Concern about Serum Institute vaccines deal
By Health System Improvement Forum : A healthcare worker poses with a vial of the Oxford/AstraZeneca coronavirus (COVID-19) vaccine at the Pentland Medical Practice in Currie, Scotland on January 7. — Agence France-Presse/Pool/Russell Cheyne
THE ongoing series of events made known around the world through national and international media centring around Oxford (AstraZeneca) vaccine, supposed to be supplied to Bangladesh and distributed on a priority basis to contain COVID-19, has raised some concern.
The COVID-19 pandemic has already caused the loss of hundreds of thousands of lives and disrupted the lives of billions more. Furthermore, the pandemic is causing $375 billion in losses to the global economy every month. The introduction of a vaccine along with a strict enforcement of non-pharmaceutical interventions — the use of face masks, frequent handwash and social distancing — are expected to contain the disease, reduce the loss of lives and help to get the economy on track. A global equitable access to a vaccine, particularly protecting healthcare workers and others at the most risk, is the only way to mitigate public health and economic impacts of the pandemic.
The Access to COVID-19 Tools has been established by multiple development partners and coordinated by the World Health Organisation to accelerate the development, production and an equitable access to COVID-19 test, treatment and vaccines. COVAX is one of the pillars of the Access to COVID-19 Tools and it is jointly led by the Global Alliance for Vaccine, the Coalition for Epidemic Preparedness Innovations and the World Health Organisation. Developing vaccines against COVID-19 was acknowledged as the most pressing challenge of the time and COVAX’s aim was to accelerate the development and manufacture of COVID-19 vaccines. COVAX also guarantees fair prices and every country an equitable access to the vaccine.
COVAX’s Research and Development and Manufacturing Investment Committee is a multidisciplinary group. The group, which includes industry experts, manages the allocation of funds to COVAX-funded vaccine candidate projects that accelerate vaccine development and manufacturing. A number of vaccine candidate projects, including Inovio, Moderna, CureVac, Novavax, University of Hong King, Themis/Institut Pasteur/University of Pittsburg (Merck), Clover Biopharmacuticals, and Oxford (AstraZeneca), have received financial and technical support from COVAX which enabled them to rapidly develop the COVID-19 coronavirus vaccines within a record quick time.
Oxford (AstraZeneca) received up to $384.1 million in public funding from COVAX for its COVID-19 vaccine development. This contribution was granted in two parts — an initial grant in March 2020 supporting preclinical and phase 1 testing ($1.1 million) and a subsequent payment in June 2020 supporting the technology transfer of the vaccine production to manufacturing sites ($383 million). This support was provided under strict conditions that Oxford (AstraZeneca) and its manufacturing partners must be willing to sell vaccines on a not-for-profit basis during the pandemic and accordingly, Oxford (AstraZeneca) made a public statement saying that the vaccine will be sold on a not-for-profit basis during the pandemic period.
Oxford/AstraZeneca transferred the technology to several manufacturers, including those based in Argentina, China, India, Japan, Mexico, South Korea, and Russia. The Serum Institute of India is the contract vaccine manufacturer in India where COVAX-supported technology was transferred by Oxford (AstraZeneca). Notwithstanding, the government of India is not a party to this contract manufacturing arrangement.
On November 25, all major national daily newspapers in Bangladesh announced that it would receive 68 million doses of the COVID-19 vaccine from Gavi the Vaccine Alliance under a global arrangement of the COVAX facility within 2021. The cost for each shot of the vaccine under this arrangement has been estimated at $1.62–2. However, Bangladesh has signed a deal with the Serum Institute to buy an additional 30 million doses of the vaccine at more than double the COVAX price — at $5 a dose.
Beximco Pharmaceuticals Limited, a private pharmaceutical company registered in Bangladesh, became the sole distributor of the Oxford (AstraZeneca) vaccine in Bangladesh. They entered into a memorandum of understanding as a sole source supplier and distributor of 30 million doses of the Oxford University/AstraZeneca SARS-CoV-2 vaccine where the Bangladesh government became a co-signatory. We believe that this is contrary to the earlier statement publicly announced by COVAX that any vaccine that was developed through financial and technical support from its research and development facility will be treated as a global public good and not be overtly commercialised.
Like any other COVID-19-hit countries, Bangladesh is in a desperate need of vaccines. While COVAX is committed to supplying 20 per cent of the total required doses for its entire 164 million population, the government of Bangladesh bilaterally needs to explore other options to ensure that a maximum of its vulnerable population is vaccinated within the shortest possible time. However, the sole distributorship of Beximco Pharmaceuticals from the Serum Institute and the memorandum with the Bangladesh government lead to several questions. First, is not it a breach of the earlier declaration that all vaccines developed and manufactured with support from the COVAX’s Research and Development and Manufacturing Investment Committee, including the Oxford/AstraZeneca vaccine, are global public good and all countries will access them on a not-for-profit basis? Second, COVAX’s goal is to ensure an equitable distribution of the vaccines at the minimum cost. Now, how ethical is it for the Serum Institute to offer Beximco Pharmaceuticals the exclusive right to procure and distribute the vaccine in Bangladesh? Third, and the foremost, while a dose of the Serum Institute vaccine is sold locally at $2, at what consideration the same is sold to the Bangladesh government for about $5 a dose? How ethical is this price disparity amidst a global pandemic?
Bangladesh has observed countless cases of corruption and mismanagement in procuring and distributing personal protective equipment and medical consumables, supplies and equipment to support COVID-19 testing, screening and treatment. In a country where around 74 per cent of medical expenses are paid out of people’s pocket, each case of the corruption cases builds additional pressure on people’s financial sufferings and ultimately it is millions of poor who shoulder all sorts of catastrophic shocks. With the roll-out of the COVID-19 vaccine, Bangladesh is walking towards the same path which is paved with uncertainty, inequity, deprivation, and suffering. The degree of uncertainty surfaces further after India’s latest declaration on the export ban on the COVID-19 vaccine although it was affirmed on January 5 that India’s highest leadership is committed to delivering vaccines to Bangladesh as assured.
Health System Improvement Forum is an online platform of professionals dedicated to protect people’s health and health systems in Bangladesh.
