need to do this. They can make it a condition of exporting the technology would be that they can’t sell low cost doses back to the wealthier countries. Meanwhile it benefits the entire world to stop the pandemic fast.
Yet, the other vaccine manufacturers, J & J, Moderna, Pfizer, are not yet facilitating technology transfer and as a result are seldom used by the weaker economies. They are not permitted to make them and can’t afford the prices of the wealthy countries, and also can’t compete for the limited supply of doses. Again this benefits nobody not even the drug companies. Meanwhile, these vaccine manufacturers took no financial risks; the funding was provided by the governments.
As we’ll see, Brazil just started making its own AstraZeneca doses under the AstraZeneca technology transfer agreement, and will make 100 million by July which will have a huge impact on its desperate medical emergency. The world could have many more vaccine doses available to them if the wealthier countries facilitated more technology transfer. There are many ways of doing this including the WHO’s “ACT accelerator” but these tools are only being used by a few companies. It’s the same situation for therapeutics, the generic drug dexamethasone is widely used but not many countries will be able to afford more expensive drugs such as the antiinflamatory antibody tocilizumab (promising new drug from a UK trial) and as more drugs are approved for therapeutics then some will not be available to the weaker economies..
The lack of technology transfer is why India and South Africa are asking for the wealthier countries to stop blocking TRIPS, the provision under the World Trade Organization to issue compulsory licenses in an emergency if a country can’t access live saving vaccines or therapeutics in any other way – more on this later in this article. How many of my readers have heard of TRIPS and know that the USA, Canada, UK and EU are blocking it? There are many alternatives to these compulsory licenses but they aren’t backing those either.
The wealthier countries need the support of their people to start work in earnest on technology transfer to the weaker economies end the pandemic far faster – which will benefit everyone including the wealthy countries themselves.
[This article is around 9000 words. At an average reading speed of 200 words per minute it will take 45 minutes to read it all – but you can get a good idea of it by reading this introduction and the headers, then focus in on any section that interests you]
Skip to next section: Frontline health workers dying
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Skip to next section: It’s not fair, simply not fair
This is the obituary of Professor James Gita Hakim, a specialist on HIV and foremost heart specialist at the university of Zimbabwe, who died in of COVID on 26th January;
Professor James Gita Hakim, HIV specialist, Foremost heart specialist at University of Zimbabwe
Died 26th January of COVID
Never offered vaccination against COVID
“He has left a void that will be so difficult to fill”
This man shouldn’t have had to die. We had vaccines for him. In storage, some of it not even going into people’s arms. Him and many others like him.
Just by sharing a percentage of our vaccine doses from the wealthier countries, we could have vaccinated all the health workers and doctors in Africa.
In Zimbabwe in 2018 (latest WHO data) there were 2.1 doctors per 10,000 in Zimbabwe.
Zimbabwe has only 2.1 doctors per 10,000, Professor Hakim was one of the few that stayed in his country instead of emigrating to high paid jobs elsewhere
With a population of 14.65 million that’s a little over 3000 doctors.
Just a few thousand doses would have made a huge difference to them, given early.
Africa already have so few doctors for their population compared to the USA. US states have between 19 and 45 doctors for every 10,000 people. In this graph blue is for active medical doctors and black for active doctors of osteopathic medicine.
Massachusetts, 44 doctors (MD) per 10,000.
Zimbabwe has 2 doctors per 10,000. Sub Saharan African doctors are dying right now of COVID
Mississippi 17 doctors (MD) per 10,000
Those 3000 doctors were unvaccinated when not only all health workers were vaccinated in the USA and EU / UK but in the UK we were already vaccinating everyone in their 60s. I am 66 and I got my vaccine at about the same time he died. I am almost zero risk. I can do my paid work (selling my own music software over the internet) and voluntary work (writing these blog posts and helping scared people over the internet) with no COVID risk.
But Professor James Gita Hakim couldn’t do that. As a medic who continued work on the frontline in clinical work alongside his research, his job was to work with people with COVID and he put his life at risk on the frontline like frontline health workers the world over, and he died of COVID.
Countries like Zimbabwe have a huge problem retaining health workers. I am sure professor Hakim could have got a far better paid job at some university in the USA. Someone like him would have been welcomed with open arms, and then he would have been vaccinated early. But he was dedicated to his people, stayed in Zimbabwe, so wasn’t offered a vaccine, and died.
It’s just not right. Of course we need to keep vaccinating everyone in the UK / US / EU but we need other countries to vaccinate too.
As Dr Mike Ryan of the WHO put it, it’s not fair, it’s simply not fair.
Vaccines are a major thing. We don’t know for sure yet if they’re going to completely stop transmission, but what we do know is that they stop people dying. But we cannot have a situation where frontline workers, health workers, risking their lives every day, and the most vulnerable people are not accessing vaccine.
If we reach a situation in the developed world where perfectly healthy people have been vaccinated and those front-line workers and vulnerable people are not, it is not fair it is simply not fair.
Unless we start to bring all countries out of this, we won’t recover together. There will be long-term economic impacts if we leave countries behind. We’re all in this together. We’ve seen things over the last number of years that scare us all for the future. This pandemic, climate change, racism, authoritarianism. We simply need to now start doing the things that turn the tide on this.
