The 51st Union Conference on Lung Health: Race to secure COVID-19 vaccine doses leaves most countries behind

The United States is lagging behind other high-income countries in cutting deals with COVID-19 vaccine developers for doses of vaccine per capita, scientists at the 51^st Union World Conference on Lung Health showed. With 48 candidate vaccines currently in human clinical trials globally, countries and multilateral organizations are in a race to secure enough doses of candidate vaccine before approval, scientists said. Saying this race is driving “vaccine nationalism," scientists noted that “vaccine multilateralism” is what is needed to ensure equitable access that will eventually control the pandemic.

While the U.S. currently has deals with six companies with candidate vaccines in Phase II or III clinical trials – comparable to other high-income countries -- the U.S. has secured far fewer doses per capita than other countries, despite having a much higher rate of coronavirus infection. While Canada has reported 212,000 cases -- a fraction of total reported cases in the U.S. -- that country has secured more doses per capita than the U.S, along with the United Kingdom, Japan and the European Union, Dr. Suerie Moon of the Graduate Institute of International and Development Studies showed in a presentation.

Based on publicly available data, Dr. Moon and colleagues estimate that the U.S. has secured 100 million doses of Moderna’s vaccine candidate, which will likely require two doses per person to be effective, along with 100 million doses of several other candidates which are also likely to require more than one dose for protection. The U.S. has struck deals to acquire a total of 800 million doses from six companies, compared to 900 million doses acquired by the European Union from three companies.

Middle-income countries, particularly those with manufacturing capacity, have made notable strides in striking deals as well. India has secured 1 billion doses of the candidate vaccine from AstraZeneca and Oxford, locking up one-third of the company’s manufacturing capacity. Brazil has locked up 100 million doses of the Oxford candidate, while Mexico and Argentina have jointly secured 150 million doses.

While a handful of high- and middle-income countries have secured access to potential vaccines, the rest of the world is getting left behind. Thus far a very small proportion of global supply has been allocated to COVAX, the vaccine procurement arm of the World Health Organization’s Access to COVID-19 Tools Accelerator. COVAX -- led by the WHO, Gavi the Vaccine Alliance and the Coalition for Epidemic Preparedness Innovations – has firm commitments from 171 countries to participate, making up about 90 percent of global population.

“The idea is to pool risks and divide up the piece of the pie they get access to in an equitable way,” Dr. Moon said. “It offers a channel to subsidize lower-income countries that might not be able to cover the full costs of vaccines. The key question is, how big of a slice of the global supply is for COVAX?”

So far, COVAX has secured 300 million doses of the AstraZeneca/Oxford candidate, a fraction of the target of 2 billion doses. However, millions of doses across candidates have yet to be allocated, Dr. Moon said, leaving the question of how many of those doses will be available to COVAX versus to countries with greater capacity to pay or greater political influence.

“If we want equitable access, we have to agree to divide up the global pie in a manner that is transparent and based on ethical and public health principles,” she said. But now is also the time to start thinking about how to enlarge the pie, she added, which can be done through technology transfers, sharing intellectual property and know-how and increasing investments. “The larger we can make the pie, the easier it will be to agree on how to divide it.”