Covid-19 vaccination plans in Latin America
The race to acquire, distribute and apply the vaccine against Covid-19 has begun, and several developed countries have already granted emergency authorization to start vaccination. In Latin America this process could take a little longer due to economic, logistical and social difficulties; although most states in the region are part of the COVAX mechanism, which will allow an efficient and equitable supply of vaccines, and countries like Chile have already made advance purchases.
On Friday, December 11, the health authorities of the United States and Mexico granted an emergency authorization to the Pfizer-BioNTech vaccine against COVID-19. Both nations joined the United Kingdom, Bahrain, Canada, Saudi Arabia in approving this vaccine against COVID-19 and will begin applying it in the next few hours, according to their respective governments.
As reported by the newspaper El Espectador, the outlook in Africa and Latin America is different: countries with heavily battered economies, with large differences, tropical climates and isolated populations, where enormous efforts are made to buy the doses they can to begin immunizing their population, one of the most affected by the coronavirus pandemic in the world.
To ensure the immunization of more than 630 million Latin Americans, most governments are part of the Covax initiative, a common fund made up of 172 developing nations seeking access to vaccines. However, the mechanism falls short, as it will only cover 20% of the population in developing countries by the end of 2021, while rich countries will be able to take 50% of world production, according to a study by the Global Health Innovation Centre at Duke University in the US. USA.
Duke also listed the countries that have secured the most vaccine supplies so far: first is India, with 1.6 billion; followed by the European Union, with 1.425 billion doses; the United States, with 1.01 billion, and follows the the Covax initiative, with 700 million.
The Tool Access Accelerator against COVID-19 (ACT) is a global collaboration project that was launched in late April 2020, bringing together governments, health organizations, scientists, businesses, civil society organizations and philanthropists, to accelerate the end of the pandemic through the development and equitable allocation of the diagnostic tests, vaccines and treatments the world needs. The Accelerator consists of four pillars of work: diagnosis, treatment, immunization and the strengthening of health systems.
The Global Access Mechanism for COVID-19 vaccines, also known as COVAX, the mechanism is led by the Coalition for Innovations in Epidemic Preparedness (CEPI); the Alliance for Vaccines (GAVI) and the World Health Organization (WHO).
The main goal of COVAX will be to create a broad, diverse and actively managed portfolio of candidate vaccines against COVID-19 to maximize the likelihood of success of several candidates, so that the best vaccines are finally available and that the supply is sufficient and equitable for the groups that have the highest priority worldwide.
Advance purchase plan in LatAm
The Spanish newspaper El País, in a full report, highlights that in COVAX the poorest nations have a kind of access or advance purchase commitment (AMC) financed by development funds. But everyone is free to purchase dosage packages on their own.
In Latin America, more and more countries are embarking on these bilateral purchases. The largest and highest-income countries in the region also understand that COVAX will benefit mainly those with lower resources. Because of this, and because political pressure acts by comparison (each government perhaps feels that its management during the pandemic will now be measured in available doses per head), the market is accelerating. These are the vaccine purchase plans, country by country:
According to the data analyzed by EL PAÍS, Chile is the country with the largest pre-purchased stock of vaccines, but three quarters of them are from the Chinese Sinovac, with no evidence of effectiveness to date. For their part, Ecuador and Mexico, the country with a more diverse shopping portfolio, include agreements with two of the most promising firms currently (Oxford with AstraZeneca and Pfizer). In Argentina, Brazil and Venezuela mainly bet on Gamaleya’s Russian project Sputnik V, which has announced a very high effectiveness, but at the same time raises doubts in the scientific community about the lack of transparency of the process. Meanwhile, in countries such as Bolivia, El Salvador, Haiti, Honduras, Nicaragua and several Caribbean islands will receive doses of Covax since, according to the Pan American Health Organization (PAHO), ‘under economic criteria they are the poorest countries or because, because of their small population, they have more difficulty of access’.