This is one of the first opportunities we have this century to send a signal to the future that this will be a fairer world. We will share more, we will do more together to make our planet and our environment and our populations healthy.
The US has already pre-ordered so many doses for 2021 that by the end of the year it will have excess enough to vaccinate 1.6 billion people outside of the US, or enough to fully vaccinate a fifth of the world population.
For the background, cites and the calculations see my
The reason for such a huge excess is that it pre-ordered enough of multiple vaccines to vaccinate its population, and remarkably all the vaccines are being approved in stage 3. Even if the US vaccinates everyone in its population three times over, it will have excess doses at the end of 2021 for nearly a billion people, or about 12% of the world’s population. Biden says they will release unused doses for other countries but he hasn’t said when.
Meanwhile COVAX has only managed to secure enough doses to vaccinate 27% of the 90% of the world population that it supplies doses to. The US vaccines will make a huge difference to COVAX once it releases it to them later this year. The US has also donated $4 billion to COVAX making it by far the largest donor.
However the USA can do so much more right now to help them by swapping position in the queue for the AstraZeneca doses, which it might not even need a month from now. This will not harm the USA in any way and make an absolutely enormous difference to COVAX.
Skip to next section: India as an example to the world of a country generous with vaccines
The USA is the largest donor in the world to the health care system of sub Saharan Africa, donating $100 billion in 20 years to build up their health system and training more than 300,000 health workers for their countries. Yet now those very health care workers they trained are dying, and they aren’t doing anything to stop this now. They have donated to COVAX, a major donation, but it’s finance, not early doses, and they are dying right now.
This is not rational or logical. It is not sensible from the point of view of self-interest either. A damaged health system in sub Saharan Africa doesn’t benefit the USA in any way – it slows down the economic recovery of Africa after the pandemic and a weaker economy means that the world economy will take longer to recover.
These health care workers who are dying are also on the frontline saving COVID patients in Africa and also helping the country to be healthier working to fight other diseases like HIV, cholera, yellow fever etc. A healthier Africa means a healthier workforce making the goods that the USA imports from Africa. Also in countries that the USA often goes to for tourism. For that matter the pandemic continuing for longer in Africa means that American tourists will be wary about visiting countries with unvaccinated people and ongoing epidemics as the vaccine doesn’t 100% prevent you getting sick with COVID – and some Americans either refuse the vaccine or can’t be vaccinated – it directly increases their risk.
Also the longer the disease spreads amongst more people, the more the risk of new variants.
Yet now, by hoarding these doses, it is helping to set back their health care system by decades.
By stopping this the USA is benefiting everyone including the USA.
By saving the lives of health workers in Africa the USA can benefit the entire world.
India is getting bad press right now for temporary suspending exports of its doses of AstraZeneca to the wealthy countries such as the EU in order to cope with a sudden health crisis in its own country with rising cases of COVID which have been falling for a long time.
Journalists in the West are not explaining why India has done this. After a fall in cases for many months it is seeing a recent huge increase again, and vaccines can stop this.
Also deaths are starting to rise too.
Meanwhile it has only vaccinated a little over 4% of its population compared to over 14% for the EU.
When asked about India’s suspension of exports, Dr Tedros opened up his reply by thanking India for its generosity, saying
If you would call just one country who has contributed more than any other country on Earth in terms of sharing vaccines it’s India.
To thank India for its generosity – India has shared lots of vaccines globally. If you would call just one country who has contributed more than any other country on Earth in terms of sharing vaccines it’s India. So I would like to thank its prime minister and its government for its support.
India gives away half of its doses to its neighbours such as Bangladesh and Sri Lanka. It started doing that even well before it vaccinated all its frontline workers and the most at risk.
You can see that here, Bangladesh and Sri Lanka actually have a higher percentage vaccinated than India itself, although they are depending on free doses from India for their vaccinations.
If only other countries were as generous as India.
Skip to next section: To donate vaccines is rational, logical, sensible and ethical
China and Russia are also doing this. With China it makes a lot of sense. There is almost no remaining COVID transmission within China. All its outbreaks start with imported cases from other countries. So the best way to make China itself safe is to help other countries to vaccinate as fast as possible and so reduce the cases in China.
This also helps other countries to control the virus, and to stop their variants too.
China can’t do much within China itself to stop imported cases. Vaccinating within China will do next to nothing to stop this pandemic. So China needs to export nearly all its vaccines for optimal use. Also many in China don’t want to get vaccinated, not because of vaccine hesitancy, they trust their government’s vaccines, it’s because their risk is just about zero because China has eliminated the virus except for very occasional outbreaks quickly stopped.
So for instance they have given a million doses to Pakistan.
This is a story in Global Times, which is Chinese run propaganda, they say that they are donating doses to Africa, to the Phillipines etc.
This is a better source:
China’s vaccine diplomacy campaign has been a surprising success: It has pledged roughly half a billion doses of its vaccines to more than 45 countries, according to a country-by-country tally by The Associated Press. With just four of China’s many vaccine makers claiming they are able to produce at least 2.6 billion doses this year, a large part of the world’s population will end up inoculated not with the fancy Western vaccines boasting headline-grabbing efficacy rates, but with China’s humble, traditionally made shots.
