Vexed over vaccines

The Directorate General of Health Services announced this week that Bangladesh’s stock of Covid-19 vaccines was running out, with only some 1.4 million jabs remaining in government hands. Given the current crisis in India, there is little to no hope of receiving the next consignment in accordance with the contract signed between Beximco Pharmaceuticals and the Serum Institute of India anytime soon.

Speaking at a virtual press briefing, DGHS spokesperson Robed Amin said, “We had around 10.02 million vaccine doses in our hands…around 8.8 have already been administered as the first and second doses. Now we have some 1.4 million doses in stock.”

He went on to warn that there would be a vaccine crisis if a fresh consignment does not arrive in the country before the existing stock is exhausted. Robed said around 5.8 million people have so far received the first dose of the vaccine while 3 million of them have got the second, booster dose to complete their course of the Oxford University-AstraZeneca vaccine. That leaves 2.8 million people yet to complete the course, of which 1.4 million can be covered from the current stock, since the government has stopped registering any new recipients through the Shurokkha app.

Clearly, the priority has shifted to covering these people rather than reaching a situation where a large number of them are left in limbo, considering the uncertainty over when Serum may resume supplies. As reported before, the government is now looking at alternative suppliers, something they would possibly have been well-advised to do earlier, from Russia and China, as well as others.  But in the absence of any clear data yet on whether the vaccines can be mixed or matched, concentrating the remaining doses on letting as many people as possible complete their course is only the right thing to do.

Till Eid, which is about when supplies are estimated to lost, you’re unlikely to see any new faces popping up on your social media feed with their ‘vaccine selfie’. Unless they skipped it the first time, which is unlikely.

From pillar to post

Reaffirming that the government is making all-out efforts to collect Covid-19 vaccines from different sources, Health Minister Zahid Maleque on Thursday (May 6) said they are now “at the stage” of signing a deal with Russia to procure the Sputnik V vaccine.

Speaking at a virtual discussion arranged by Bangladesh Private Medical College Association, he said they are also trying to procure the Oxford–AstraZeneca vaccine from other countries besides India – AstraZeneca has licensed production in some 15 countries already.

“We’ve been using the AstraZeneca vaccine as we had placed an order for 3 crore (30 million) doses of it. We’ve got only 70 lakh (7 million) jabs in addition to 30 lakh (3 million) that came as a gift…but now we don’t have that much vaccine in our stock and whatever is left will be given as the second dose,” the minister said.

He said the prime minister, Health Ministry, Foreign Ministry and other relevant ministries are making joint efforts to procure vaccines from other sources.

“We’ve already made a huge progress in discussions with Russia over procuring its vaccine … now we’re at the stage of signing a deal in this regard,” Maleque said.

He said they are also in talks with China to have Sinopharm’s Covid vaccine. “They informed us that five lakh (500,000) doses will arrive in Bangladesh by May 12. We’ve also sent a letter to them seeking more vaccine doses.”

The minister said the Chinese government is now assessing the possibility of vaccine export to Bangladesh. It must be observed that it sounds like an uncharacteristically conservative offer from Beijing, for which the episode back in August 2020 comes to mind, when it all seemed very close to an agreement with the Chinese for vaccine supply, before the government seemed to get cold feet.

Getting back to Maleque, he was desperate to explain the government’s all-out efforts to get the vaccine. “Even, we’re trying to have AstraZeneca’s vaccine from other countries as it’s being manufactured in different countries. So, every effort is there to bring vaccines. We hope our efforts will yield good results, and we may be able to give you good news over the vaccine very soon,” he said.

The minister also said they will encourage the private sector if it tries to manufacture vaccines in Bangladesh. “If anyone can produce vaccines, we’ll provide all-out support, and it’s my commitment.”

Speaking at the same programme, State Minister for Disaster Management and Relief Dr Enamur Rahman said there is no alternative to vaccinating people to control the coronavirus. He too tried to assure everyone the government is working sincerely on procuring vaccines from Russia, China and other sources as there has been a crisis of AstraZeneca’s jabs in India.

