The global fight against vaccines: Some countries have ordered enough vaccines for the whole country to fight 10 times. What about those poor countries?

The new crown vaccine has not yet been officially launched, and countries around the world have already begun to “grab the vaccine.”

At present, more than 11 billion doses of the new crown vaccine have been ordered globally, of which nearly 8 billion doses have been subscribed by countries or economies, and 3.9 billion are reserved or are still in the negotiation stage.

Among them, Pfizer, Moderna, Sinopharm and other popular models have been launched in many countries, and many vaccines have not yet completed clinical trials, but have sold more than 1 billion.

Over time, these data will continue to rise rapidly.

Although only from a numerical point of view, the vaccines that have been rushed to cover the vast majority of the world’s population and the global anti-epidemic seems to have seen the light, but unfortunately, more than half of the vaccines have already been used by developed countries such as the European Union, the United States, the United Kingdom, and Canada. The economy is the first to subscribe, and the subscription volume in some countries is even enough for the national population to vaccinate 10 times.

But for people in most parts of the world, it will take longer to get a vaccine.

According to forecasts, rich countries are expected to complete the vaccination of high-risk groups in the spring of 2021 and basically complete the vaccination work after the summer, but poor countries may lag behind by nearly a year.

Such a fierce and cruel battle against seedlings is like looting strategic resources. It seems that whoever can grab more vaccines faster will have the priority to end the country’s epidemic.

On November 9, 2020, in New York, USA, when a pedestrian walked past Pfizer’s global headquarters, the building glass reflected the new crown epidemic prevention information publicized on the street. On the same day, Pfizer announced on its official website that preliminary results showed that the new crown vaccine candidate developed in cooperation with BioNTech was more than 90% effective.
Rich countries cast their nets, and the four countries share 40% of the world’s vaccines

“Rich countries have been pre-ordering vaccines all summer.” Melinda Gates, co-chairman of the Gates Foundation, is true.

According to incomplete statistics from “Phoenix Weekly”, as of December 23, 2020, 7.93 billion new crown vaccines worldwide have been confirmed to be pre-purchased by countries and international organizations, of which more than half are in the pockets of developed countries, with a total of 4.13 billion doses, enough for the world /4 is used by the population.

Among them, the European Union, the United States, the United Kingdom, and Canada have all pre-purchased more than 300 million doses of vaccines. They have bought 44% of the world’s new crown vaccines with only 11% of the world’s population, and have achieved fruitful results.

But this also means that the number of reservations will far exceed actual demand, and there will be a situation of fewer monks and more porridge.

For example, as of press time, Canada, with a population of less than 40 million, has ordered 350 million doses of the new crown vaccine. If we estimate that each person needs to be vaccinated with 2 doses, this number is enough for each person to get nearly 10 doses, which is nearly 4 times higher than normal.

The per capita orders in the United Kingdom, the European Union, the United States, New Zealand, and Australia are also 1-3 doses more than normal.

The gap is still widening.

On December 23, 2020, the United States announced an additional order of 100 million doses of vaccine, with a total price of approximately US$2 billion. U.S. Department of Health and Human Services Secretary Alex Aza said that this move is intended to “provide adequate doses of vaccine for all who are willing to be vaccinated before July 31, 2021.”

However, most of the time such a large order quantity is not intended to monopolize resources, but to prevent risks.

As there is still no new crown vaccine officially approved for marketing in the world, there are still a large number of candidate vaccines undergoing clinical trials, which may be greatly delayed or even aborted due to unsatisfactory results at any time, resulting in invalid orders and no receipt of particles.

For example, as early as September 2020, the new crown vaccine jointly developed by AstraZeneca and the University of Oxford had emergency suspension of global clinical trials due to “rare and severe” neurological symptoms of vaccinators.

The peer-reviewed data published by The Lancet shows that the vaccine still needs to complete more work to determine whether the effectiveness of its new crown vaccine can reach 90%.

The clinical trials of Sanofi and GlaxoSmithKline vaccines, which are favored by European and American countries, are still in their infancy. In mid-December, the R&D work of the two companies was postponed due to the poor immune response of elderly subjects, and the market could not be launched until the end of 2021 at the earliest.

It can be seen that if you want to ensure that at least one of the vaccines can be ordered successfully, or even earlier, you need to cast the net, bet more, and order multiple vaccines separately as “spare tires.”