By Elias Camhaji
Mexico has plans to purchase 198 million vaccines, although this month it will only receive 250,000 doses of Pfizer. The initial goal was to immunize 2.6 million people in a first wave of vaccination between December and January, but the flow will take longer, with shipments of 1 million doses per month during the first quarter of 2021. As announced on Tuesday by the Undersecretary of Health, Hugo López Gatell, the medicine will be initially applied in two areas, Mexico City and the State of Coahuila, in the north of the country, and its distribution will be in charge of the Armed Forces. For his part, the president, Andrés Manuel López Obrador, has promised that the vaccine will be free and universal for the 127 million inhabitants.
The Pfizer prototype is expected to be approved in the middle of this month, a few days after US regulators authorize it, and CanSino’s Chinese vaccine is also expected to be approved in the coming weeks. The vaccination plan consists of five phases: the first, which will begin this month and will last until February, will be aimed at the first-line health workers fighting against covid-19. The second stage (from February to April) will benefit other health workers who do not deal directly with the pandemic, those over 60 and those with chronic diseases such as diabetes, hypertension or obesity. The third stage, from April to May, will include those aged over 50; the fourth, from May to June, those aged between 40 and 49, and the last, from June 2021 to March 2022, the rest of the population will be vaccinated.
If the first doses given will be those of Pfizer, as the months go by the challenge will be to administer a portfolio that includes four different prototypes. Mexico negotiated in October to purchase up to 34.4 million doses of Pfizer; 77.4 million from Oxford and AstraZeneca; 35 million from CanSino; and 51.5 million through the Covax initiative, which will provide access to the most expensive vaccine available from Moderna. Russia wants to send the country up to 32 million doses, although no formal talks have been held to buy them. In addition, Jansen has already started phase 3 trials in Mexico, while Novavax and Curevac are in the process with the US country as well.
The government’s initial hopes were for the Oxford and AstraZeneca vaccine, with which it signed an agreement in August to produce and distribute to other countries up to 250 million doses, in partnership with Argentina and the foundation of the magnate Carlos Slim. López Obrador has said that 20,000 million pesos (about 1,000 million dollars) will be allocated, although if the country concretizes the purchase of the 198 million doses, the cost will exceed 35,000 million pesos (1,659 million dollars). That difference would be settled upon completion of monthly payments against delivery in 2021, according to the authorities.
By Wilfredo Miranda
In Central America, Costa Rica and Panama are the most advanced countries in the search for immunity against the pandemic. The government of Costa Rican Carlos Alvarado signed a manufacturing contract for the covid-19 vaccine with Pfizer and BioNTech. The supply of this vaccine is expected to be three million doses, which would protect one and a half million of the country’s 4.9 million people. Meanwhile, Panamanian Laurentino Cortizo announced in November an agreement with Pfizer for the purchase of 4 million doses of vaccine for the country of 4.2 million inhabitants. The vaccines, for which $48 million was spent, will immunize two million people, as each patient requires two doses.
In El Salvador, President Nayib Bukele announced an agreement with AstraZeneca for the purchase of two million doses of a covid-19 vaccine starting in the first half of 2021. ‘We have already concluded the agreement for the supply of the first 2 million doses of vaccine for the covid-19 of AstraZeneca and Oxford University,’ Bukele announced on his Twitter account. In statements to the media, the president assured that his government will acquire four different types of vaccines against covid-19 but said he could not reveal the names of the other three pharmaceutical companies. According to him, vaccination will be ‘free, universal and voluntary’ for the 6.4 million Salvadorans.
Guatemala, the most populous country in the region, with more than 17 million inhabitants, is guaranteed 3.3 million vaccines thanks to the Covax mechanism. In the coming weeks, the government of Alejandro Giammattei plans to announce a preliminary plan of how vaccination will be distributed and managed in the country.
For their part, Honduras and Nicaragua, considered the two poorest countries in the region, do not have a clear plan to obtain the antidote against coronavirus, but focus their hopes on the international community to subsidize them. Until today, the main bet of Central America, recently severely hit by hurricanes Eta and Iota, is the proposal of the World Health Organization (WHO) of the Covax initiative. In Nicaragua, the nebula over vaccines is greater, due to the natural secrecy of the regime of Daniel Ortega and Rosario Murillo.