China has said it is supplying “vaccine aid” to 53 countries and exports to 27, but it rejected a request by the AP for the list.
. Chinese vaccines sweep much of the world, despite concerns
By “traditionally made” they just mean an inactivated whole vaccine. That type of vaccine may well end up being more protective against the variants. That’s for Sinopharm and Sinovac. While Cansino is made the same way as the Oxford vaccine.
The US and the EU are criticizing China and Russia for “vaccine diplomacy” claiming they are doing this to boost their own image abroad. Whether they are or not, giving doses like this is also just rational good sense, especially for China where helping the rest of the world to vaccinate faster directly benefits China far more than vaccinating its own citizens.
It would also make rational sense to the EU, UK and USA to do the same, to protect their own citizens by protecting the rest of the world.
It really doesn’t matter the motive, whether it is vaccine diplomacy, or ethical altruism, or to protect the world economy and so protect their own economy – or whether it is to vaccinate the rest of the world to reduce the risks of variants and imported cases from other countries, to stop the pandemic fast, worldwide, and reduce the risk of the virus entering more animal reservoirs worldwide like yellow fever.
The main thing is, whatever the motive, to start donating vaccines now.
If you are citizens of a wealthy country, do ask your government to do the same. You are benefiting yourself by asking them to do this!
Skip to next section: US is major financial donor to COVAX
These vaccines were made with tax payer dollars underwriting all risks. It normally costs around a billion dollars to make a new vaccine and a company risks losing all of that if it fails and has to recoup their investment. But these vaccines were developed by the vaccine companies through public funding at no financial risk to themselves.
The public have a say in what happens to these vaccines developed with their own funding, and what is happening right now is unethical, illogical, and harms the wealthy countries too, economically and adding to the risk of new variants.
This is not rational, and I think few in our populations would agree to what is being done in their name if they fully understood what was happening. I think few of the politicians fully understand either.
Skip to next section: Plenty of vaccines for the future
One of President Biden’s first acts in office was to sign up the US to Covax.
Covax has raised $6bn (£4.3bn), of which the USA provided $4 billion, or two thirds of the COVAX doses.
This is great. Though the scheme says it needs at least another $2bn (£1.4bn) to meet its target for 2021. The rest are optional doses for now. It has the doses secured, but only as options and can’t yet pay for them.
But surely the funding will come in. The problem is though, that early doses are being hoarded and pre-ordered by wealthy countries.
Skip to next section: Dr Tedros’s call to action
Some people will tell you we can never vaccinate the whole world, in less than several years (like the smallpox vaccine which was a very slow rollout over the entire world). But this is nonsense, fails basic fact check.
We will have plenty of vaccines later in the year for most of the world population already in 2021.
- World total – enough to vaccinate 5.45 billion people in 2021 leaving only 2.45 billion unvaccinated.
If the US and EU fully vaccinate everyone twice over, their excess doses are still enough to increase the COVAX total from 2.03 billion to 3.63 billion people in the rest of the world.
Even if the EU, UK, USA, entire G7 and in total a billion people are fully vaccinated a second time in the fall the world total becomes 4.95 billion out of 7.9 billion or 62.7% of the world population fully vaccinated at least once in 2021.
That’s with pre-orders alone.
But we can make many more than these advance orders suggest. Remarkably all vaccines that get through phase 1 so far also pass phase 2, phase 3 and are approved. Four vaccines were abandoned in phase 1 but they all could have been developed further, if the competition wasn’t so effective and, with a small tweak in the case of the Australian vaccine, would surely have passed phase 3 eventually too.
So – it is reasonable to suppose all the vaccines in phase 2 and 3 will be approved. Even the inactivated whole vaccines – none have yet passed WHO emergency use authorization but the early results show they are safe and effective too.
- Total vaccine capacity if all the vaccines are approved – 11.15 billion.
That’s enough to fully vaccinate the world population of 7.9 billion and then fully vaccinate 2.25 billion people a second time – e.g. a second vaccination in the fall for new variants.
Then by 2022 we will have enough vaccine capacity, as long as it is funded, to vaccinate the entire world population every three months and still have some to spare at the end of the year.
For the background, cites and the calculations see my
Skip to next section: WHO calling on wealthier countries to empower weaker economies to make vaccines
This is Dr Tedros’s call to action
At the beginning of the year, I issued a call for countries to work together to ensure vaccination begins in all countries within the first 100 days of the year.
177 countries and economies have started vaccination. In just one month, COVAX has distributed more than 32 million vaccines to 61 countries. COVAX works.
There are now just 15 days left before the 100th day of the year, and 36 countries that are still waiting for vaccines so they can start vaccinating health workers and older people.
Of those, 16 are scheduled to receive their first doses from COVAX within the next 15 days. That leaves 20 countries who are ready to go and waiting for vaccines.
COVAX is ready to deliver, but we can’t deliver vaccines we don’t have.
As you know, bilateral deals, export bans, vaccine nationalism and vaccine diplomacy have caused distortions in the market, with gross inequities in supply and demand.
