LONDON — An ambitious humanitarian project to deliver coronavirus vaccines to the world’s poorest people is facing potential shortages of money, cargo planes, refrigeration and vaccines themselves — and running into skepticism even from some of those it’s intended to help most.
In one of the biggest obstacles, rich countries have locked up most of the world’s potential vaccine supply through 2021, and the U.S. and others have refused to join the project, called Covaxe.
“The supply of vaccines is not going to be there in the near term, and the money also isn’t there,” warned Rohit Malpani, a public health consultant who previously worked for Doctors Without Borders.
Covax was conceived as a way of giving countries access to coronavirus vaccines regardless of their wealth.
It is being led by the World Health Organization, a U.N. agency; Gavi, a public-private alliance, funded in part by the Bill & Melinda Gates Foundation, which buys immunizations for 60% of the world’s children; and the Coalition for Epidemic Preparedness Innovations, or CEPI, another Gates-supported public-private collaboration.
Covax’s aim is to buy 2 billion doses by the end of 2021, though it isn’t yet clear whether the successful vaccine will require one dose or two for the world’s 7.8 billion people. Countries taking part in the project can either buy vaccines from Covax or get them for free, if needed.
One early problem that emerged: Some of the world’s wealthiest nations negotiated their own deals directly with drug companies, meaning they don’t need to participate in the endeavour at all. China, France, Germany, Russia and the U.S. don’t intend to join.
And so many rich countries bought vaccines from manufacturers — before the shots have even been approved — that they have already snapped up the majority of the vaccine supply for 2021.
The European Union has contributed 400 million euros ($469 million) to support Covax, but the 27-country bloc won’t use Covax to buy vaccines, in what some see as a vote of no-confidence in the project’s ability to deliver. Instead, the EU has signed its own deals to buy more than 1 billion doses, depriving Covax of the bulk negotiating power of buying shots for the continent.
Gavi, WHO and CEPI announced in September that countries representing two-thirds of the world’s population had joined Covax, but they acknowledged they still need about $400 million more from governments or elsewhere. Without it, according to internal documents seen by The Associated Press before the organization’s board meeting this week, Gavi can’t sign agreements to buy vaccines.
Covax did reach a major agreement this week for 200 million doses from the Indian vaccine maker Serum Institute, though the company made clear that a large portion of those will go to people in India.
By the end of next year, Gavi estimates, the project will need $5 billion more.
Covax said negotiations to secure vaccines are moving forward despite the lack of funds.
“We are working with the governments who have expressed interest earlier to ensure we receive commitment agreements in the coming days,” Gavi’s Aurelia Nguyen, managing director of Covax, said in an email. She added that nothing similar has ever been attempted in public health.
Covax “is a hugely ambitious project,” she said, “but it is the only plan on the table to end the pandemic across the world.”
Still, the project is facing doubts and questions from poor countries and activists over how it will operate and how effective it will be.
Dr. Clemens Auer, who sits on WHO’s executive board and was the EU’s lead negotiator for its vaccine deals, said there is a troubling lack of transparency about how Covax will work.
“We would have no say over the vaccines, the price, the quality, the technical platform or the risks,” Auer said. “This is totally unacceptable.”
He said WHO never consulted countries about its proposed vaccine strategy and called the health agency’s goal of vaccinating the world’s most vulnerable people before anyone else a “noble notion” but politically naive.
As part of Covax, WHO and Gavi have asked for countries to first prioritize front-line health workers, then the elderly, with the goal of vaccinating 20% of the world’s population.
One expensive hurdle is that many of the vaccine candidates need to be kept cold from factory to patient, according to internal documents from Gavi. Industry has signalled that “air freight for COVID vaccines will be a major constraint,” and a “significant and urgent ramp-up of cold chain capacity” may be needed.
Another obstacle: Many of the leading vaccine candidates require two doses. That will mean twice as many syringes, twice as much waste disposal, and the complications involved in ensuring patients in remote corners of the world receive the second dose on time and stay free of side effects.
“Because of the fact that we’re looking at trying to get vaccines out as quickly as possible, we’re looking at limited follow-up and efficacy data,” said Gian Gandhi, who runs logistics from UNICEF’s supply division in Copenhagen.
There is also concern that the fear of lawsuits could scuttle deals. According to the internal documents, Gavi told countries that drug companies will probably require assurances that they won’t face product liability claims over deaths or other side effects from the vaccine.
Dr. Nakorn Premsi, director of Thailand’s National Vaccine Institute, said officials there are reviewing whether that condition is acceptable. Thailand so far has only signed a nonbinding agreement with Covaxe.
If anything, some critics say, Gavi isn’t ambitious enough. The pandemic won’t end — and the world can’t reopen its borders — until there is herd immunity well beyond the rich nations that have secured their own doses, said Eric Friedman, a scholar of global health law at Georgetown University who is generally supportive of Covax.
“If we want to achieve herd immunity and get rid of this, 20% is not going to do it,” he said. “What’s the end game?”
Alicia Yamin, an adjunct lecturer on global health at Harvard University, said she fears the “window is closing” for Covax to prove workable. She said it is disappointing that Gavi, WHO and their partners haven’t pushed pharmaceutical companies harder on issues like intellectual property or open licenses, which might make more vaccines available.
With little evidence of such fundamental change in the global health world, Yamin said it’s likely that developing countries will have to rely on donated vaccines rather than any equitable allocation program.
“I would say that poor countries probably will not get vaccinated until 2022 or 2023,” Yamin said.
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Lori Hinnant reported from Paris.
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Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak
Maria Cheng And Lori Hinnant, The Associated Press
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
