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Closing the gap: A question of access behind the vaccine race

The search for life-saving treatment is becoming increasingly intertwined with sociopolitical realities. The launch of Sputnik V, a Russian COVID-19 vaccine candidate whose name is a callback to the Soviet-era satellite, has become a symbol for what some—not least billionaire-philanthropist Bill Gates—have called the “vaccine race”. 

Yet, as some vaccine candidates begin Phase III of their trials, the Harvard Business Review warned of a growing trend within nations to splinter off and produce their own vaccine, prioritizing their own citizens rather than forming a collective push with other nations. The United States (US), the United Kingdom (UK), Russia, China, India, and South Korea are just some of the countries developing their own COVID-19 vaccines.

With this “my nation first” approach, however, a dilemma starts to take shape: who gets the vaccine first—and how?

Free and fair market?

In resolving the question of distributing the vaccine, a market-based approach appears to present a possible solution. Instead of sinking significant government funding into vaccine production, private corporations are instead encouraged to develop their own vaccines to sell at the market for a profit and incentivize further production. 

In its Global Vaccine Market Report, the World Health Organization (WHO) tagged high-income countries—which include the US, the UK, and South Korea—as the biggest drivers of the vaccine market’s value. These countries pay the highest vaccine prices, but in turn, provide the largest funding for developing new ones.

But the idea is not without its shortfalls. Last June 30, US health officials announced that the country had bought 500,000 doses of Remdesivir, a drug used as medication for COVID-19 but whose effectiveness is disputed by health experts, citing limited clinical trials. The US order, however, takes up the entire production for July and 90 percent for August and September of Gilead Sciences, the manufacturer of the drug, leaving little stock for other buyers.

Renz Calub, a lecturer from the DLSU School of Economics whose research work includes health economics, warns that entrusting vaccine supply and distribution entirely to market mechanisms will not ensure the vaccine availability for the general public. While market competition may speed up the creation of a vaccine and push down production, higher prices may put the vaccine out of reach of many citizens, he warns.

Instead of leaving vaccine development entirely to a market-based strategy, Calub points out that partnerships between countries and vaccine developers is a better approach. By allocating government funding to purchase the product, and thereby offsetting the cost of vaccine development, vaccine production can be sped up without incurring losses for vaccine developers.

Such partnerships are already emerging as the preferred strategy across the globe. Last August 7, Japan agreed to buy 120 million doses of pharmaceutical company AstraZeneca’s COVID-19 vaccine, although Japan did not reveal the deal’s costs. Meanwhile, the US awarded USD 1.53-billion to biotechnology company Moderna for early access to its completed vaccine.

For countries without deep pockets, the international COVAX Facility presents another alternative. Led jointly by the WHO, the Coalition for Epidemic Preparedness Innovations, and international vaccine alliance GAVI, the mechanism aims to raise a total of USD 2-billion from partner states to guarantee purchases from manufacturers, in turn, allowing them to scale up production and push prices down. Already, 165 countries, mostly lower-income and middle-income economies, are taking part to secure two billion doses of a vaccine.

Calub stresses that making vaccines free to the public is “the best option” to combat the spread of the virus, as it is critical “[to assure] that everyone will be covered…This entire issue of COVID-19 vaccination, to sum this up, is hinged on the idea that the benefits of protecting everyone from the disease far exceeds the cost of procurement and distribution.”

Local mandates

In the Philippines, the Department of Health (DOH) maintains the National Immunization Program (NIP). Under this scheme, the government foots the bill for procuring vaccines which are then administered to citizens for free, explains nurse Ma. Victoria Arquiza, the program manager for the NIP in the Zamboanga Peninsula, the second poorest region in the country. 

Their distribution model, moreover, prioritizes “low income” recipients, who she laments “don’t like to avail of the free vaccine,” leaving her office with no choice but to instead hand out doses to those of relatively higher income who are more likely to avail of the service. They are also looking to create demand for the product by seeking the cooperation of the civil sector and by educating and informing the public about the vaccine.

On the matter of supply, however, Arquiza maintains that not everyone will be able to receive vaccines expected to be procured by DOH because the department, as per protocol, will only select a target population. “We really have to prioritize [those] who are the most vulnerable [to the disease]; that’s how we are doing it with all the other vaccines,” she reasons.

Break in the chain

Arquiza further details problems in the chain of vaccine distribution. She explains that the regional office, after receiving supplies from the central office in Metro Manila, distributes the vaccines to the provinces and cities under its jurisdiction, who then hand over the product to the municipalities and the barangays, respectively.

This system, however, is abound with issues, according to the Zamboangeño health official. “We always receive complaints that the allocation to the municipalities and the provinces are lacking,” she shares. Further, some “very far” localities lack transport options, rendering them unable to collect stockpiles from their respective provincial offices.

She justifies that these are more of local problems. “If I am to summarize it, it’s more on allocation from the provinces to the municipalities and from the cities to the barangays because we (regional office) can’t also do the distribution, [we] cannot distribute [to] every municipality, although [for] some of the municipalities, that’s what they were asking from us.”

But even acquiring supplies from the DOH central office is not free of troubles. Arquiza imparts that they sometimes do not receive enough vaccines.

Currently, the DOH is eyeing at least a P2.4-billion budget allocation for a two-dose treatment to immunize 20 million Filipinos, totalling an order of 40 million doses. President Rodrigo Duterte repeatedly tagged China and Russia as the likeliest sources for the vaccines. “I would like to thank Russia, President [Vladimir] Putin, and China, President Xi Jinping, for offering to provide us with the vaccine as soon as it is possible for distribution to the public,” Duterte said in an address last August 17.

But even if Moscow and Beijing win the vaccine race on the world stage, little answer can be had for deep-seated problems that burden the Philippine healthcare system. The country’s current vaccine woes, for Arquiza, are likely to be encountered even in the distribution of a COVID-19 vaccine. She surmises, “We will be facing the same challenges.”

The difficulties in distributing the anti-COVID-19 shots in the domestic level and in their procurement on the international stage both pose difficulties to allowing Filipinos access to the limited resource. As the Philippines awaits being able to buy the supplies from abroad, health experts advise that government officials must not rely on the oncoming product. The Regional Director of the WHO’s Western Pacific office, Dr. Takeshi Kasai, thus urged, “We must continue to improve our response and not just hope for the vaccine.”

By Gershon De La Cruz

By Jan Emmanuel Alonzo

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