UN’s slow COVID-19 vaccine rollout raises equity concerns in Latin America, Caribbean

Governments across Latin America and the Caribbean eagerly signed up for access to COVID-19 vaccines through a United Nations-backed alliance created last year to ensure poor countries across the world aren’t left behind.

But as wealthy nations begin massive inoculation campaigns, political leaders and citizens in one of the world’s hardest-hit regions are growing impatient. No vaccines have been delivered yet through the COVAX Facility, only one manufacturer has been authorized and a limited supply of doses secured.

Concerned that they are lagging behind in the global race to to control the pandemic, some nations are making their own arrangements with pharmaceutical companies as infections and deaths continue to rise, political pressure mounts and worry grows that while richer countries are getting access, less developed ones must wait.

“The whole issue of equity and solidarity seems not to play any role in the manner in which this vaccine has been rolled out,” said Molwyn Joseph, Antigua and Barbuda’s health minister. “It’s very, very disconcerting.”

The Caribbean nation paid $400,000 to get 20,000 vaccines for 10,000 citizens through COVAX. Still recovering from 2017’s devastating Hurricane Irma, the twin-island nation decided to go with the initiative not just to ensure access, but also because it doesn’t have the ability to evaluate vaccines on its own.

The latest projections indicate Antigua and Barbuda will get just 3% of its allotment when the initial shots go out, enough to inoculate 300 people with two doses.

“It’s frustrating and it points to the historic type of treatment that Caribbean countries have received for decades,” Joseph said. “We were hoping we would get over that type of practice in the world today, and as I speak now, I cannot say with any level of certainty that Antigua and Barbuda will get vaccines at a particular time.”

Frustration grows as virus toll mounts

The virus has pummeled the hemisphere, leaving over 1 million dead, more than half from Latin America and the Caribbean. In the past week, over 1.8 million new COVID-19 infections were recorded in the Americas, as well as 47,000 deaths. Months of strict lockdowns and closed borders in many countries didn’t stop the virus from surging. Economies have been crippled and scores have been thrown deeper into poverty.

Countries in Latin America and the Caribbean account for one-fifth of all of the participants in COVAX, which is backed by the U.N. and Geneva-based GAVI vaccine alliance. Proponents assert it is the best way for low-income countries to get access to vaccines that they wouldn’t obtain negotiating on their own.

On the free market, vaccines can cost up to $30 a dose, but through the initiative, the price averages out to $10 each, PAHO’s lead expert on the facility said this week.

But the slow rollout has countries looking for alternatives. Eight countries in Latin America and the Caribbean have requested financing support from the Inter-American Development Bank, which in December announced that it had mobilized $1 billion to help countries in the region acquire and distribute COVID-19 vaccines.

“There are countries that were depending on COVAX, like Colombia for example, and they quickly realized that COVAX was going to take much longer than expected, and that is why it signed bilateral agreements,” said Antonio Pratto, the former president of the International Federation of Pharmaceutical Manufacturers and Associates of Peru.

Colombia isn’t alone. Peru recently reached an agreement with China for 38 million doses of its Sinopharm vaccine. Last month Bolivia, announced that it was negotiating a deal with India’s Serum Institute to obtain 5 million doses of AstraZeneca, the Oxford University-produced vaccine. And on Tuesday, Jamaica’s health minister, Christopher Tufton, said officials are in talks with five countries, including China and Cuba, about obtaining vaccines directly from them. They are also seeking vaccines from the Caribbean Public Health Agency, which has been an allotted doses for the 15-member Caribbean Community, CARICOM.

“Our commitment has been to explore other options for vaccines outside of the COVAX facility,” Tufton said, adding that he wants to ensure as many Jamaicans are vaccinated as possible. “This will help to slow the spread of the disease and reduce the severity of illness for the vulnerable.”

Jamaica, which has seen a gradual increase in infections in the last several days, is slated to receive between 146,400 and 249,600 doses of the AstraZeneca vaccine by mid-to-late February through COVAX, Tufton said. The amount would cover up to 125,000 Jamaicans, or about 4.2% of the population.

While a start, it isn’t enough. Jamaica is one of the harder-hit Caribbean nations after initially keeping the virus at bay. A total of 15,973 people have tested positive since COVID-19 was first confirmed in the country in March, and 353 have died.

Slow vaccine rollout complicates halting virus

PAHO has said the Americas region will need to inoculate approximately 300 million people to control the virus. Others like Carlos Espinal, director of the Global Health Consortium at Florida International University, say the amount needed to halt spread is even higher— upward of 500 million.

COVAX will only provide access to 20% of the population for each country. That means countries will need to buy their own vaccines to put a stop to the virus.

“The slow rollout could have a negative impact in controlling the SARS-CoV-2 in the region,” Espinal said.

Last week, public officials with PAHO gave a grim forecast on how soon the 36 countries and territories in the Americas region that are part of the COVAX Facility could see the first doses of a vaccine. Officials said March, a forecast that was also shared with representatives of countries during a briefing at the Organization of American States.

