The COVID-AM blog is a partnership between the UMI 3157 iGLOBES and the Institut des Amériques, coordinated by François-Michel Le Tourneau, Deputy Director and Marion Magnan, researcher at the Institute. About the blog.
vaccine Cacophony in the americas
February 1, 2021
by François-Michel Le Tourneau, Deputy Director of iGLOBES and Senior Researcher at the French National Center for Scientific Research (CNRS)
The Americas are the continent the most hit by the COVID-19 pandemic in terms of deaths and confirmed cases. Despite the rise of European countries these past few months in these gruesome results, likely due to the start of winter, the Americas are still ahead in number of deaths, and they have been significantly impacted by the second wave. Some countries are the most bereaved in the world in absolute terms (United States, Mexico, Brazil) and in relative terms (United States, Peru, Mexico).
In this situation, vaccination is essential. Having a regional health agency (Pan American Health Organization - PAHO, a branch of the WHO) and pioneer countries in vaccine research, you would have thought the continent could have compensated for the weaknesses of the policies put in place to fight against the pandemic. Yet, that is not the case. Countries in the Americas have had no common plan of action, with an attitude of everybody for himself, highlighting the "vaccine geopolitics" which are taking shape at the global level, national selfishness and the way internal controversies are interfering with national and regional efforts.
A RUSH TO PRODUCE...
Right at the start of the pandemic, several countries have tried to mobilize their scientific arsenal to make vaccines, the only long-term solution to the coronavirus. The United States set in motion their huge pharmaceutical research and development, injecting considerable funds, especially through pre-orders. As we know, thanks to partnerships with innovative small and medium companies, two US companies, Pfizer and Moderna, were the first to propose products available on a large-scale and rapidly authorized by different public health authorities. Other US vaccines are in the process of being approved, specifically the one from Johnson & Johnson. Against this giant power, only one other country in the Americas has taken on developing its own vaccine: Cuba. Based on its tradition in tropical and epidemiological medicine, the island has two vaccines in phase 1 (Mambisa and Abdala), its goal being to vaccinate its own population in 2021. Obviously, if one of these products turns out to be effective, the country would have a crucial diplomatic and business tool, especially with the current shortage.
Other countries, with lesser means, preferred to either partner with other scientific powers in order to be able to produce vaccines, either by participating in the clinical trials in exchange for priority access to the products if they prove to be satisfactory.
For the first group, Brazil's Butantan Institute (equivalent to France's Pasteur Institute) partnered with Chinese pharmaceutical companies not only to test, but especially to produce the CoronaVac vaccines created by the Chinese company Sinovac Life Science. However, the São Paulo factory, which was supposed to start its production, will not be ready until Fall, which means the country is dependent on supplies from China (for now the Institute is making individual doses from the Chinese shipments). This is also the case for the Fiocruz, the federal institution which partnered with the company AstraZeneca. In both cases, the goal is not just to supply the national market, but also provide vaccines to other countries in the region. Brazil would then be in a position to profit from other countries' technolgoy, especially China's, for its own diplomatic and business standing (one Brazilian company is also getting ready to produce the Russian vaccine Sputnik, but this one has not been approved yet by the health regulatory agency - ANVISA). However, the very tense relationship between Jair Bolsonaro's government and the Chinese governement has complicated these perspectives. Faced with incessant criticisms of the first, the second has therefore (probablement deliberately) delayed shipments of the vaccine that was supposed to be put in vials by Brazil. This clearly spelled out who was really the owner of the vaccine... In an effort to bypass the obstacle, Brazil's federal authorities attempted to obtain doses of the British vaccine produced in India, exposing themselves to another snub with shipment delays from this new "alternative" source. In both cases, the factories which would enable Brazil to have an independent production will not be ready until Fall 2021 at best.
In the second group, a number of countries participated in trial clinics which helped quantify the effectiveness of the vaccines in different geographic, social and ethnic environments. Peru was thus a part of the Sinopharm vaccine test, as well as Johnson & Johnson's, Mexico in those of the German Curevac, the Chinese Cansino, as well as the American Johnson & Johnson...
...THE RACE TO VACCINATE
Though few countries were able to participate in the race for a new vaccine, they all need to get enough doses to immunize a significant portion of their population as quick as possible. They are finding themselves then confronted with the logistical challenge of "moving the doses all the way to the arms", involving opening vaccination centers, getting a census of people to vaccinate, determining who has priority, etc.
Here also the United States, which has several major producers in the country, are ahead of the game. Having started their campaign in November 2020, the country is vaccinating over one million people per day right now, and the Biden government hopes to double that amount - at this rate however, it will require at least six months to vaccinate a sufficient portion of the population to reach the famous herd immunity (while hoping the variants of the virus that are popping up will not put the effectiveness of the vaccines in question).
Despite the serious logistics that have been put in place, there are many bottlenecks and even if the providers seem to favor supplying the US market, most of the ground administrations are complaining of insufficient influxes to be able to work at full capacity. However, there are already over 26 million people (7.91% of the population) which have received the first dose. But Canada, despite approving the Pfizer vaccine two days before its big neighbor, is also having problems and the rate of vaccination is much slower. Barely 2.41% of the population has been vaccinated by January 28, 2021. Trying to get vaccinated at any cost, some are ready to travel to the Yukon and pretend to be local employees in order to get the precious inoculation.
