A recent study by researchers at the Yale School of Medicine finds that high-income countries have had better access to COVID-19 vaccines than low- and middle-income countries, possibly due to vaccine delivery failures and a trend for private vaccine manufacturers to prioritize countries that can pay a higher premium for doses.

Simona hausleitner

11:15 p.m., 07 Dec. 2021

Cecilia Lee

A group of researchers affiliated with Yale recently discovered that there are significant inequalities in the global distribution of the COVID-19 vaccine – especially among countries that have hosted vaccine trials, low- and middle-income countries have received a lot. fewer doses than high income countries.

In the long run, these low-income countries are less able to immunize their populations, ultimately resulting in a high disease burden and overcrowded hospitals in economically disadvantaged regions, the researchers found. Of the countries that have hosted clinical trials, high income countries were able to immunize an average of 51.7% of the population, while lower and upper middle income countries could only provide doses for 31% and 14, 9% of the population, respectively. This result occurred despite equally high vaccine authorization and approval rates in all countries, indicating that wealth-based inequalities in vaccine distribution are due to variations in vaccine delivery.

“Enrollment was not the obstacle,” explained Reshma Ramachandran, lead author of the study and researcher at the Yale School of Medicine. “Basically, over 90 percent of all countries that have tested vaccines, regardless of income group, have approved the vaccine for use in their populations. The disparities really existed in terms of delivery… vaccine manufacturers, because they are the ones controlling the supply, prioritized orders from high-income countries over orders from low- and middle-income countries.

One of the reasons for this, she explained, is that richer countries are able to pay higher premiums for vaccine doses, often before research and development is even completed.

According to Ramachadran, the National Institute of Health, or NIH, launched Operation Warp Speed, which has contributed about $ 20 billion to the development, manufacture and purchase of vaccines. In Canada and several European countries, similar programs have been put in place, with the governments of these countries negotiating contracts with large pharmaceutical companies such as Pfizer, Moderna, BioNTech and Johnson & Johnson.

Alka Menon, a medical sociologist and researcher at the MacMillan Center for International and Area Studies at Yale, said the emergency of the COVID-19 pandemic also increased the speed at which the clinical trial process unfolded, this which is ultimately disadvantageous for low and middle income regions.

“Countries with a lot of money could get a seat at the table faster and engage upfront with a lot more resources, and that’s exactly what the United States has done,” Menon said. “The government made bets on several different manufacturers simultaneously, even before middle-income countries had a conversation with some drug companies.”

Although the U.S. federal government, along with other high-income countries, has pledged to donate millions of doses of the vaccine to low-income countries, follow-up has been far too slow, according to Ramachandran. In addition to having priority access to vaccines, high-income countries have also obtained doses or boosters in quantities greater than the needs of their own populations. This means that the majority of the current vaccine supply is concentrated in only a few countries.

Professor of public health and epidemiology Albert Ko added that countries like Germany and the United States, which are concerned about the risks associated with finding vaccines that will work, have prepaid each of those companies to buy a reserve doses for “sometimes several times the number of people in the population to get enough vaccines.”

During public health crises, countries typically aim to launch a coordinated effort both in terms of disease surveillance and vaccine and treatment development. The rapid spread of COVID-19, combined with a lack of preparedness for a pandemic of this magnitude, has resulted in a gap in access to vaccines between high-income and low-income countries.

The actions of the US government are also to blame, according to Ramachandran. In contracts between government and pharmaceutical companies, policymakers may implement certain provisions or stipulations requiring vaccine manufacturers to share their technology with other biotechnology companies in order to facilitate large-scale vaccine production. However, Ramachandran pointed out that the government has left vaccine distribution in the hands of private vaccine manufacturers and pharmaceutical companies.

“Despite repeated requests from patient communities, nonprofits and healthcare providers, [the government] decided to write them a blank check, instead of requiring access as a condition of these contracts [which is] … One of the biggest political failures we’ve seen during this pandemic, ”said Ramachandran.

One of the most important next steps, especially with the recent emergence of new strains of COVID-19, is to find a way to promote more equitable access to vaccines in all countries, regardless of national income. Ramachandran has suggested that President Joe Biden could expand the Defense Production Act, an emergency response clause that allows the country’s leader to reallocate resources and facilities to promote national defense. Although the Biden and Trump administrations both used the law to expand vaccine production, expanding its scale to require vaccine makers to share their clinical trial results with other companies would likely reduce disparities in access. vaccines.

Jennifer Miller, assistant professor at the Yale School of Medicine and founder of the nonprofit Bioethics International, highlighted the ethical issues surrounding these disparities.

“Populations or communities who participate in clinical research should benefit from this research,” Miller said. “This is a basic principle of research ethics and, as a corollary, the advantages and disadvantages of research should generally be shared fairly among participants. ”

The result of a recent legal battle, a dispute between Moderna and the NIH over whether NIH researchers were unfairly left out as co-inventors of a vaccine patent, also has the potential to improve the vaccine delivery to low-income countries. Winning the case could allow the NIH to “collect royalties and grant the patent to manufacturers in other countries,” especially countries that are sorely lacking in vaccine doses, according to Ramachandran.

Overall, centralizing the control of vaccine distribution under the auspices of the World Health Organization and continuously improving its programs, such as the COVAX initiative, could result in a more equitable distribution of vaccine doses. vaccine. Menon further explained that the development of more vaccine production facilities on each continent and their dispersal could potentially eliminate the logistical difficulties in vaccine delivery.

All vaccine clinical trials completed in the study were identified using the WHO COVID-19 Vaccine Tracker.