Increased demand for vaccines has led to delays in securing tens of millions of doses that COVAX was counting on.
But getting all countries started by day 100 is a solvable problem. COVAX needs 10 million doses immediately as an urgent stop-gap measure so these 20 countries can start vaccinating their health workers and older people within the next two weeks.
So today I’m asking countries with doses of vaccines that have WHO Emergency Use Listing to donate as many doses as they can to help us meet that target.
And I’m asking manufacturers to help ensure these countries can rapidly donate those doses.
There are plenty of countries who can afford to donate doses with little disruption to their own vaccination plans.
The more countries that donate A.S.A.P., the more doses we will have to share with countries who need them desperately.
Sharing doses is a tough political choice, and governments need the support of their people. I’m encouraged by surveys in high-income countries showing widespread support for vaccine equity.
10 million doses is not much, and it’s not nearly enough, but it’s a start.
We will need hundreds of millions more doses in the coming months.
There are many countries who invested in COVAX in good faith, but have been left frustrated because of the bilateral deals that have left COVAX short.
WHO and our partners are continuing to work around the clock to find ways to increase production and secure doses.
You can listen to Dr Tedros make this request here:
Skip to next section: Actions by CEPI, GAVI and COVAX to scale up global production
Here I am summarizing the WHO call to action published in the British Medical Journal here:
AstraZeneca is the wonderful example here to the world. Through its agreement with the Oxford University it promised to make its vaccine with zero profit for the duration of the pandemic. Its books are audited to make sure it makes no profit from the vaccine.
Remember the vaccine companies had zero risk and invested zero of their own finance to make these vaccines.
AstraZeneca also committed to technology transfer. India and South Korea are already making the vaccines and Japan, South Africa, Australia and Brazil also have had the AstraZeneca technology transferred to them and will soon be making its vaccines.
However sadly none of the other funding agreements had a requirement like this, e.g. the funding by Germany for Pfizer or operation Warp Speed in the UK, both let the companies can charge the same price for their vaccine to weaker economies as for the wealthy countries and they include no commitment for the drug companies to transfer their technology to the weaker economies so they can make their own drugs for the duration of the pandemic.
The EU is benefiting from this technology transfer when it buys its doses of AstraZeneca from the Serum institute in India. The Serum institute can make AstraZeneca and its own native doses but can’t make J & J, Pfizer, Moderna, Novavax or any of the other vaccines.
We see the value of the AstraZeneca approach acutely in Brazil.
Brazil has its own vaccine manufacture plant and they built a new huge vaccine factory which opened in early 2021 to make the COVID vaccine as well as other vaccines.
Brazil’s planned new vaccine factory which opened in early 2021 to make Astrazeneca’s vaccine. It is designed to make the AstraZeneca vaccine, and they started the project already, before the vaccine was approved.
This factory is already making vaccines for Brazilians and will make 100 million vaccines by July 2021.
This will let them vaccinate nearly a quarter of their population by July, or half if they do a first dose and then follow up with a second dose three months later like the UK is doing.
This will have a huge impact on the current desperate situation in Brazil.
Brazil also has vaccines from other countries and using them has vaccinated 8% of their population already. They reached 4% already at start of March so should see a fall off in the deaths amongst the vaccinated by about mid April – it’s about a six weeks delay from the vaccination first dose to the effect on deaths once you factor in the time to get protected, and then the time it takes from incubation to symptoms to the first deaths.
It’s a really rough time in Brazil. Cases still rising fast, cases per day – and many not taking precautions and intensive care beds full and it’s going to get worse for a month or so but then then deaths and the hospitalizations / intensive care should start to ease off a bit. But with cases rising and rising – it’s a very difficult situation.
However this is one chink of good news.
“The expectation is to reach the end of March with a production of about one million doses per day. With this, the Foundation expects to deliver 3.8 million doses to the Ministry of Health by the end of March. In April, the delivery estimate will increase to about 30 million doses, and by July Fiocruz should complete the delivery of the 100 million doses resulting from the technology order agreement with AstraZeneca. “
What Brazil and Australia did, the EU could have done too, they could have had an extra factory making AstraZeneca doses and add an extra 100 million doses by July if they had been as far sighted as Brazil.
Though none of the current vaccines have followed AstraZeneca’s example yet, we have one more that should be approved soon that is using the same model, Novavax.
Like AstraZeneca, Novavax has been a CEPI funding recipient partnering with Takeda in Japan, SK Bioscience in South Korea, Baxter in Germany, and Biofabri in Spain if its vaccine is approved.
Novavax should be approved soon with good early results. It has 86% efficacy and like the Johnson and Johnson vaccine, it is effective against the variants too, including the South Africa variant. It works in a new way from the other vaccines, instead of triggering the cells to make the protein spikes, the vaccine actually consists of the protein spikes already sufficiently stabilized to be able to trigger the antibodies and immune reaction to fight COVID. It is the first vaccine nearing approval to use this new technology – and the results suggest it works well.
Skip to next section: Four ways to increase vaccine supply worldwide and stop this pandemic fast
It’s not just the vaccines, it’s also fill and finish (putting vaccines into syringes) and supply of the ingredients to make the vaccines.