For example, the European Union, which ranks first in the order of rich countries, has pre-ordered 1.58 billion doses of vaccines, including 7 vaccines, but with the exception of Pfizer vaccines, the rest have not been approved for use in the EU.

List of panic buying of new crown vaccines in various countries [organized according to public information]
In the United States, which has pre-purchased 1.21 billion doses of vaccines, as early as May 2020, the United States obtained the largest booking rights for the vaccine by investing in multiple vaccine research and development parties, and purchased 6 vaccines in six months.

Since two vaccine candidates (namely Pfizer and Moderna) are the first to complete Phase III clinical trials, the United States has been able to guarantee at least 400 million doses of vaccine supply. According to statistics from the US Centers for Disease Control and Prevention, as of the 23rd local time, more than 9.4 million vaccines have been distributed across the United States, and 1 million of them have received their first shots.

In order to further consolidate the supply of vaccines, US President Trump signed a decree according to which “the priority of vaccination will be given to American citizens before being shipped to other countries.”

“Although this is not unreasonable from the perspective of a single country, it will cause serious inequality in global vaccine distribution.” The Duke University Global Health Innovation Center, which continues to track global vaccine supply and demand, commented.

According to reporter statistics, as of press time, 15 high-income countries and 9 low- and middle-income countries have only 1.14 billion doses and 1.78 billion doses of vaccines, respectively. Together, they are only comparable to those in the United Kingdom, the United States, Europe, and Canada. The total order quantity is comparable.

In order to avoid becoming a weaker party in the fight against seedlings, middle-income countries have also resorted to every possible means.

For example, India has the world’s largest vaccine manufacturer, the Serological Institute of India, and about 65% of the world’s children have received at least one dose of the vaccine made by this institute. With strong manufacturing capabilities, India can obtain a vaccine for itself by signing a production agreement with a new crown vaccine research and development company.

At present, India has pre-purchased as many as 1.6 billion doses, which is currently the world’s “most competitive” country.

But for more low- and middle-income poor countries, they lack the financial and manufacturing capacity and other bargaining chips, they will inevitably fall into a disadvantaged position or even be excluded.

“This will be a tragedy for the entire world, not just for low-income countries.” Melinda Gates said.

On December 18, 2020, Canadian and French officials stated that the two countries are working to develop a mechanism to encourage rich countries to donate or exchange excess new crown vaccines to other countries and economies. Both countries have not disclosed specific details.

Previously, the European Commission also stated that the vaccine will be distributed in proportion to the population of member states, and the remaining part will be donated or sold to other countries.

According to reporters’ estimates, the total amount of vaccines shared by the three parties will reach 970 million doses, which can be used by nearly 500 million people.

“Vaccines are a public product and have ethical considerations. Wealthy countries will also take this factor into consideration and come up with excess vaccines to support countries without vaccines,” said Gong Wenfeng, senior strategy officer of the Gates Foundation Beijing Representative Office.

Economic level distribution of subscribed countries 【According to public information】
Grabbing ≠ being able to hit, demand exceeds demand and restricts seedling effectiveness

With many orders and tight schedules, whether the supply of the new crown vaccine can keep up will also determine the battle.

Production capacity is the threshold for vaccine supply, but at present, it is difficult for global vaccine production capacity to increase rapidly.

The Global Health Innovation Center of Duke University once predicted the existing vaccine procurement and production data, and found that before 2023-2024, it will not be possible to produce a new crown vaccine for the global population.

It can be seen that the world may face a long-term situation where the supply of new crown vaccines exceeds demand.

If you focus on the research and development side of popular vaccines, you can also clearly see the huge gap between production and ordering.

For example, the new crown vaccine jointly developed by AstraZeneca and the University of Oxford has been subscribed by at least 24 countries or economies around the world, with a total of 274,000 doses, and is currently the most sought-after vaccine.

Among them, the United States, India, the European Union and the Global Covid-19 Vaccine Implementation Plan (COVAX) have each ordered 300-500 million doses. However, as of press time, the vaccine has not yet been approved for use in any country. Unable to start supply.

Even more difficult is that, according to the Financial Times, the British Vaccine Working Group admitted that due to production delays, the vaccine will only be able to supply 4 million doses to the UK in 2020, which is far below the original target of 30 million doses in September.

The popular Pfizer vaccine was not spared either.

At present, Pfizer’s global order for vaccines has exceeded 800 million doses, and more than half of the orders come from the European Union, Japan, the United States and China. All countries have orders for more than 100 million doses.

