Australia-The Elegy of a Weak Country under the "Gap between the Rich and the Poor": Only 25 doses of vaccine were allocated to the country... | Chinatown Australia

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The new crown epidemic is still circulating around the world, and the highly hoped vaccine has shifted from the research and development competition to the resource allocation dispute.Among more than ten vaccines evaluated by WHO,. . .
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The new crown epidemic is still circulating around the world, and the highly hoped vaccine has shifted from the research and development competition to the resource allocation dispute.

Among the more than ten vaccines evaluated by the WHO, one reality that we have to admit is that European and American countries hold prejudice against Chinese vaccines, whether it is political or scientific.

However, this attitude has recently loosened, starting with the European Union.

After experiencing the delayed delivery of the new crown vaccine produced in the United Kingdom and the United States due to insufficient production capacity, EU President Von der Lein was criticized by all parties for inadequate decision-making considerations on vaccine procurement, circulation and distribution.

There are not many vaccines. The 27 EU member states are waiting to be fed. Internal officials are still throwing the pot, rumors, and rumors.

Hungary can't stand it anymore. It is the first to act and has approved the procurement of Chinese vaccines.Germany may be moved, but it is still waiting and watching, waiting for EU instructions.The European Union has reservations about China’s publicly disclosed effective rates that have reached the standard, and hopes to disclose (clinical trial) data first.

In the past two months, more than a dozen countries including Thailand, Indonesia, Peru, and Egypt have purchased Chinese vaccines in batches. The President of Serbia has picked up the vaccine, and the Presidents of Turkey and Indonesia have taken the lead in vaccinating. There has been no shortage of production capacity, delayed delivery, or serious adverse reactions. News report.

As of February 2, WHO has received reports of more than 8 million confirmed cases and more than 1 million deaths worldwide. There is still no light spot in the black hole, and vaccine supply and distribution have become hot issues of the epidemic in the past two months. .

01

Contradiction between supply and demand

On January 1, WHO Director-General Tan Desai pointed out that at least 18 high-income countries have received more than 46 million doses of the new crown vaccine, and the lowest-income countries received only 3900 doses.However, according to the WHO's first-phase distribution target, the vaccines available globally have not yet reached the 25% population coverage rate.

BBC screenshot

It is necessary to understand the current supply and demand situation.The ideal situation is to achieve universal coverage of the vaccine, which is 78 billion doses.

尤其新冠疫苗很可能需要二次强化注射,这意味着全球或需要超过150亿剂疫苗。即便按照群体免疫60%~80%的阈值来估计疫苗需求量,大体也需要90~120亿剂。这还没考虑病毒变异、疫苗持续保护时长等干扰因素。

Although no new crown vaccine has passed the final assessment of the WHO, the purchase demand has already emerged.According to statistics from the Duke University Global Health Innovation Center (hereinafter referred to as "Duke Statistics"), as of January 1, the number of vaccines confirmed to be purchased worldwide reached 19 billion doses, and another 70 billion doses are under negotiation.

The countries that have purchased the largest number of vaccines are Europe, the United States, and COVAX (WHO's New Coronary Vaccine Acceleration Program), with the number exceeding 10 billion, and China ranking 14th.

The top three with the strongest purchase intentions are the United States, Europe, and COVAX, with more than 18 billion doses.Although India has purchased less than 1 million doses, the potential purchase volume exceeds 10 billion doses.

Pre-market commitments to purchase new crown vaccines in each economy

The high purchasing desires of the United States, Europe, and India are not difficult to understand. The three places are the top 3 of the world’s cumulative confirmed cases of the new crown virus. The United States has confirmed 1300 million cases. The figures in Europe and India are 1200 million and 1000 million, respectively. In all regions, the fatality rate exceeded 1%.

But the supply is far behind the procurement demand.

According to Duke statistics, the confirmed demand for the new crown vaccine is 122 billion.Pfizer claims that it can produce 2021 billion doses in 13, Moderna’s goal is 5 million, and Johnson & Johnson promises to supply 1 million doses to the United States; the chairman of China National Pharmaceutical Group has given an annual output of 10 billion doses, while Kexing’s figure is 5 million; Oxford-AstraZeneca stated that 2021 million doses of vaccine will be prepared in the first quarter of 7, with an annual output of 30 billion doses.These add up to just over half, and it is difficult to achieve one step.

Not only that, two months ago, Pfizer cut the 2020 new crown vaccine production, from the previously claimed 1 million doses, halved to 5000 million doses. One month ago, at least 8 European countries were released with pigeons and delayed delivery.AstraZeneca also missed the appointment, reducing its output from 2020 million doses before September 9 to 3000 million doses, leaving only 400%.

EU officials say that AstraZeneca has cancelled the meeting on vaccine supply, and AstraZeneca has denied this

Countries that have been delayed in delivery are naturally unhappy. Italy's Minister of Regional Affairs Francesco claimed that Pfizer will be sued for delayed delivery of the vaccine.