Many other countries want to make the vaccines and have the capability to do that. Not just the vaccines, they can make therapeutics too. As an example, dexamethasone can be used worldwide because it is a generic drug. But Remdesivir is too expensive for the poorer countries and it could be made available to them if they were permitted to make it themselves. Bangladesh is making its own Remdesivir under a compulsory license, which it can do as such a poor country, has a precedent of doing this, but most countries have to import it at high cost from the manufacturer.
The WHO give the example of the Durban Declaration where leading scientists and public health experts called on world leaders to share effective treatments for AIDS in this way. They did do this eventually but the response was so slow that millions died of AIDS before the medicine got to them that was already saving lives in the wealthier countries.
The WHO say that we can’t repeat this. We must remove this artificial scarcity.
The WHO point out, as I have already explained here, that much of the vaccine development was publicly funded. Billions of dollars from the UK, US, Germany etc went into these vaccines, taking away the risk that a manufacturer usually has developing a new vaccine – it was all paid for up-front.
The WHO say that it is time to use all the legal and public health tools to get them to the people who need them.
The WHO are asking for:
- The US to immediately fund urgent renovation and expansion of factories in Africa, Asia and Latin America, and incentivize Moderna, J & J and Pfizer to share the knowledge of how to produce the vaccines with the rest of the world – which they developed with significant public funding.
- European and other countries to do the same.
- COVAX partners to agree that vaccinating 3% of the world population in the first half of 2021 and 20% by the end is not acceptable or sufficient. They need COVAX to back a global push to do all this, including the TRIPS waver.
The conclusion is:
In a world where there are enormous inequalities COVID vaccinations offer us the opportunity to provide everyone globally, regardless of income, race, or nationality, immunological equity to be protected from SARS-CoV-2.
The covid-19 pandemic will not be over for us until it is over for everyone.
Skip to next section: Method 4, the TRIPS agreement
There are four approaches to increase vaccine supply that Dr Tedros described in a recent WHO presser:
- To connect companies that produce vaccines with ones that can do “fill and finish” as for the agreement between Johnson and Johnson and Merck in the USA. The WHO can provide a match-making service to help achieve this.
- bilateral technology transfer through voluntary licensing from a company that owns the patents to another company who can produce them. AstraZeneca has done this, transferring the technology for its vaccine to the Serum institute in India and SK bio in South Korea.
- Coordinated technology transfer with universities and manufacturers licensing their vaccines through a global mechanism co-ordinated by WHO who would also facilitate training of staff and coordinate investments in infrastructure. This provides more transparency and a more coherent global approach. It would increase production capacity for this pandemic and for future pandemics as well as for routine immunization programs.
The WHO did this already for H1N1 in the mid 2000s
- Invoking TRIPS to waive intellectual property rights.
As Dr Tedros said:
Those provisions are there for use in emergencies. If now is not a time to use them, then when? This is unprecedented time, and WHO believes that this is a time to trigger that provision and waive patent rights.
We need to get the governments of the wealthier countries to start talking about this as a matter of great urgency. The world will be hugely better as a place for us all to live in, at the end of 2021, if the weaker economies are empowered to make their own vaccines.
The WHO has already attempted all those first three things. But with no success. The ACT accelerator was an attempt to solve the problem using the second method, voluntary licensing by the drug and vaccine companies of vaccines and therapeutics to weaker economies following the example of AstraZeneca, but they didn’t get much uptake.
How many of you have heard of TRIPS? This has been huge news in the weaker economies but I have yet to see it mentioned on the BBC news in the UK.
I think few people in the UK, EU, Canada, or USA even know that their countries are actively blocking the rest of the world from making their own therapeutics and vaccines under this agreement. when they are fully entitled to do so during an emergency, under the rules of the World Trade Organization.
What they are talking about here is a special provision called TRIPS to temporarily suspend intellectual property rights.
- In emergency situations such as a pandemic, under World Trade Organization Rules, countries can grant themselves a compulsory license to make patented drugs.
They must give fair remuneration to patent owner but don’t need permission, They can also export it to others who grant themselves compulsory licenses. Compulsory licensing of pharmaceuticals and TRIPS
This is a provision under the World Trade Organization called TRIPS. Most countries are members of the WTO – the ones shown as green in this map.
Bangladesh is already producing Remdesivir under this arrangement, and as a least developed country they don’t need to pay anything to Gilead.
Skip to next section: Details about the TRIPS agreement
However although technically any country could do this, could declare that they will do compulsory licensing under TRIPS – in practice they don’t because when countries try, the developed countries retaliate. The drug companies can withhold other drugs from them, the developed countries can threaten trade sanctions, and drug companies can also take out -legal cases against them such as patent infringement lawsuits in their domestic legal system.
Here are some examples from the past (from this paper)
“After Thailand issued a compulsory license for Abbott’s HIV drug, Kaletra, Abbott stated it would not sell certain drugs in Thailand and withdrew seven new drug applications from Thailand.”
