The virologist Margarita del Val, from the Severo Ochoa Molecular Biology Center (CBMSO-CSIC-UAM), is one of the expert voices that has been heard the most since the current pandemic began. He says that from the beginning he has insisted that we needed a more global vision of the world situation. But the message was always overshadowed by the most urgent and immediate news.
Now that COVAX – the international initiative to ensure that all countries have prompt and equitable access to COVID-19 vaccines, regardless of income level – is about to begin distributing its first doses, it is time to talk in depth with Del Val about all that it involves.
Why is the COVAX initiative so important?
It is the only way for countries without resources to have the necessary support to receive sufficient doses of vaccines, to administer them and, in the longer term, to be self-sufficient and carry out their own vaccination campaigns. COVAX is the heir to GAVI, the Global Alliance for Vaccines, which this fall received the Princess of Asturias Award for International Cooperation for promoting equitable access to childhood vaccination since 2000 in low-income countries.
COVAX has just announced that by the end of the month it will distribute 337 million doses among the 145 requesting countries of the 186 countries that have adhered to it. Who puts the money?
Philanthropists, donors, international organizations, governments of countries with more resources… I am proud to say that at the Paris Peace Forum, held last November, Spain confirmed the donation of 50 million euros for the COVAX cause. In addition, we contributed as members of the European Union, which jointly donated 100 million on that occasion, completing a total of 500 million donated from the beginning.
It is not a trivial expense. Vaccines are the best investment that can be made in any developing country. Every euro that is dedicated to childhood vaccination pays more than any other health or education initiative. In direct costs, for every euro invested in childhood vaccines, about 16 euros are saved. And if we count what is earned in years of life without sequelae, it goes up to 44 euros. Objectively, vaccinating is very profitable.
In the specific case of vaccination against COVID-19, it is added that, since it is not aimed at children but at the adult population, properly immunizing prevents society from being de-structured in places where conditions are very precarious.
How is the order of priorities established in COVAX?
Countries with a high risk of their health workers, and that have not yet started vaccination, are prioritized. Especially since it is more than proven that until you start to vaccinate you do not discover what you really need. We have seen it right here in Spain. We had been preparing for the moment when the COVID-19 vaccination campaign would start, but until the day we had the vials in our hands, we were not aware of the problems we were facing, because it is all too new and complex .
If it has cost us, imagine what can happen in countries that do not have exactly the best health systems in the world – rather the worst. On the one hand, there is the challenge of ensuring that the vaccine reaches all corners of countries where the entire population is not even registered. With the added difficulty that you have to choose the people who should be prioritized. It should be borne in mind that we are talking about countries like Niger, Nepal or Cameroon with a much less aged population than that of European countries. The same guidelines cannot be applied. The essentials here are the first line toilets.
You were referring a moment ago to GAVI, the Global Alliance for Vaccines, as the germ of COVAX.
Yes. And it has brought the experience of no less than two decades. The main difference is that GAVI supplied vaccines only to countries with few resources, while COVAX collects requests from all types of countries, because the objective is to make an equitable distribution worldwide of a vaccine for which there is more demand than supply . Avoid vaccine apartheid. That is why in the first list that has just been announced are applicant countries such as Canada, Singapore or New Zealand, which are not exactly “poor”, and which pay for their own vaccines and campaigns.
But not Spain …
Spain participates as a donor, but has not requested to be part of the COVID-19 vaccine distribution, nor has the rest of Europe. We have chosen to manage it on our own.
Of the 337 million doses to be distributed by COVAX, 336 million will be developed by AstraZeneca and Oxford University, and 1.2 million by Pfizer-BioNTech. Why this decision?
AstraZeneca and Pfizer are the same that we have bought in Europe, which at the moment we have total guarantee that they work and are safe. It is a problem that Pfizer’s vaccine must follow a complex cold chain, deep freezing, because many countries lack the necessary infrastructure.
AstraZeneca was the one who ran the most active pre-sale campaign, committing in advance many of the doses it could manufacture. And that is why it is the majority option, as long as the WHO includes it in its list of emergency drugs (which it will possibly do soon).