He gave some hint as to what the government is looking at as a way to get past the pandemic, saying that all the pandemics that emerged in the world earlier had been brought under control through vaccination, although that’s not entirely true. “We hope we’ll be able to control the corona pandemic by vaccinating 60-80 percent of our people.”

What sort of timeframe they’re looking at to achieve that is up in the air, but it could be a good 2 years. Cases have been coming down in Bangladesh recently, but you never know when there can be another wave. The lesson we must heed going forward, is that never to close out any options during this crisis. And not to rest on our haunches. In that, the public has a role too, most evidently in maintaining the public health guidelines we’re now getting used to.

A shot at salvation?

It is of course well-documented by now that the pandemic has exposed some dangerous inequities between the rich world and the rest. The kind of problem the Bangladeshi authorities are dealing with today is scarcely seen in the West. While one in four citizens of rich nations have had a vaccine, just one in 500 people in poorer countries have done so, meaning the death toll continues to climb as the virus remains out of control. According to Oxfam, an international NGO, epidemiologists are predicting we have less than a year before mutations could render the current vaccines ineffective.

One of the reasons Pharma companies have been able to generate such large profits is because of intellectual property Last week, 175 former heads of state and Nobel Prize winners, including Gordon Brown, Ellen Johnson Sirleaf and Francoise Hollande wrote to President Biden to support the temporary waiving of intellectual property rights that restrict production to a handful of companies (those that develop the vaccine and others who obtain the license from them), to enable the rapid scale up of vaccine production across the world. They join the 1.5 million people in the US and other nations who have signalled their support for a People’s Vaccine.

Over 100 low- and middle-income nations, led by India and South Africa, are calling at the World Trade Organisation for a waiver of intellectual property protections on COVID-19 products during the pandemic, a move that had so far been opposed by the US, EU and other rich nations.

In a major shift, the Biden administration in the US this week joined the calls for more sharing of the technology behind COVID-19 vaccines to help speed the end of the pandemic, a shift that puts the US alongside many in the developing world who want rich countries to do more to get doses to the needy.

US Trade Representative Katherine Tai announced the government’s position, amid World Trade Organisation talks about a possible temporary waiver of its protections that would allow more manufacturers to produce the life-saving vaccines.

“The Administration believes strongly in intellectual property protections, but in service of ending this pandemic, supports the waiver of those protections for COVID-19 vaccines,” Tai said in a statement.

She cautioned that it would take time to reach the required global “consensus” to waive the protections under WTO rules, and US officials said it would not have an immediate effect on the global supply of COVID-19 shots.

In a tweet, the director of the Africa Centres for Disease Control and Prevention, John N. Nkengasong, said the Africa CDC welcomed the waiver and called the decision “leadership in action.” He added: “History will remember this decision as a great act of humanity!”

Tai’s announcement came hours after WTO Director-General Ngozi Okonjo-Iweala spoke to a closed-door meeting of ambassadors from developing and developed countries that have been wrangling over the issue, but agree on the need for wider access to COVID-19 treatments.

The WTO’s General Council took up the issue of a temporary waiver for intellectual property protections on COVID-19 vaccines and other tools, which South Africa and India first proposed in October. The idea has gained support among some progressive lawmakers in the West.

More than 100 countries have come out in support of the proposal, and a group of 110 members of Congress — all fellow Democrats of Biden — sent him a letter last month that called on him to support the waiver.

Opponents — especially from industry — say a waiver would be no panacea. They insist that production of coronavirus vaccines is complex and can’t be ramped up by easing intellectual property. They also say lifting protections could hurt future innovation.

Stephen Ubl, president and CEO of the Pharmaceutical Research and Manufacturers of America, said the US decision “will sow confusion between public and private partners, further weaken already strained supply chains and foster the proliferation of counterfeit vaccines.”