“Threat of trade sanctions by the United States, which is Thailand’s biggest export market, forced Thailand to stop producing a generic version of the HIV drug, didanosine, and amend its domestic laws to restrict compulsory licenses and parallel importation”
“Indian generic manufacturers Cipla and Natco face separate patent infringement lawsuits in the Delhi High Court by Bayer Pharmaceuticals for its patented cancer drug Nexavar”
With that last example, Bayer lost their legal case.
This is why there are calls for a global waver. The US, EU, Canada, UK so far oppose this waver. South Africa and India are leading in the proposal to put it in place.
How many of you in the US, EU, Canada or the UK even know your governments are doing this? This is a major story in India but it’s not running as headline news in the US or UK etc. This is how the Times of India is reporting it:.
Skip to next section: Proposal for a global “operation warp speed”
- Patent holder still has rights over the product including right to be paid compensation
- Countries are free to decide for themselves what counts as a national emergency as grounds for granting a compulsory license
- Countries can buy cheaper versions of the product made in other countries if they can’t make the product themselves – the producing country also has to issue a compulsory order in this case.
- The license only lasts for the duration of the emergency and in the region affected, and the patent holder can continue to produce,
- The mechanism covers pharmaceutical products, including medicines, vaccines and diagnostics, needed to fight an epidemic.
There I’m paraphrasing parts of this post on the WTO website about TRIPS:
They must give fair remuneration to patent owner but don’t need permission, They can also export it to others who grant themselves compulsory licenses. Compulsory licensing of pharmaceuticals and TRIPS
The USA, EU, Canada and the UK could immediately empower this by agreeing not to sanction countries in any way that invoke TRIPS during the pandemic.
Or we could add – if not TRIPS – let’s ask our governments, what is YOUR solution?
There is an alternative solution proposed in the USA, a “GLOBAL OPERATION WARP SPEED” which could be worth considering if they are still resistant to TRIPS and to the other three approaches outlined by the WHO
Skip to next section: Boosting vaccine doses can end the pandemic ultra fast
This is an article by Chad P. Bown (PIIE) and Thomas J. Bollyky (Council on Foreign Relations)
They propose a global “operation warp speed” modeled on Trump’s program for the USA. It would leverage COVAX,
They say that
There is little question that US intervention helped scale up inputs and unlock input bottlenecks to expand production overall. Furthermore, it is also hard to argue that the tens of billions of dollars of US federal expenditures were too large, given the pandemic’s ongoing human costs (hundreds of thousands of lives lost) and economic costs (trillions of dollars of lost gross domestic product). The same would be true with regard to resources needed to expand manufacturing to meet global demand for vaccines and the critical inputs needed to make them.
Making vaccines involves a complex supply chain which they outline here:
They propose a global initiative which they call CVITA
A COVID-19 Vaccine Investment and Trade Agreement (CVITA) is needed to create the incentives to ensure the timely and sizable scaling up of output and input investments to respond to this pandemic and future pandemic threats. Baby steps toward such an agreement are found in the Trade and Health Initiative that a small, but influential, group of World Trade Organization (WTO) members proposed in late 2020. But much more is required.
There are four components to such a global “operation warp speed” that they outline.
- It must link with COVAX which already has the transparency and the links to existing networks of regulators needed for global confidence, to reduce development costs and to give better access to the poorer markets
- Investment must create a framework to subsidize the full supply chain including “bioreactors, bags, cellular materials, vials, stoppers, syringes, and other ancillary supplies”. As with COVAX, governments would pay on a subscription basis and poorer countries would be heavily subsidised or free.
- As members of CVITA governments would commit not to impose export restrictions on supplies of vaccines and related materials to participating countries.
- This needs unprecedented transparency. They suggest as a model the Agricultural Market Information System (AMIS) which was developed by the G20 to “improve transparency and coordinate policy in the event of sudden scarcity”
- CVITA needs an “effective and transparent administrator who is one part general contractor and one part ombudsperson.”
Shortages will occur. Tensions will rise. Because of scarcity problems, difficult choices will need to be made, and some may be asked to wait. Those challenges have to be resolved quickly, fairly, and transparently.
If global policymakers fail to launch and implement an enforceable COVID-19 Vaccine Investment and Trade Agreement, it will be a lost opportunity. If they succeed, lives will be saved.
You can read the details of the proposal here:
Some quotes from the article:
The United States needs to do something new: Devote resources and engage both domestic and international sources in coordinated, targeted investments to build on the existing global infrastructure of labs and manufacturers that produce specialized inputs for the vaccines, whether the drugs or syringes or vials that contain them. The vaccine manufacturing supply chain is already global. But it needs to be better organized and subsidized at multiple levels.
Governments and philanthropists have worked together to scale up HIV medicines and pediatric vaccines, but the level of policy cooperation needed for COVID-19 vaccine production is, admittedly, unprecedented. That’s why a global coordinating body will also be needed to help some countries scale up the production of early stage ingredients and critical equipment, knowing they can incentivize other countries to subsidize expansion of later steps in the manufacturing process that will also need to be scaled up. Skillfully combining those inputs into vaccine output and then guaranteeing access to the final doses and related supplies through international trade will require trust among governments that is currently in short supply. But without guarantees and coordination, individual governments will revert to self-defeating vaccine nationalism
One way to accomplish this goal would be to set up a new and enforceable COVID-19 Vaccine Investment and Trade Agreement (CVITA). Such a CVITA can draw some lessons from the US subsidization and coordination of its domestic vaccine manufacturing supply chain under Operation Warp Speed. It was not easy to get so many competing entities to work together in the United States. But its success is already clear. The even more complex policy challenge now is to get the rest of the world vaccinated.