The largest of both shipments of vaccines are manufactured in India, at the Serum Institute, which is also a recipient of vaccines.
We are drastically dependent on India for the manufacture of medicines and vaccines in the world. In the distribution that has just been announced, they are awarded more than 97 million doses of vaccines, because it is a highly populated country. But if at some point it is decided to favor or “pamper” India, it would not seem bad either.
The WHO ensures that only with COVAX can we really overcome the acute phase of the global pandemic. In that case it is not just a solidarity initiative. In a way, selfishly, we are interested in making the initiative work …
So is. Do not forget that infectious diseases know no borders. As the pandemic progresses, no one will be safe unless everyone else is. In that sense, COVAX is moved by solidarity, but also by a point of realism. Especially because if injustices are committed in the distribution, great inequalities, we will end up suffering problems of global violence.
So not only health and money are in danger …
There is a lot of thought about the effect of the pandemic on the economy, but it could have a great impact on world peace. Even out of sheer selfishness, it must be avoided.
The world is in a delicate balance right now. Many middle-income countries are falling back and bordering on poverty levels. There are recent studies that say that, although there are fewer fatalities from COVID-19 in Africa, the disruption of education and society caused by the pandemic also affects health and will end up causing a major downturn in the economy.
GAVI had been betting for years not only to give fish (vaccines, in this case) to less developed countries, but also to teach them how to fish. Or what is the same, make them self-sufficient. Many were already picking up their economies on this boost. Now all that is very threatened.
What is the immediate future of COVAX?
To date, the doses are available to vaccinate 3.3% of the population of the requesting countries. Funds have already been raised to vaccinate about 500 million people with two doses, but the goal is to get closer to 1.75 billion vaccinated by the end of 2021. As a result, those in charge continue to search like crazy for new donors. This would also involve vaccinating risk groups due to exposure and vulnerability, either by age or by other comorbidities.
With the arsenal they now have, the most practical thing, I have said before, is to try to immunize the health workers of the countries most in need. After all, the availability of health personnel is the main bottleneck in this pandemic. If they die or are on sick leave, or if they have to care for COVID-19 patients or those suffering from other more widespread chronic diseases, such as malaria or tuberculosis, they will not be available to give vaccines. They have an arduous task ahead of them, because now we are not talking about just vaccinating all children born in a year, but about vaccinating millions of adults. That is why it is necessary to prevent these valuable personnel from becoming infected.
A staff that, by the way, is mostly female …
So is. Around the world, 70% of health personnel are women. If we do not take care of them, there will be a setback in the development of the role of women in countries with fewer resources. With what it took to get here!
To reach 1.75 billion vaccinated (3.5 billion doses) in 2021, what budget will be needed?
COVAX allocates 2 billion dollars to vaccinate about 500 million people. That means that it costs 4 euros to vaccinate each person with two doses. It is cheap considering that we are talking about new vaccines and that, therefore, the first years we will also pay what it has cost to develop them. But it needs to raise an additional $ 5 billion.
By the way, in the production of COVID-19 vaccines there has been a paradox: despite being done in record time, the number of volunteers has been enormous and that has allowed to provide much more powerful guarantees of safety than in any other immunization.
Now it seems that people are finally beginning to believe that COVID-19 vaccines are safe.
Yes, fortunately. Specifically in Spain we have gone from about half of the citizens doubting whether to put it to that many groups assert their risk and exposure to immunize themselves as soon as possible.
I was confident that it would be like this. Luckily, we are a country that has a lot of confidence in the health system and in vaccines. The opposite of what happens to France: the French question vaccines and their own health system. And they rely heavily on homeopathy and other unscientific remedies.
In any case, we sin of looking too much at our navel. We ask ourselves things like whether or not we want to get vaccinated, or if we can choose which vaccine to get. Honestly, it strikes me as a whimsical attitude. I have always said that at some point you would have to look up and attend to the vaccine in the world. Perhaps the time is now.