As govts scramble for Covid vaccines, don't forget the Pacific

By Lillian Hanly

Governments all around the world are scrambling to secure access to Covid-19 vaccines for their citizens.

Over the past few weeks, companies Pfizer, Moderna and Janssen Pharmaceutica have released results of significantly effective vaccines in preventing the virus.

But what does this mean for smaller nations who may not have the financial ability to be first in first served?

The question of equitable and affordable access to vaccines for all countries is a matter of major importance to Doctors Without Borders

Its Executive Director, Jennifer Tierney, said the pharmaceutical industry was taking a business-as-usual approach in the development of the vaccine in order to protect their own intellectual property and profitability.

"The problem there is that that means it creates levels of inaccessibility for those who need the vaccine, as we all do around the world.

"It creates an opportunity for developed nations and nations with higher GDP to access those treatments vaccines and cures before developing countries or people living in countries with lower GDP might," she said.

The New Zealand government has an in-principle agreement with Janssen Pharmaceutica which would see up to five million doses of the vaccine delivered by the end of 2022.

In a statement, Dr Peter Crabtree, Chair of New Zealand's Covid-19 Vaccine Strategy Taskforce said supporting Pacific countries to have early access to those safe vaccines was a priority, but it is yet to be made clear how that would be achieved.

"New Zealand has signed up to the COVAX Facility seeking coverage for 50 percent of the population of the Realm, which covers New Zealand, the Cook Islands, Niue and Tokelau.

"It's likely that some of this will be funded by the Aid programme, but the details are still being worked through and decisions are yet to be made. Timing of delivery is complex, and some vaccine candidates will be more suited for the pacific than others."

The World Health Organisation's COVAX Facility is tasked with providing equitable access to vaccines.

The website states, "the COVAX Pillar aims to ensure that every country gets fair and equitable access to eventual Covid-19 vaccines. Wealthier countries have a greater chance of gaining access to successful vaccines, and by pooling their buying power rather than competing against one another, they enable investment in factories, so more doses are available as soon as a vaccine becomes available."

The idea with COVAX is to provide two billion doses of safe and effective Covid-19 vaccines throughout the world by the end of 2021, with both rich and poor nations participating.

Self-financing economies will be able to buy in and secure enough doses for their populations proportional to the amount they used to buy into the programme.

Other economies will be guaranteed doses to vaccinate up to 20 percent of their population until further doses become available.

In the Pacific, this includes Kiribati, Micronesia, Papua New Guinea, Solomon Islands and Vanuatu as well as Fiji, the Marshall Islands, Samoa, Tonga and Tuvalu.

Jennifer Tierney and Doctors Without Borders hoped to encourage more transparency in how the facility will distribute vaccines

"Right now I don't have any background information as to how much money has been raised, or how the money is going to be used to cover off the needs of developing countries.

"So while the donor nations into the COVAX Facility will be sure within the Facility to get access, it's unclear if they come first or how the prioritisation is going to be. So we've been calling on every country that's participating in the COVAX Facility to again make sure that there are controls within the Facility for guaranteeing equal access whether or not you're a rich or a less rich nation."

Gavi - The Vaccine Allliance, who is leading the COVAX Facility, responded to these concerns by explaining they are currently fundraising to finance the costs of at least one billion Covid-19 vaccine doses.

These early doses will be reserved to ensure lower income nations are not left behind.

"In the acute phase of the pandemic, Gavi's initial goal will be on securing sufficient supply and resources to provide all economies with vaccines to protect their highest risk groups (calculated at 20 percent of the population), subject to country readiness and availability of funding. Vaccines will be allocated equally between self-financing and AMC-eligible economies, based on the WHO-developed Fair Allocation Framework."

There may also be opportunities for COVAX to fund eligible economies beyond the 20 percent guaranteed to them through the support of multilateral development banks.

Another issue that has been raised is the type of storage required to facilitate the proper distribution of the vaccines in the warm Pacific climate. The Pfizer vaccine, for example, comes in two doses and must be stored at -70 degrees celsius. It also has a fairly short shelf life compared to the Janssen vaccine which can be distributed in one dose.

"It is important to note that to meet the huge demand that we foresee, COVAX will need as many vaccine candidates as possible for use across a range of populations and settings.

"Not all of these will have the same storage requirements; in fact the majority of the vaccines in development, if successful, will require regular cold chain infrastructure, which Gavi has spent the past two decades expanding and updating in lower-income countries."

Meanwhile in New Zealand, Peter Crabtree emphasised that most Pacific Island countries would be eligible to access vaccines. New Zealand committed $NZ27 million to the COVAX alliance.

"Our support for the COVAX Facility Advanced Market Commitment is to ensure lower income countries can access vaccines. We're working closely with other partners, particularly Australia, to ensure a co-ordinated and smooth approach to the rollout of vaccines in the Pacific."

He added that the New Zealand's Ministry of Health would collaborate with Pacific governments and regional partners such as the WHO and UNICEF on vaccine distribution and immunisation planning.