The explanation given by a Pfizer spokesperson is: "Expanding the raw material supply chain took longer than expected."

The insufficient supply of vaccine bottles once became a "stuck neck" problem that attracted much attention. In July 2020, Zhang Wenhong mentioned: “The production of glass bottles containing vaccines is more difficult than vaccines.” One of the reasons is that the medium borosilicate glass used in vaccine bottles is expensive, difficult to process, and capable. There are few vendors.

German SCHOTT is a well-known company that produces medicinal bottles. In June last year, its company website stated that it would provide vials that can hold up to 6 billion doses of vaccine to support the global fight against COVID-20. There are difficulties in delivery, but in order to absorb the increased orders, it still takes a lot of time to negotiate with US and German state officials on the production location.A Swiss manufacturer also extended workers’ working hours, which is evident in the tight supply of raw materials.

Although a number of promising vaccines have not yet ended their Phase III clinical trials, the vaccine competition has entered the second half ahead of schedule. The new phase is focused on production capacity and supply chain management.

02

How to distribute

Vaccines are in short supply, and resource allocation is naturally the focus.

As mentioned earlier, the United States and Europe account for the absolute majority of vaccine purchases.Globally, according to income levels, the number of confirmed purchases of vaccines shows a clear uneven distribution.

According to Duke's statistics, high-income countries have nearly 42 billion doses of vaccines, 11 billion doses in upper-middle-income countries, 4.11 million doses in low-middle-income countries, and 2.7 million doses in low- and middle-income countries.The most exaggerated is Canada, which has purchased a dose of five times the population of the vaccine.

On January 1, the WHO announced that COVAX is expected to deliver at least 22 billion doses by the end of 2021, including the participation in the vaccine alliance (Gavi COVAX
AMC) provides at least 92 billion doses in 13 low-income economies.However, this number is still a huge gap compared to the US with a population of 3 million, which has a total of 26 billion vaccines (including purchases in negotiations).

Professor Zha Daojiong of the School of International Relations of Peking University has long been concerned about issues in non-traditional security fields such as public health in Sino-foreign relations. He told reporter Nan Fengchuang: "It is not that Europe and the United States have the greatest demand, but that he has the most ability to pay. Strong."

Part of the reason why the United States can obtain so many vaccines is due to government funding.According to a report in the New York Times 3 months ago, Moderna has received a commitment of US$9.55 million from the US Government’s Biomedical Advanced Research and Development Administration for the development of its vaccines. The US has pledged to spend US$15.25 billion on the purchase. 1 million doses.

Although Pfizer has not received any funds from the US government to develop or test vaccines.However, Operation Warp
Speed ​​(a public-private partnership initiated by the U.S. government to promote the development, manufacturing and distribution of new crown vaccines and pharmaceuticals) has pledged to provide Pfizer with $19.5 billion worth of drugs to provide 1 million doses of vaccines.

But economically backward countries, objectively do not have such strong financial strength to support R&D and sweeping goods.

Combining the analysis of Duke's statistics, for a single country, it is to be prepared to have as many vaccines as possible, and there is indeed a risk that some pre-purchased vaccines will fail or fail to be approved for marketing, but when the total vaccine resources are scarce The fact that high-income countries spend heavily to scramble for goods, and that countries with more backward economies are forced to be exposed to higher risks have also raised concerns.

WHO Director-General Tedros Adhanom Ghebreyesus described the disparity in distribution as a "catastrophic moral failure."He said: "It is wrong for young, healthy adults in rich countries to be vaccinated before health workers and elderly people in poor countries."

WHO wants to play a coordinating role.

In June 2020, the World Health Organization proposed the title "COVAX
Facility’s new crown vaccine plan to promote the distribution and accessibility of vaccines. The WHO’s distribution concept is not based on the actual contributions of countries to vaccine development and production, but aims to distribute vaccines in proportion to the output and population regardless of income level. , To ensure that all countries and regions, especially low- and middle-income countries, get the vaccines they need quickly.

In the first phase of distribution, COVAX will provide vaccines to participating countries at the same time until they can cover about 20% of the population of each country.The first goal is to provide 2021 billion doses of vaccines to participating countries by the end of 20 to protect high-risk populations around the world, with first-line medical workers and elderly people over 65 years old as the top priority.

COVAX's consideration of distribution is based on the public nature of the vaccine, but it should also be noted that this does not mean providing it for free.Zha Daojiong believes: "The ideal vaccine distribution should ensure fair access to users without damaging the interests and enthusiasm of producers, and maintain the public goods attributes of global health." In other words, it should be available to low- and middle-income countries. , Affordable, and at the same time, vaccine manufacturers need to recover costs and also need profit incentives, which involve sales prices and supply.

Zha Daojiong once pointed out that in the field of vaccines, three types of supply and marketing mechanisms are mainly used internationally: the first is market procurement, where the supply and demand sides negotiate; the second is subsidized sales, where the manufacturer sells the vaccine to an intermediary agency and then Intermediary agencies distribute and sell; the third is free assistance. COVAX has the nature of subsidized sales to participating low- and middle-income countries.

