Virus, variant and vaccines

The main worry is the price of vaccines, not production, says Sunita Narain

It’s a make-or-break moment for our world. A race is on between the virus and its variants and vaccination. The speed at which the novel coronavirus is mutating means that nobody is safe until everyone is safe. According to the WHO, the world needs some 11 billion doses of vaccines and these need to reach the poorest and the remotest places as quickly as possible. Otherwise, there is a fear that the virus will spread and it will return in a mutated form and make even the protected vulnerable to the new variant.

The issue is not the vaccine, or even the ability of the world to manufacture it. As of June 2021, there are over 200 vaccine candidates in the offing — with 102 reaching the stage of clinical trial. The WHO estimates that the world will be able to manufacture some 14 billion doses by the end of 2021. China’s two vaccine makers — Sinopharm and Sinovac — plan to produce around 3 billion doses. US-headquartered Pfizer-BioNTech have ramped up capacity to 3 billion doses as have Oxford-AstraZeneca. And then there are others. So, there is no shortage per se.

The problem is related to the cost of the vaccine; it needs to be affordable for a vast number of people in the world. The going price of the vaccine is extremely opaque as companies are seeking profits wherever they can take them. The WHO does not track the price and the only sources are media reports. A review shows the price in general ranges from $2.50 to $20 per dose, with Oxford-AstraZeneca being the cheapest. Interestingly, while the EU paid $2.50 per dose, South Africa was charged $5.25. The vaccine by Sinopharm costs $15 per dose in Sri Lanka and $10 per dose in Bangladesh — in both cases the governments have placed the orders. But there are also reports that Sinopharm is selling its vaccine at $40 per dose in Argentina and that the US price for Moderna is $37.

Vaccine companies want to keep the windfall coming. The strategy for ramping up capacity is to either do so themselves — like Pfizer, which has reportedly outsourced its legacy vaccines to other companies and will manufacture the 3 billion doses in-house — or sign contracts with other facilities so that the Covid-19 vaccine supply is ramped up but prices and profits remain intact.

In all cases, the companies will control the price. Wherever they have offered discounts, as in the case of Astra-Zeneca in the EU, they say they have done so because the governments have invested in the research and development of the vaccine. But company executives have been quick to say these are “pandemic prices” and they expect the cost to increase manifold next year or the year after.

In this situation vaccine inequity is inherent and inevitable. Poor countries cannot afford the vaccine. The Indian government, which has agreed to vaccinate its 1 billion people free of cost, has placed orders for some 440 million doses (of the 2 billion it needs) at Rs 150 per dose ($2) from Serum Institute of India (Covishield) and Bharat Biotech (Covaxin). This will put a burden on India’s economy, already reeling from the pandemic losses. Yet, the country’s universal vaccine programme is within its reach because of the low cost of each dose. There is no way other countries — from Bangladesh to Cameroon — can afford to pay $10-15 per dose to vaccinate their people free of cost.

So, the way ahead has two options. One, which Germany and the UK favour, is to buy the vaccine from their companies and supply it to the WHO’s COVAX facility — set up to distribute Covid-19 vaccines worldwide. Boris Johnson, host of the recently concluded G7 Summit, has with much fanfare said his country will donate 100 million surplus vaccines — they bought in excess of their needs — of which it will dispatch 5 million by September 2021. All together with the US contributing another 500 million, the G7 has said it will provide 1 billion doses by mid-2022. This is too little, too late — cases in Africa are already on the rise.

There is also no plan on how the world will, in this strategy of buying and donating, be able to afford the cost of universal vaccination. COVAX is already facing shortages and broken promises of supply. This is where the second option of providing a temporary waiver on intellectual property rights (TRIPS) comes in. It will allow other companies to mass produce the vaccine. And, as it happened in case of HIV/AIDS drugs, the price would go down when this waiver is given. The reduced price will allow for increased availability and access. This makes the pandemic response truly global — and the vaccines a global good.

But this does mean that the “free world” has to deepen its tryst with democracy. To fight what the US president called “autocracy” in the world, it will need to show how it will reestablish the “public” in the public — currently we have dismembered the state and allowed the market to grow and believed that this will empower societies. This has not. The state-market-consuming society combine has brought things to such a pass. This is what needs to be reinvented. For Covid-19 and beyond. 

The writer is at the Centre for Science and Environment | sunita@cseindia.org | Twitter: @sunitanar