RIO – Inequality in vaccination against Covid-19, said the director of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, is becoming “more grotesque every day”. By the end of March, according to a New York Times survey, 86% of doses applied on the planet were for rich or upper-middle-income nations. Only 0.1% of those immunized are in poor countries.
If the moral argument is not enough to convince the need for a more equal vaccination, say experts heard by GLOBO, the health risks should be. As the virus continues to circulate, the greater the chances of more contagious and resistant variants appear, they say, prolonging the pandemic even for those who are already vaccinated.
– Nobody is safe until everyone is safe. It is in the collective interest to work together – said Olivier Wouters, a professor at the London School of Economics and co-author of an article published by Lancet magazine on the challenges of equal access to the vaccine.
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Today, the contrast is reflected in the speed with which countries should be able to vaccinate 75% of their population, a level at which it is estimated that herd immunity will begin to be achieved. The United States, United Kingdom and Chile should only take three or four months. Nigeria, Rwanda and Iran will take more than a decade if they maintain their current pace. In Brazil, the estimate is one year.
It was the fear of the concentration of vaccines that made WHO, together with partner organizations, launch in April 2020 the Covax consortium. In the search for a collective solution, the initiative promises to guarantee all nations, regardless of their income, sufficient doses to inoculate 20% of their population in 2021.
“It is one of the best vehicles we have right now to guarantee at least some equal access to low-income countries,” said Chris Dickey, director of Global Public Health at New York University.
The central objective is that 92 of the world’s poorest countries have access to these doses, subsidized by donations from wealthier nations and diverse organizations. So far, the initiative has raised US $ 6 billion (R $ 34.3 billion), but it needs at least another US $ 2 billion (R $ 11.4 billion) to meet the goal.
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Covax also serves as an intermediary between laboratories and governments able to afford their own vaccines, a mediation used by about 50 nations. Larger orders would have lower costs, while nations would wait for their turn in distribution.
One hundred and ninety countries – almost all of the 193 UN members – have joined the consortium in some way, but several wealthier ones have chosen to sign contracts on their own. The strategy diminished confidence in the mechanism, and intensified the dispute for the vaccine.
“Rich countries have basically emptied the shelves by going directly to vaccine producers,” said Gavin Yamey, a professor of global health and public policy at Duke University and a member of an unpaid board that helped design the Covax.
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The dispute was further intensified by governments that invested in vaccine research and demanded priority access to distribution, such as the American and the British. Many bet on the purchase of large volumes from several laboratories in the testing phase. If any were not effective, there would be an alternative.
Canada, for example, has ensured sufficient doses to immunize its population five times, even though it now finds it difficult to receive them, either due to production delays, wrong bets or the protectionism of other countries. The same goes for the European Union, which has bought more than twice the required doses, but is fighting a battle with laboratories to gain access to shipments and speed up its vaccination campaign.
Both, however, should still be able to immunize 75% of their populations by the middle of 2022. In contrast, the forecast is that several peripheral countries will only start vaccinating on a large scale after 2023.
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Perspectives of delay
Of the more than 564 million doses that were applied on the planet until the end of March, only 6% came from Covax. The WHO says it should meet its goal of providing 2 billion doses in 2021, but so far it has only sent 32.9 million vaccines to 70 countries and territories.
“It is difficult to say whether the consortium will be able to achieve its goal in the face of competition from rich countries,” said Wouters.
The slowdown in exports from the Serum Institute, determined by the government of India to be able to increase the pace of vaccination internally, should further delay distribution by Covax. Alone, the factory signed a contract to produce up to 1.1 billion doses for the consortium between 2021 and 2022.
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For the African Union, which ordered 500 million Indian doses on its own, the delay could be “catastrophic”, according to the continent’s Centers for Disease Control and Prevention.
The imbalance between demand and supply of doses, say the experts, should be gradually reduced, with the endorsement for the use of new vaccines and the increase in manufacturing capacity. Immunizers that do not need to be frozen and that require only one dose should catalyze the process, particularly in countries with less infrastructure. Still, a mass vaccination horizon remains distant.
The issue of patents
Human rights organizations argue that part of the solution is to suspend vaccine patents. South Africa and India have taken the issue to the World Trade Organization (WTO), but have come up against the lack of support from wealthy nations, where pharmaceutical companies maintain their headquarters.
– The countries that accumulate vaccines are the same ones that block knowledge and intellectual property – said Yamey. – It is a moral disgrace that should make us disgusted.
Adherents of the measure argue that no economy or health system will return to normal without most of the planet being immunized. Without patents, he said, it would be easier to increase production capacity.
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Adherents of the measure argue that no economy or health system will return to normal without most of the planet being immunized. Without intellectual property, according to them, it would be easier to increase production capacity. Groups favorable to the breaking of patents also point out that several laboratories received massive funding from governments and social organizations. Some, like AstraZeneca and Janssen, have pledged to sell doses at cost prices. Others do not.
In the US, sections of the Democratic Party are pushing for President Joe Biden to at least endorse a easing of the restrictions, but there is strong opposition from the pharmaceutical lobby. Brazil, on the other hand, is against the idea. According to the government, the current WTO rules, which allow for the suspension of patents by each country individually, are sufficient.
However, Wouters says that breaking the patents would only be part of the solution. Producing and distributing doses, he points out, demands technology and specialized infrastructure that does not exist in many corners of the planet.
– Brazil is in a better situation due to the collaboration of Sinovac with Instituto Butantã and Fiocruz with AstraZeneca – pondered the professor.
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Even in countries where there are enough doses for everyone, the researchers point out, collective immunization faces barriers, such as the anti-vaccine movement. This is an unrestricted but particularly significant obstacle in European nations like France. According to data from Imperial College for March 30, only 40.2% of French people would get the vaccine if they could that week.
The reasons for this, Dickey believes, vary from case to case and transcend latitudes: ranging from fear to distrust in governments and laboratories, through false information. For the teacher, it is imperative that health authorities communicate especially with the most vulnerable groups:
“The misinformation surrounding the vaccine is a major obstacle,” he said. – It is necessary to give a special focus to communication with the most vulnerable and low-income communities, which have already been largely ignored.
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If minority groups are proportionately more affected by the pandemic in rich countries, inequality is also present in access to the vaccine. In England, for example, 90% of whites over 70 have already been vaccinated, against 58.8% of blacks. In 40 American states analyzed by the NGO KFF, an average of 25% of the white population has already been vaccinated. Among blacks and Latinos, the rates are 15% and 13%.
– This has nothing to do with hesitation about the vaccine. It is structural racism, without a doubt. – pondered Yamey.
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