THE DIRECTOR general of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, has warned that the globe “is on the brink of a catastrophic moral failure” that will prove costly for the world’s poorest countries. The richest nations are scooping up the supply of vaccines to fight the pandemic, while poor nations are still waiting for their first shots. The ideal of vaccine equity for all is being lost.

Dr. Tedros declared Jan. 18, “As the first vaccines begin to be deployed, the promise of equitable access is at serious risk. More than 39 million doses of vaccine have now been administered in at least 49 higher-income countries. Just 25 doses have been given in one lowest-income country. Not 25 million; not 25 thousand; just 25.” That country was Guinea, officials said.

The world’s wealthiest countries, including the United States; their regulatory agencies; and the major vaccine developers and manufacturers have grabbed vaccine supply in what Dr. Tedros called a “me first” approach. The doses have been locked in through bilateral deals made between countries and manufacturers, often on secretive terms, creating a hypercompetitive market in which poorer countries cannot easily compete. By necessity, they too are jumping into the fray; the African Union just completed a set of deals for 270 million doses, according to Duke University’s Global Health Innovation Center. Dr. Tedros said 44 bilateral deals were signed last year, and at least 12 so far this year. Moreover, he said, manufacturers have sought regulatory approval first in rich countries where the profits are highest. The possible consequences are “hoarding, a chaotic market, an uncoordinated response, and continued social and economic disruption,” he warned.

To avoid this, a global risk-sharing procurement initiative was established, the Covax Facility, led by the WHO, the Coalition for Epidemic Preparedness Innovations and Gavi, the Vaccine Alliance. The goal is to pool vaccine buying power, with a target of obtaining nearly 2 billion doses to protect more than 20 percent of populations by the end of 2021. Ninety-two lower-income economies will be supported by the financing mechanism in Covax, the Advanced Market Commitment (AMC). Ninety-eight higher-income economies have signed up as self-financing members of the Covax Facility. So far, Covax has commitments to get the doses from five producers, and Pfizer announced Friday an agreement to provide up to 40 million doses. However, the negotiations have been difficult and none have yet been administered. A major Covax supplier, the Serum Institute of India, submitted regulatory paperwork to the WHO about 10 days ago , and probably will not get emergency use listing for another month.

Meanwhile, countries are tempted by vaccines from China and Russia that have not yet been subject to stringent regulatory review. To improve the situation, nations that have doses on hand that have passed through review could directly share them with the Covax Facility. Reversing former president Donald Trump’s decision, the United States is now wisely joining Covax, which should allow it to vaccinate every American while also helping others who need vaccines, as secretary of state nominee Antony Blinken has promised.

As the pandemic has demonstrated, no country, rich or poor, is an island.

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