However, according to the Wall Street Journal, Pfizer has cut its new crown vaccine production target this year to 50 million doses, which means that the company’s previously announced 100 million doses are taking longer than expected to expand the raw material supply chain and the clinical trial results are later. The agent production target was directly cut in half.

Order status of several major vaccines [organized according to public information]
According to the Washington Post, citing sources familiar with the matter, Pfizer has informed the U.S. government that the company cannot provide more doses of the new crown vaccine to the U.S. before the end of June to July next year because other countries have joined the vaccine panic buying war.

However, in a reply to “Phoenix Weekly”, Pfizer said that the company’s production network with BioNTech could provide 1.3 billion doses of vaccines worldwide by the end of 2021.

Pfizer said that once the vaccine is approved for use in the ordering countries, it will be supplied through “a very strict procedure” in accordance with the requirements of the agreement.

Previously, Pfizer had stated that half of the 50 million vaccine doses produced in 2020 will be sold to the United States. According to reports, according to the order agreement between the United States and Pfizer, Pfizer will provide at least 70 million doses of vaccine to the United States by June 30, 2021, and complete the delivery of the remaining 130 million doses by July 31 of that year.

As for how the vaccine will be distributed in each country and which groups will be given priority, Pfizer said that it should be determined by the health authorities of each country.

“But according to the Global Public Health Guidelines, we believe that first-line medical workers and essential workers (note: essential workers are practitioners in public transportation, post and telecommunications, banks, supermarkets, police, government departments and other industries closely related to public life), People who are immunocompromised, nursing homes and public safety officials should have priority.” Pfizer emphasized in its reply.

However, according to the medical media STAT, some wealthy and privileged Americans can jump in the queue by expanding the range of high-risk groups, prompting doctors to vaccinate themselves, and paying bribes to get the vaccine first. Prior to this, the practice of many American conference members jumping in line for vaccination was also questioned whether it was to prove the safety of the vaccine to the public or to protect themselves.

“(Behind the new crown vaccination) there is absolutely black trading.” STAT said.

In addition, there are many challenges after vaccine ordering and production.

Cha Daozong, a professor at the School of International Relations at Peking University, asked some vaccine companies and found that 40% of the cost of vaccine exports was incurred in cold chain, storage and other infrastructure investment and inoculation personnel capacity training and other labor costs.

The long-term tracking of vaccine safety and effectiveness, as well as the response and compensation plan for serious side effects or accidents, also need to be coordinated.

These conditions will also restrict the global supply of the new crown vaccine.

A fair plan for 2 billion vaccines

At present, the global new crown epidemic is still spreading rapidly. The development of vaccines as soon as possible and fair distribution will be the only way to contain the spread of the epidemic.

Michael Ryan, the head of WHO’s emergency planning, emphasized that ordering vaccines should not be viewed as a game of winners and losers, or a kind of nationalist competition. The world needs to stand in a team to complete the game.

“Someone reaching the finish line first does not necessarily enable others to get help. Unless everyone wins, no one can win this game.” Ryan said.

How to achieve a win-win situation, especially to prevent poor countries from falling behind in the fight against seedlings, COVAX provides a solution.

The mechanism is led by the Epidemic Prevention Innovation Alliance (CEPI), the Global Alliance for Vaccines and Immunization (GAVI) and the WHO. Its goal is to accelerate the development and production of the new crown vaccine, while concentrating on the needs of various countries, and quantitatively bargaining with vaccine companies. Ensure that all participating countries have fair and reasonable access to vaccines to end the acute spread of the new crown epidemic.

Among them, CEPI mainly provides support for vaccine research and development, GAVI integrates purchase orders, coordinates pricing and production capacity arrangements with vaccine manufacturers, and WHO provides more policy guidance on vaccine safety supervision and distribution plans.

In addition, UNICEF will also participate in the distribution and vaccination of the new crown vaccine. On December 18, 2020, the organization stated that it will prepare to deliver 850 tons of new crown vaccine per month in 2021. Most vaccines can be delivered on existing commercial flights, and charter flights or other options will be considered when necessary.

According to the COVAX vaccination plan, vaccines will be allocated according to priority, with the highest priority being medical and health workers and other key position workers who account for about 3% of the total population, followed by the elderly and other high-risk groups, and finally ensuring that every participating country Get the vaccine needed to cover at least 20% of the population.