The aforementioned New York Times report revealed that the price of vaccine supplied by Pfizer to the U.S. government was US$19.5 per dose. After the US government injected US$25 billion, Modena charges US$24.8 per dose for its purchases, and will charge other governments. 32 to 37 dollars.The international price of China's vaccine has not been disclosed by any authority. The reference domestic price is 200 yuan/dose.

COVAX’s interpretation document states that an investment plan with a total investment of US$62 billion has been formulated to cover the down payment, inventory and reservation fees, expansion of production scale, and technology transfer for 20 billion doses of pre-purchased vaccine orders. The average dose is US$3.1 or US$6.2 per person (2 doses).Through procurement commitments, countries that join COVAX need to pay a lower upfront payment, that is, US$1.6/dose or US$3.2/person, and provide financial guarantees of US$8.95/dose or US$17.9/person, and a single dose is about US$10.

Countries that join COVAX need to pay a lower upfront payment

It can be seen that the vaccine price of COVAX is lower than the aforementioned market purchase price of the US government from Pfizer and others.This makes vaccines relatively affordable in low- and middle-income countries.

Zha Daojiong told reporters from Nanfengchuang: "The price difference between the middle (and the cost) depends on economically developed countries, or international charitable organizations, corporate donations to make up... (COVAX) it (also) is a sales fundraising mechanism, not a charity organization."

Zha Daojiong summed up the three principles of COVAX in vaccine distribution to reporters: First, the vaccine price cannot be capped, it should be a meager profit; second, advance deposit to ensure vaccine production and sales; third, subsidize low- and middle-income countries. "In this way, all parties have input, and the poorest and weakest people can get the vaccine at the same time."

03

Viruses know no borders

North America and Europe mainly rely on vaccine manufacturers in the region, Southeast Asia relies on India for vaccine supply. India has the world's largest vaccine production company-the Indian Serum Institute, and the global vaccine trade pattern shows regional characteristics.

However, in the specific context of the global spread of the new crown and the lack of specific medicines, countries have high hopes for the vaccine to accelerate the end of the epidemic. Supply pressure has risen sharply, and there is limited room for regional supply efficiency. On the contrary, multilateral cooperation is more conducive to pressure relief and risk reduction. Zha Daojiong described it as "everyone gathers firewood with high flames."

In October last year, Chinese officials announced that they would join the COVAX program. Zha Daojiong analyzed that by allowing China to participate in collective procurement negotiations as a supplier, it can save manpower and material resources and reduce the probability of being kidnapped by some countries or geopolitical relations; it can also be used. COVAX is a mature supplier channel for vaccine transportation and inoculation; in its supporting mechanism, it also helps resolve disputes and help Chinese vaccines go overseas; it can also cope with the shortage of domestic self-produced vaccines in case.

On February 2, the Chinese Ministry of Foreign Affairs stated that China will provide 3 million doses of vaccine to the "New Coronary Pneumonia Vaccine Implementation Plan" (also known as COVAX), mainly for urgent needs in developing countries.However, before this, the Chinese vaccine still needs to obtain an emergency use authorization from the WHO.

When discussing how Chinese vaccines have become international public health goods, Zha Daojiong said: The safety and effectiveness of Chinese new vaccines must be internationally recognized.Passing the WHO prequalification is necessary but not sufficient.The technical "safety" of a new crown vaccine is not directly equivalent to the patient's "rest assured".Specific steps such as overseas clinical trials, approval and certification, vaccine storage, logistics, and vaccination training need to be low-key and pragmatic.Choose a multilateral platform in the promotion strategy to share experience and share risks.

Since the global response to the new crown epidemic, geopolitical interference has been obvious to all.In the field of vaccines, prejudice based on vaccine nationality also risks evolving into vaccine nationalism.Viruses know no borders, and a consensus should be clear. The earlier and more vaccinations, the sooner you can get rid of the predicament that the epidemic is dragging the economy.

On January 1, the Ministry of Foreign Affairs announced that the new crown vaccine developed by Sinopharm, Kexing, and Cansino Biotechnology has applied to join COVAX.Zha Daojiong told reporters from Nanfengchuang: "Put the vaccine into the COVAX pool. The quality has been certified by the World Health Organization. In terms of effectiveness, safety, and cost-effectiveness, it has reference to other countries and will face international doubts. It’s smaller, and the need for door-to-door negotiations proves that... the path of multilateralism is far more effective than vaccine nationalism for China's vaccines to the world."

COVAX is a path of multilateralism. However, the procurement of vaccines in various countries is still based on comprehensive considerations of safety, effectiveness, accessibility and affordability. Although China's vaccines are not top-notch in effectiveness, there are few adverse reactions reported, and The difficulty of storage and transportation is small, the circulation cost is dominant, and the production capacity is still sufficient.

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