Skip to next section: Summary and call for action
It will benefit everyone to vaccinate everyone fast. In this scenario, the world economy recovers faster, and the better health care and fewer dying in the weaker economies leads to a better world for everyone. They are the people who grow the food and make many products that many of the wealthier countries depend on. If they are healthy too we all benefit.
It also means that holiday destinations, conferences, travel is safer because worldwide there won’t be raging epidemics in the weaker economies. Also very importantly, it means less risk of new variants arising. And less risk of the virus jumping into animal reservoirs like the mink, and now, mice too.
The variant first identified in South Africa has also developed the new capability to infect unmodified mice. This opens up the possibility that the virus as it evolves and transmits worldwide may find new animal reservoirs in those countries and could become like Yellow fever, a virus that often jumps back to humans from other animals.
There has to be an animal reservoir, perhaps of pangolins, somewhere in China, but if so the leap to humans is very rare and hasn’t happened again since China controlled their outbreak. We don’t yet have any other confirmed animal reservoirs – Denmark’s cull of the entire mink population in their fur farms was to prevent a new reservoir being established in wild mink in their country. By stopping the pandemic fast we can reduce the risk of new reservoirs or reduce the number of countries they get established in if they do this.
Skip to next section: Perspective of our future civilization 100,000 years from now
The COVID vaccines have been a great scientific success, and now it’s time to turn then into an ethical, logistical, practical and economic success. First we must immediately supply COVAX with the 10 million doses that Dr Tedros has called for and save the lives of doctors like Professor James Gita Hakim who are dying for the lack of a few thousand doses for their countries, when the USA is hoarding tens of millions of doses it may not even need.
Then in addition, many countries worldwide have the technology and the ability to make these vaccines, but they need permission, and transfer of detailed knowhow of how to make these specific vaccines. AstraZeneca have already done this and have committed to make no profit from the vaccine during the pandemic as part of their agreement with Oxford University. As a result, manufacturers in India and South Korea are already making millions of doses of their vaccine, and will be making billions of doses for the world, and will be joined by manufacturers in Brazil, South Africa, Japan etc.
None of the other vaccine companies are doing this yet. The wealthy countries used public funds from the tax payer to develop the vaccines. The vaccine companies like Moderna, J & J, Pfizer, Novavax took no significant financial risk to develop the vaccines. These companies would still have made a profit from the arrangements if none of their vaccines had worked.
India donate half their own doses with neighbouring countries like Bangladesh and Sri Lanka – this is in addition to ones they export to fulfill pre-orders. France is sharing 5% or 1 in 20 of its early doses and is asking other European countries to do the same.
It is of course a priority for any country to vaccinate all their most vulnerable, elderly and frontline workers especially doctors. However, after that, to donate 1 in 20 doses to the weaker economies like France did is surely a minimum.
This makes sense. The vaccines are also effective in stopping transmission. By vaccinating the world fast we help countries stop community spread. Every new case is another opportunity for the virus to develop new variants.
We already have three variants of concern, first identified in Brazil, the UK, and South Africa. They are all more transmissible, and the variant identified in South Africa has started to evade the AstraZeneca vaccine.
This is not out of our control. We can stop this happening.
Stopping the pandemic worldwide stops new variants that
- transmit faster
- evade the vaccines
- can jump back to more animal reservoirs
It also affects the world economy. A country that is fighting the pandemic and has to go into frequent lockdowns is not going to recover from the recession so quickly and its recovery may be delayed for a long time. The world is so connected this impacts us all worldwide.
We also need to protect the vulnerable and the medical workers worldwide, not just in our country. A few thousand of the over 28 million vaccinations a week in the UK, EU and USA would make a huge difference to a country like Zimbabwe with only around 7000 doctors for the entire country.
Let’s do this. For us in the wealthy countries, our governments used tax payer’s dollars to make these vaccines. It is to the benefit of us too, as well as the rest of the world,. to use these dollars to vaccinate the whole world at once, not just us.
Please – if any of you reading this are good at communication, try to explain this to your readers and followers. I don’t think many people would support this, if they truly understood what was happening and our governments represent the people, and they will listen if public opinion changes.
We have moved on hugely since the time of the AIDS pandemic but we aren’t there quite yet and we can do this at almost no cost to the wealthier countries, by empowering the weaker economies to make the same vaccines we are making. Either through TRIPS or by incentivizing the vaccine companies to follow the example of AstraZeneca to make their technology available to manufacturers worldwide for the duration of the pandemic.
Skip to next section: Many promising vaccine developments
This is another way of thinking bout it. Our generations great, great, great … grandchildren, 3000 generations in the future likely still have access to the historical records of our time. For them our technology will seem more primitive than paper tape and punched cards seem to us. We will seem to be little advanced beyond stone axes and the early technology to be able to make a fire by rubbing two sticks together.