Following the report, Antigua and Barbuda’s representative, Sir Ronald Sanders, called for the “urgent and equitable” release of vaccines, describing PAHO’s report as “chilling.”

“The situation is extremely troubling,” Sanders said during the meeting, as he detailed the decimating financial and economic toll the global pandemic has had on his tourism-dependent nation in the eastern Caribbean.

Though Antigua only has 70 active cases and seven deaths, the pandemic has caused an 18% decline in the economy. Like most countries in the region, it was forced to close its borders early on, and has struggled since to reopen, like most tourism-dependent nations.

“We have neither the financial resources, nor the capacity to continue this desperate fight unless there is some relief. We are running out of resources,” Sanders said. “Unlike developed countries, our central banks cannot print money to provide relief and stimulus; we cannot give the unemployed a salary check for money we do not have, therefore…we need vaccines.”

Two days after Sanders’ statement and the PAHO meeting, COVAX informed the 119 countries worldwide participating in its alliance that the timeline had sped up somewhat, with the first doses expected for delivery by the end of this month. While Peru, Bolivia, El Salvador and Colombia are among 18 countries that will receive doses of the Pfizer/BioNTech vaccine, most countries will be receiving AstraZeneca’s inoculation, developed by the University of Oxford in the United Kingdom.

According to COVAX, an estimated 35.3 million doses will arrive in the Americas in this first stage.

Nearly all of the doses for the initial-phase rollout are expected to come from AstraZeneca, because the British-Swedish drugmaker’s vaccine can be stored at normal refrigeration temperatures. U.S.-based Pfizer and German-Partner BioNTech’s vaccine requires ultra-cold storage which many countries cannot accommodate.

Pfizer has offered 1 million doses of its vaccine for immediate deployment, but PAHO is still trying to get an agreement on the delivery of the other 39 million doses for the second quarter, said PAHO Assistant Director Dr. Jarbas Barbosa.

Trials have shown the vaccine has less efficacy than others authorized for us, and there is limited data on its efficacy in people who are older than 65.

Barbosa acknowledged that PAHO does not yet have a final date for when vaccines will arrive in any country in the region. Pfizer/BioNTech is the only manufacturer that has been authorized by the WHO. AstraZeneca is in the final stages of the review for an early WHO qualification for emergency use.

PAHO’s acquisition of vaccines for the Americas involves “very complex logistics,” he said.

“In today’s world, with flight cancellations, it’s difficult moving supply from one country to another,” Barbosa said. “That poses important challenges. And this is very complex, but we are ready.”

The letter from the COVAX Facility to countries last Friday, he said, was to provide an estimate for the first half of the year so they could adjust their plans and prepare.

Antigua and Barbuda’s health minister said the vaccine should have already been in the region.

Whether intended or not, he said, the slow rollout has sent the message that people’s lives are being elevated in importance based on their social and economic status.

“This is a perfect opportunity for world powers to show that they have respect for poor nations and they embrace the concept of equity, and they’re failing,” Joseph said. “The international institutions are failing to turn around that perception, which is now a reality.”

PAHO: COVAX is still region’s best shot

PAHO Director Dr. Carissa Etienne, who is from the eastern Caribbean island of Dominica, said equitable access and distribution remain a top priority.

“The truth is many smaller countries would not have been able to access any vaccines in the short term, in any serious quantity, without a mechanism like COVAX,” she said.

While recognizing governments’ frustrations over the slow rollout, Etienne noted that the COVID-19 vaccine has been developed and deployed at record speed. When the HIN1 swine flu pandemic hit the Caribbean and Central America in 2009, Etienne said it took 10 months after a vaccine was developed for shots to reach the region.

“They are under political pressure, they are under growing social demands for a vaccine, and that’s driving our governments to make decisions and demand vaccines at a faster rate,” she said. “The truth is that doses are very limited and they’re going to remain in short supply everywhere.”

Vaccine supplies are expected to steadily increase, with some 218 million COVID-19 vaccine doses slated to arrive in the Americas, including the Caribbean, by the end of 2021. But as of now they are in short supply. Etienne stood by COVAX as the most promising way forward.

“We believe it offers our region the best opportunity to fast track the access to COVID-19 vaccinesand at the same time reduce the impact of the pandemic on peoples’ lives,” she said.

While countries are free to make their own bilateral agreements with vaccine manufactures, Etienne said it does have an effect on the COVAX facility.

“We are less able to negotiate lower prices,” she said.

PAHO, she said, will continue to work with member states to ensure they are able to receive, store and administer vaccines. The organization’s revolving fund also will be purchasing vaccines for member states, as well as purchase syringes and needles.

“We have to manage the anxiety,” she said, “Even in countries like the United States of America, they are not getting the quantities that they expected to get and so we need to anticipate that vaccines will be provided over a period of time.”

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