As the race for a Covid-19 vaccine may be coming to a positive end, many advanced countries are already securing millions of future doses for their citizens but what’s the plan for the world at large especially Africa?
Ideas.memo | Oluwatobi Olakanye
Global competition is in motion to create, produce and distribute an effective vaccine to stop the new, deadly, and highly infectious COVID-19 virus which as of Monday, August 8, 2020, has infected over 20 million people and killed over 734,247 worldwide. Several governments have cautioned that normal life cannot return until the general populace has built up herd immunity to the virus. The need to return to a semblance of normalcy has accelerated the race for a Covid-19 immunization.
Traditionally, vaccine development takes over a decade, which may not even include the initial research. The steps in the development of a successful vaccine include:
- Preclinical test: Test tube and animal experiments
- Clinical test
Phase 1: Testing in small groups for safety
Phase 2: Larger tests for effectiveness
Phase 3: Large-scale efficacy and safety trials
- Regulatory Authorization: Allowed under emergency use authorization or other limited use authorizations.
- Regulatory Approval: Safety and efficacy results have met regulators' satisfaction, and the product may now be marketed commercially
However, scientists have sought to accelerate clinical trials on a large scale to get a definitive answer on the vaccine’s efficacy. Although, clinical trials are difficult to accelerate because antibodies require time to develop in the body. Experts have suggested 'human challenge trials', in which patients are purposefully exposed to a disease, as another way to cut time out of the process, but this process is ethically controversial and highly regulated. Usually, human challenge trials are only done with curable diseases and there is no known cure for COVID-19 yet.
The race for a Vaccine
There are currently over one hundred vaccines in the preclinical stage of development by pharmaceutical companies, academic institutions, government agencies, and others many of which are being tracked by the World Health Organization (WHO). Several are already undergoing clinical trials. One of the frontrunners, a combined effort of Oxford University and AstraZeneca, published data showing their vaccine does not show severe side effects and it prompts the immune response needed to counter the virus.
The Oxford Group is moving into Phase 3 of development has stated that they plan to have a vaccine ready for mass production as soon as September of this year. These efforts are joined by other candidates in showing favourable immune responses such as vaccines from Moderna Inc. and a partnership of Pfizer Inc. and BioNTech SE. CanSino Biologics has also received authorization for limited distribution of its vaccine among the Chinese military, and the Russian Defence Ministry has suggested its state-backed vaccine from the Gamaleya Scientific Research Institute has completed all three phases of human clinical trials successfully and they will begin production in mass soon.
Creating a successful vaccine is just the first step. There is still a looming problem of producing large quantities enough to provide immunity to all citizens and competition is gearing up over who will have access immediately a vaccine is ready and tested. This task has both motivated countries to prepare for large-scale production and has also raised competition amongst them amid fears of potentially limited vaccine supply. Certain countries are already looking to sign monopoly agreements with vaccine manufacturers to avoid domestic shortages. In fact, Brazil, the United States, and the European Union have all signed agreements with AstraZeneca for hundreds of millions of doses of the University of Oxford vaccine. Novavax announced a partnership with Takeda Pharmaceutical to sell 250 million doses of NVX‑CoV2373, its COVID-19 vaccine candidate in Japan. Experts have warned that bidding wars over a vaccine could lead to inequitable distribution and, ultimately, fail to eliminate the risk of new outbreaks.
Pricing a future Coronavirus Vaccine
Research and development for potential vaccines are expensive and uncertain, especially if a candidate fails during clinical trials. Intellectual property rights and patents, which give exclusivity and price control, are essential to the pharmaceutical industry as they allow companies to take on costly research with the assurance of future profits. The pharmaceutical industry is confronted with two pertinent questions; how quickly it can produce a vaccine? and also equally important how much it’ll cost?
Many factors impact the cost of producing a vaccine, including the cost of manufacturing, the availability of ingredients, the number of doses required, and how it needs to be stored and transported. Vaccines are typically the most expensive when they are new. Prices can range from the tetanus vaccine of the 1920s which costs less than $35 a shot to Gardasil, an HPV vaccine from Merck approved in 2006 which cost nearly $230 out-of-pocket for a single dose, the chickenpox vaccine cost $135. Recent vaccines targeting more limited populations, such as a meningitis B and the shingles vaccine for older adults, have a retail cost of $300 to $400 for a full course.
Countries like the United States have some leverage over prices because each of the companies (except Pfizer) involved in the production of the coronavirus vaccine has accepted substantial federal funding to support its vaccine development. Early clinical studies indicate that a Covid-19 patient will require two doses to be successfully vaccinated. For instance, Pfizer has indicated that the estimated cost for their vaccine is $20 per shot which means that the two doses will cost $40/patient which amounts to N15,520.* Experts have also indicated that this price is very unlikely to go higher unless another competitor can readily show that their vaccine is significantly more efficient. Also, based on the US government's $1.6 billion deal with vaccine maker Novavax for 100 million doses of its coronavirus vaccine, this amounts to an average price of $32 per patient (N12,416) for two doses.
Experts such as Dr John Amuasi have warned that by the time the race for COVID-19 vaccines production ends, Africa will be the last in line to get any vaccine.
What is the plan for Africa?
Many advanced countries are already securing millions of future doses for their citizens but what’s the plan for the world at large especially Africa? African leaders and health experts have called for equitable and fair access to any approved vaccine against the coronavirus. As the number of confirmed COVID-19 cases in Africa skyrockets, governments across the continent are in dire need of a vaccine promptly. Experts such as Dr. John Amuasi** have warned that by the time the race for COVID-19 vaccines production ends, Africa will be the last in line to get any vaccine or medicines.
According to the Brookings Institution as of 2019, one in three Africans—422 million people—live below the global poverty line. They represent more than 70 percent of the world’s poorest people. The standard measure of poverty is the World Bank's definition of living on less than $1.90 per day. To the World Bank, 85% of Africans live on less than $5.50 per day. This puts a potential vaccine (priced at about $40) out of the reach of many African families.
As a point of reference, the National Bureau of Statistics (Nigeria) estimates that 40.1 percent of the total population in Nigeria was classified as poor. In other words, on average 4 out of 10 individuals in Nigeria have real per capita expenditures below 137,430 Naira per year. This translates to over 82.9 million Nigerians who are considered poor by national standards. At an estimated price of N15,132 Naira, a Covid-19 vaccine could cost Nigerians over N3 trillion. It is important to note that in 2019, households in Nigeria already spent N2.46 trillion on health. To put this in more perspective, the revised Nigerian budget for 2020 stands at N10.8 trillion Naira. This shows that even if there is a subsidy by the government, the price of a future vaccine may still be too great for Nigerian and African families to bear.
Several non-profit organizations such as GAVI, the vaccine alliance, the WHO, and the United Nations have been raising funds to purchase a potential vaccine for distribution in Africa and other regions. The Bill & Melinda Gates Foundation has said it is backing the world’s largest vaccine maker to churn out 100 million doses of coronavirus vaccine for poorer countries and price them at less than $3. But for how long will African countries rely on aids and bailouts? It is also hoped that the African Union and the various African countries can reach a suitable agreement with vaccine companies using collective bargaining power to get realistic prices for African families.
notes
* Naira to Dollar is calculated at N388 - $1 which is the rate as at 11 August 2020
** Executive Director of Kumasi Centre for Collaborative Research in Tropical Medicine
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