Dr. Michelle McMurry-Heath, chief executive of the Biotechnology Innovation Organization trade group, said in a statement that the decision will undermine incentives to develop vaccines and treatments for future pandemics.

“Handing needy countries a recipe book without the ingredients, safeguards, and sizable workforce needed will not help people waiting for the vaccine,” she said.

Pfizer declined to comment on Biden’s announcement, as did Johnson & Johnson, which developed a one-dose vaccine meant to ease vaccination campaigns in poor and rural areas. Moderna and AstraZeneca didn’t immediately respond to requests for comment.

The companies have made some efforts to provide vaccine doses to poor countries at prices well below what they’re charging wealthy nations.

For instance, Johnson & Johnson agreed last week to provide up to 220 million doses of its vaccine to the African Union’s 55 member states, starting in this year’s third quarter, and agreed in December to provide up to 500 million vaccines through 2022 for low-income countries via Gavi, The Vaccine Alliance.

Shares of Pfizer, AstraZeneca and Johnson & Johnson — huge companies with many lucrative products — fell less than 1% on the news. But Moderna, whose vaccine is the company’s only product, fell 6.2% in late-afternoon trading before gaining back two-thirds of a percent in after-hours trading.

It remained unclear how some countries in Europe, which have influential pharmaceutical industries and had previously shared U.S. reservations about the waiver, would respond.

WTO spokesman Keith Rockwell said a panel on intellectual property at the trade body was expected to take up the waiver proposal again at a “tentative” meeting later this month, before a formal meeting June 8-9. That means any final deal could be weeks away at best.

Authors of the proposal have been revising it in hopes of making it more palatable.

Okonjo-Iweala, in remarks posted on the WTO website, said it was “incumbent on us to move quickly to put the revised text on the table, but also to begin and undertake text-based negotiations.”

“I am firmly convinced that once we can sit down with an actual text in front of us, we shall find a pragmatic way forward” that is “acceptable to all sides,” she said.

Co-sponsors of the idea were shuttling between different diplomatic missions to make their case, according to a Geneva trade official who was not authorized to speak publicly on the matter. A deadlock persists, and opposing sides remain far apart, the official said.

The argument, part of a long-running debate about intellectual property protections, centres on lifting patents, copyrights and protections for industrial design and confidential information to help expand the production and deployment of vaccines during supply shortages. The aim is to suspend the rules for several years, just long enough to beat down the pandemic.

The issue has become more pressing with a surge in cases in India, the world’s second-most populous country and a key producer of vaccines — including one for COVID-19 that relies on technology from Oxford University and British-Swedish pharmaceutical maker AstraZeneca.

Michael Yee, a Jefferies Group biotech analyst, wrote to investors that the key access issues for developing countries aren’t patents or price, but an inadequate supply of the materials needed and the know-how to produce the vaccines and keep quality high — which one of Johnson & Johnson’s contract manufacturers in the U.S. failed to do, ruining millions of doses.

“Manufacturing supplies, raw materials, vials, stoppers, and other key materials are in limited supply for 2021,” and may still be next year and beyond, Yee wrote. That’s partly because it takes time to make all those components, and Moderna and Pfizer have commitments to buy them “from major suppliers in huge bulk over the foreseeable future.”

He added that Pfizer previously sought authorization to sell its vaccine to India, which rejected its application and asked that additional studies be run. The U.S., European Union and many other countries have given that emergency authorization.

Proponents, including WHO Director-General Tedros Adhanom Ghebreyesus, note that such waivers are part of the WTO toolbox and insist there’s no better time to use them than during the once-in-a-century pandemic that has taken 3.2 million lives, infected more than 437 million people and devastated economies, according to Johns Hopkins University.

“This is a monumental moment in the fight against COVID-19,” Tedros said in Wednesday statement. He said the U.S. commitment “to support the waiver of IP protections on vaccines is a powerful example of American leadership to address global health challenges.”

Additional reporting by Masudul Hoque and AP.

  • Vexed over vaccines
  • Vaccine
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  • Covid-19
  • Coronavirus

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