Mexico, Colombia, Panama and Costa Rica have chosen to get the vaccines made in the United States to start their vaccination campaigns. However, production is too weak to be able to give them enough supplies and they know they are not a priority against clients such as the United States and the European Union. Those countries will therefore not get enough doses to cover their entire population, far from it. Also these are expensive vaccines. As the Colombian health minister summarized it for the Wall Street Journal on December 25, 2020:
“We are not Canada or the U.S., with capacity to buy several times our population’s size in vaccines,” said Fernando Ruiz, Colombia’s health minister. “We have much more modest means and have to buy wherever we can.”
Furthermore, the RNA messenger vaccines produced in the United States are not well adapted for most of the countries in the region, especially in rural and remote areas, especially in Latin America, because they require consistent super cold storage. Of note are also the issues on the legal terms of the contracts with companies such as Pfizer and Moderna. Peru has thus refused to sign a contract with Pfizer because it includes a clause exempting the manufacturer of all responsibility in case of side effects on people who will get the vaccine. Although finances partially played in on the issue - it is easier to condemn a contract clause than to admit political and financial problems, the issue is still legitimate.
VACCINE DIPLOMACY, INEQUALITIES AND INTERNAL DISORDERLINESS
For these reasons, faced with the second wave (for some the third) of Covid-19, a number of countries have turned toward China (such as Peru) or Russia (such as Argentina and Mexico) to get the vaccines. These two countries are therefore playing the "vaccine diplomacy" card as best they can and are trying in this way to compete against US influence in Latin America. Preoccupied with their self-centered politics during the Trump administration, they in fact did not try to promote their products in what has been for a long time their domain. Choosing Chinese or Russian products however is not without controversy. As a matter of fact, the effectiveness of the Chinese vaccine has in the end been less than initially announced. As for the Sputnik vaccine made by the Russian Gamaleya, all the data needed to evaluate its effectiveness still has not been published (however an article from the Lancet on 02/02 shows it is very effective). Since no manufacturer is able to supply enough doses for all the countries, everybody is using various suppliers, resorting to secondary suppliers such as Astra-Zeneca.
As seen in Table 1, the other countries in the Americas are way behind. By the end of January 2021, none have vaccinated more than 1% of their population. Surprisingly, it is Costa Rica that seems ahead, in front of Brazil and Mexico. Argentina has received, with a loud dose of publicity, its first shipment from Russia, but delays have been signaled.
What is the situation in the "little" countries, those whose smaller population or whose less developed economy does not give them much weight in negotiations with the suppliers? Guatemala and Nicaragua, for example, still haven't signed an agreement with a supplier. Most of them will probably have to lean on the WHO's COVAX initiative, which must eventually make two billion doses available to the most disadvantaged countries. Given the supply problems and the intense pressure of the most powerful nations to get first dibs, the equitable distribution of vaccines however seems rather remote. In other words, despite the good intentions of the international organizations and despite the announcement of imminent availability of 164 million doses for disadvantaged countries, these countries will probably have to wait! In this situation, we can only observe the total absence of PAHO...
Finally, there are internal controversies, specific to each country, which may have considerably hampered the implementation of vaccination policies. In the United States, though the Trump administration boasted of its huge effort to implement vaccinations, the federal government did not really take charge, which explains the delays in delivery and the differences that can be seen throughout the States. In Brazil, the political war between president Bolsonaro and the State of São Paulo's governor, João Doria, on the "Chinese vaccine" issue was totally counter-productive, enshrouding in controversy the partnership with China and delaying the federal government's orders. As mentioned above, these quarrels have also affected the relationship with China. In Peru, political instability accounts for the delay in finalizing contracts with suppliers and a late start in the vaccination campaign. Outraged by the government's lack of planning, doctors went on a hunger strike. Finally, in Mexico, overwhelmed by the pandemic, the president just allowed the States to get the vaccines directly, which augurs an everybody for himself policy, rather detrimental to national unity.
In competition with each other and divided internally, countries in the Americas have not avoided the vaccine cacophony, nor profited from cooperating with each other or from developing diplomatic and geopolitical strength which would have allowed some to have alliances with vaccine manufacturers. In this rather unflattering picture, China's role is now unavoidable and Cuba can position itself quite favorably if the country succeeds in its attempt to make a viable vaccine. President Biden will have his work cut out for him to restore US leadership on the continent.
François-Michel Le Tourneau is a senior research fellow at the French National Center for Scientific Research (CNRS), Deputy Director of the UMI iGLOBES and a member of the Institut des Amériques Scientific Committee. His work focuses on settlement and use of sparsely populated areas, especially the Brazilian Amazon. He is particularly interested in indigenous people and traditional populations and their relationships with their territory. He has authored a number of papers in national and international scientific journals (list here on HAL-SHS, here on Researchgate or here on Academia.edu).