To accomplish this goal, COVAX needs at least 2 billion doses of vaccine before the end of 2021.

On December 18, 2020, the WHO stated that COVAX has obtained nearly 2 billion doses of the new crown vaccine supply agreement. If these vaccines can be approved for use, low-income participating countries are expected to start using the vaccine as early as the first half of 2021.

At present, 190 countries and economies around the world have confirmed to join the mechanism. Among them, 92 are low- and middle-income countries and some island countries with high incomes but small populations. The latter have no bargaining power in vaccine ordering and need to purchase vaccines through various aid funds.

The remaining 98 countries and economies, including China, are at the middle-to-high income level. All the costs of vaccine procurement and vaccination are paid by each country, but the vaccine procurement price may be lower.

“But the biggest problem may still be funding.” Zhang Li, director of the GAVI Strategic Innovation and New Investor Center, said that because many high- and middle-income countries have signed subscription agreements with vaccine manufacturers, and want to ensure that poor countries can obtain vaccines in time, COVAX also To continue to sign purchase agreements with enterprises, a large amount of capital guarantee is required.

According to estimates, the total amount of funds required to purchase and distribute 1 billion doses of the new crown vaccine for the aforementioned countries is as high as 7 billion US dollars.

“So far, US$2.4 billion has been raised, and there is a gap of about US$4.6 billion by the end of 2021.” Zhang Li said that if intermediate transportation, vaccination and other related costs are considered, the funding gap will be further widened.

Currently, only 10 candidate vaccines have been selected for the COVAX program. Except for the mRNA vaccine developed by Moderna that has been authorized for emergency use in the United States, the remaining 9 vaccines are still in different clinical trials.

It is worth noting that Pfizer, Sinopharm, Kexing and other major subscribers that have attracted much attention are not included in the plan. Although COVAX did not announce the reason for not being selected, it can still get a glimpse of the criteria for the selected vaccine.

Zhang Li said that for the selected vaccine, it is necessary to ensure timely disclosure of vaccine clinical data. For this purpose, GAVI has established an expert review team. In addition, it needs to pass WHO pre-certification or strict drug regulatory agency certification. Second, the price of vaccines must be guaranteed by non-self-paying countries.

“Price is not the most important standard, but safety, effectiveness and related certification are indispensable. There is no ambiguity at all.” Zhang Li said.

For example, domestic vaccines are often subject to regulatory restrictions and it is difficult to enter the market.

On November 9, 2020, in New York, USA, when a pedestrian walked past Pfizer’s global headquarters, the building glass reflected the new crown epidemic prevention information publicized on the street. On the same day, Pfizer announced on its official website that preliminary results showed that the new crown vaccine candidate developed in cooperation with BioNTech was more than 90% effective.
At present, China has not adopted a regulatory model of strict drug regulatory agency certification. Therefore, if domestic vaccines are to be purchased internationally, they must be pre-certified by the WHO.

According to Cha Daozong, among the 155 vaccines pre-certified by WHO, 4 are domestic vaccines, and another 5 vaccines are still in the submission stage.

“If China’s new crown vaccine can obtain the WHO pre-certification, it will be an important milestone for the internationalization of my country’s vaccine brand.” Cha Daozong said.

As for Pfizer’s vaccine, which has preempted the market in the United Kingdom, the United States and the European Union, Pfizer told Phoenix Weekly that the company has expressed to COVAX its willingness to provide new crown vaccines to poor countries and is communicating with GAVI (on behalf of COVAX).

“We intend to provide a fair supply of vaccines to the global priority population identified by the WHO.” Pfizer said that the two sides have not yet determined the quantity and price of vaccine supply.

As for whether China’s domestic vaccines can enter the international market through this, Cha Daozong believes that domestic vaccines can be sold to the world through various channels, such as market procurement, which requires negotiation between buyers and sellers, or joining the COVAX plan to sell to poor countries at lower prices. Subsidy sales, or free assistance.

However, no matter what method is adopted, it needs to be formally approved for marketing by my country’s drug regulatory agency or pre-certified by WHO.

But he also believes that the vaccine market is essentially a region or a single country as the center, or developed countries as the center. Especially when a major epidemic is encountered, the vaccine supply and demand situation is a seller’s market, not a buyer’s market. Global vaccine sales High monopoly Among the five major pharmaceutical giants in developed countries, China’s vaccines are bound to face strong competition.

“But there will always be opportunities,” he said.

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