Nepal | September 22, 2020

Are we thinking about COVID-19 vaccines yet?

Kiran Raj Pandey
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It is now clear that for Nepal, like every other country, vaccines are going to have a crucial role in getting rid of the COVID-19 pandemic. What are we doing to source a vaccine when it becomes available? 

Many countries understand that every month’s delay in deploying vaccines for COVID-19 will compound the suffering the disease has already caused, not to mention the damage to livelihoods and economies. And hence, they are scurrying to get vaccines as early as possible. We haven’t done so in Nepal yet. This is the time to start doing it. 

Needless to say, this argument assumes that vaccine developers will distribute a vaccine only when it’s deemed safe and effective. The farthest ahead on the global vaccine development and testing race is a partnership between the University of Oxford and the British company AstraZeneca with their vaccine candidate AZD1222. China’s Sinovac, and America’s Moderna are also in the late stages of testing. And rich countries are out on a limb to lay claims on this bounty. 

On May 21 this year, Operation Warp Speed, a United States government vaccine initiative, announced a $1.2 billion grant to AstraZeneca to conduct clinical trials on AZD1222. In return, the company agreed to provide the US government with 300 million doses of the vaccine on a preferential basis. The American government has made similarly large investments and pre-orders with several other vaccine companies, including Moderna, Pfizer/ BioNTech and Novavax.

And the Americans aren’t the only ones in the vaccine rush. The British Government has secured an advanced commitment for 100 million doses of AZD1222 with AstraZeneca. Not to be left behind, the European Union’s Inclusive Vaccine Alliance (IVA) has already secured contracts for the supply of 400 million doses of the vaccine. AstraZeneca has claimed to have secured manufacturing capacity for two billion doses of vaccines, out of which almost a billion have already been spoken for on behalf of the billion or so people that live in rich countries. No wonder then that “vaccine nationalism” has entered our lexicon.

Many other countries are also making arrangements either through their own vaccines or through ones that are being developed by others. The Chinese have several vaccine candidates they are developing, including ones by SinoVac, CanSino and SinoPharm. The Koreans and the Japanese also have vaccines under development. Several countries are also looking to secure and scale up vaccine manufacturing — India being at the centre of such global efforts. India may also be Nepal’s most realistic source of COVID-19 vaccines.

Even before COVID-19 pandemic, India was already the largest manufacturer of vaccines in the world. Its generic vaccine manufacturers, including the Serum Institute of India (SII) and Bharath Biotech, produce most of the vaccines that are used in the developing world including Nepal. In fact, SII, the world’s largest vaccine manufacturer by volume, makes about 1.5 billion doses of vaccines per year. Its vaccines are used by more than half the children around the world. And India’s companies are aiming to do the same with COVID-19 vaccines.

Of AstraZeneca’s two billion dose vaccine manufacturing capacity, one billion doses are going to be manufactured by SII in India. Both AstraZeneca and SII have said that these one billion doses will be for use in the developing world, and that SII will sell these doses at the cost of manufacture. In addition, the company has said that half of its vaccines will be used in India, while the other half will be supplied to the rest of the developing world. It is this tranche of 500 million doses that Nepal should be eyeing for.

Early indications are that AZD1222 may be as efficacious, if not more, as any other vaccine under development. In anticipation of successful clinical trials of AZD1222, SII has already started manufacturing the vaccine. Should the trials prove that this vaccine works, it will have about 400 million doses of vaccine ready to ship by the end of the year. Health ministers and leaders from around the world have been making a beeline for SII’s vaccines. SII is a private family-held company led by Adar Poonawalla, the scion of the company’s founder Cyrus Poonawalla. Nepal should be exploring ways to secure an early consignment of SII’s vaccines. After all, it’s in India’s best interest to help Nepal out — the 2,000 kilometre open border between the two countries means that no epidemic control will be achieved in India unless it can be controlled in Nepal.

There are other vaccines that might be available within the next 6-12 months. Like AZD1222, SinoVac, CanSino and Moderna’s vaccines have also entered the final phase of testing that they expect to complete in the next few months. China has promised that any Chinese vaccine will be treated as a global public good, but it is not clear how China wants to charge for its vaccines. Moderna has indicated that a course of its vaccines will cost about $60, an astronomical price for a country like Nepal. In comparison, based on media reports, SII’s vaccine may cost anywhere between $2-$15. At $2 a dose, Nepal could initially vaccinate the 5 million or so Nepali people at a high risk of infection out of its own resources.

To be fair, there are ongoing global efforts to make sure that the entire world has access to these vaccines. A global initiative called COVAX, backed by the global vaccine alliance GAVI, the World Health Organisation and the Coalition for Epidemic Preparedness Innovations (CEPI), aims to make sure people all over the world have fair and equitable access to COVID-19 vaccines. So far it has only managed to commit about 300 million doses of COVID-19 vaccines for the 6 billion people in the developing world.

Our vaccination and immunisation programmes have benefitted from the generosity of partnerships like the GAVI before, but this time around we may want to go a step ahead and make arrangements of our own. Waiting in line is fine, but it looks like that is not how everybody else is playing the game right now. 

Kiran Raj Pandey is a physician and a researcher. He is the author of Up Is The Curve — A genealogy of healthcare in the developing world.  

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