They won’t call us a civilization for our technology.They won’t be impressed by our technology.
What they will call civilized is our ethics, human rights, and our basic rationality and logic. They will see our response to the COVID pandemic and to the climate crisis as the first beginnings of true civilization and of true species wide rationality.
Let’s help make this happen soon!
Skip to next section: Need to #DOITALL and make pandemic history
We will likely have the pandemic largely over later this year, with the very effective vaccines or through to 2022, when, so long as we continue the funding, we’ll be able to fully vaccinate everyone in the world four times.
The Pfizer vaccine which is first generation is already 94% effective at stopping transmission of the B 1.1.7 variant in Israel. This is far more effective than flu vaccines, typically 40 to 60% effective. This is our first ever experience of a coronavirus vaccine, an unrelated virus to flu, and it seems to have an effectiveness closer to a measles vaccine than a flu vaccine.
Also remember a fifth of the world population has already eliminated it locally without a vaccine. This has never been achieved for flu pandemics.
Future generations of vaccine will be more effective, e.g. the hexapro modification should end up with the mRNA from the Pfizer vaccine producing ten times as many stabilized spikes once it enters a cell and the vaccine will be stable at fridge temperatures for at lest several days, able to be heated to 55 C and able to survive three freeze thaw cycles.
. The 2P tweak – Why Pfizer and Moderna are so effective as vaccines – this tweak could be used by other vaccines like AstraZeneca – and 2nd generation vaccines may use the even more effective Hexapro tweak published July 2020
Other things we can do include mix and match of vaccines with a different vaccine for the first and second dose. This has worked with other vaccines in the past and is expected to work with the COVID vaccines with several trials underway including mixing Pfizer with AstraZeneca and the AstraZeneca with Sputnik V. All the medical evidence we have from mixing vaccines suggests it boosts immunity. It’s a rare thing to do mainly because most diseases only have one vaccine in regular use. This situation his unprecedented with so many vaccines for a single disease. But it likely makes the immune system response far stronger.
Ross Kedl, PhD, a vaccine researcher and professor of immunology at the University of Colorado in Aurora, says that mixing is likely a better option, as interviewed by Medscape:
“Each vaccine has a number of components in it that influence immunity in various ways, but between the two of them, they only have one component that is similar. In the case of the coronavirus vaccines, the one thing both have in common is the spike protein from SARS-CoV-2. In essence, this gives you two shots at generating immunity against the one thing in each vaccine you care most about, but only one shot for the other vaccine components in each platform, resulting in an amplified response against the common target.”
He agrees that it’s best to stick with one manufacturer for now but adds
“I would be very surprised if we didn’t move to a mixing of vaccine platforms for the population,” .
The UK trial will also study mixing other vaccines as they are approved for the UK.
Health reporter Smitha Mundasad for the BBC describes it like this:
The Oxford vaccine, for example, uses a harmless virus – almost like a viral postman – to deliver the key part of the vaccine (the bit with coronavirus’s genetic code) into the body.
This bit of code helps train the body’s immune system to recognise coronavirus and prepare defences to fight it off in the future.
When a second dose of the same vaccine is given, there is some evidence to suggest that our immune systems can shift a bit of their focus onto the viral postman – rather than coronavirus itself.
Approaching the challenge using various vaccine combinations may strengthen results.
We also have many more vaccines on their way and it’s unlikely the first vaccine to be approved, Pfizer, is the best of all the first generation vaccines or that the specific doses and interval used for Pfizer is optimal for that vaccine.
As for the variants then we can use vaccines with multiple variants in the same vaccine shot.
Moderna, Pfizer, and AstraZeneca are already testing various mixes including a booster to stop a variant after the original full vaccination, a second dose for a variant after a first dose of the original, and multiple variants in the same shot.
Novavax will be testing a “bivalent” vaccine with vaccinating against the original variant and then the South African variant in April.
And the UK is also saying that by the fall they will have trivalent vaccines, able to vaccinate against three variants in a single shot.
Then we have over 400 therapeutics in clinical trials, some of them very promising. Even if less than 1 in 10 pass phase 3 we may well have several dozen new therapeutics to use with COVID by the end of the year.
. Promising landscape for therapeutics – expect several more by the end of 2021 – but we can’t know in advance that any particular drug will be a winner – there’s a reason we need to do clinical trials for promising drugs
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As Dr Mike Ryan says, if we follow the example of Australia, and add vaccine equity as well, we can make this pandemic history.
As the WHO said in one of their earlier Social Media Q/As, we can all be super heroes – we already have practical solutions we can use to bring down this pandemic quickly. We have a tool kit full of these, not magical but practical solutions we can apply right now, and now we have vaccination too, to add to our toolkit.
COVID-19 TOOLBOX – Face coverings, Contact tracing, Vaccination [when ready], Hand Hygiene, Quarantine, Mass Testing, Physical distancing, Stay Informed.
#DoItAll – Not magic – Practical
Spiderman graphic from here
This is a WHO tweet about the need to #DOITALL as we vaccinate:
#COVID19 vaccines are part of the solution, but alone they won’t end the pandemic. Please keep:
↔️ physical distancing