Although the possibility of Russia sending its Sputnik V vaccine has been considered due to the political proximity of Managua and Moscow, giving priority to health workers, chronic patients and older adults, the official information is confusing. Iván Acosta, the Finance Minister of the Sandinista government reported last week that they had 107 million dollars to purchase the coronavirus vaccine from the Inter-American Development Bank (IDB) and the Central American Bank for Economic Integration (BCIE), but the director of the second organization assured that Nicaragua has not requested funding in this regard. The only countries to do so have so far been Honduras and Guatemala. In turn, Vice President Rosario Murillo reported on a meeting with a PAHO team that discussed the progress of four vaccines but did not give details of whether there were any agreements or when they could reach the country.
By Santiago Torrado, Florantonia Singer, Sara España and Jacqueline Fowks
In Colombia, the authorities have chosen to combine a multilateral and several bilateral strategies, from which the details have not gone into detail, to seek immunization. The country of about 50 million inhabitants is part of the Covax, a mechanism by which it has insured vaccines for ten million people, planned for the second half of 2021. In addition, it holds bilateral negotiations, under confidentiality agreements, with six pharmaceutical companies in phase three of development -Pfizer, AstraZeneca, Janssen, Sinopharm, CanSino and the Serum Institute of India-. In these cases, they expect to get an additional five million by the first half of 2021, thus completing the first phase of vaccination against covid-19. ‘We cannot confirm the number we are negotiating with any company. The target is 15 million and we already have vaccines for 10 million, ‘Minister of Health and Social Protection Fernando Ruiz Gómez said last week. A resolution from the Ministry of Finance leaked by the press revealed that the government is willing to buy some 123 million dollars to buy ten million doses of the vaccine developed by Pfizer and BioNtech -which correspond to five million people, by the need for a double dose-.
The Colombian plan gives priority in this first phase to health workers (about 813,000), those over 60 years of age (6.8 million) and people with comorbidities such as hypertension, diabetes and heart disease, among others (6.7 million). The vaccine will be free, according to the bill that has already passed through Congress. One of the most criticized aspects was that pharmaceutical companies will be exempted from compensation payments due to adverse effects of the vaccine. The country has a solid vaccination record, without major adverse movements, but the chains of disinformation promoted through social networks can raise mistrust against pharmaceutical companies, says Cristina Vélez, of Linterna Verde, an interdisciplinary group that has studied citizen perception on the subject in Colombia. ‘As the vaccine is also a trust issue, the same lack of transparency can damage the process,’ he warns.
In Venezuela, Nicolás Maduro plans to start a massive vaccination against covid-19 starting in April and has ensured the immunization of at least 10 million people. The Venezuelan government has opted for the product developed by its Russian allies, the Sputnik V, from which were brought in October test doses for 2,000 Venezuelan volunteers. Thus, Venezuela was the first country in Latin America to test this medicine questioned in the scientific world due to the lack of transparency and inconsistency in the data of the first two phases of the development of the Gamaleya National Center published in the scientific journal The lancet. The results of this phase and those who applied them are not known.
Venezuela has indicated that it will not only vaccinate but also participate in its manufacture in a plant in Caracas. In Maduro’s health geopolitics, diplomatically surrounded by the country’s political crisis, he has also relied on his other partners, the Chinese, who during the pandemic have provided him with the few rapid and molecular tests that the country has been able to carry out, which reaches December on the 100,000 cases confirmed in only two laboratories authorized for diagnosis and more than 900 deaths. Although the president has been optimistic with the arrival of Russian vaccines, the basic immunization schedule is on the rise. The country was left out of the Clovex program due to the debts it accumulates with the agency, 11 million dollars since 2017. This could be an additional stumbling block to obtaining credit lines for acquiring covid-19 vaccines.
The Government of Ecuador assures that it will begin to vaccinate from January the health workers who are on the front line and the elderly people who live in shelters. According to the planning of the Minister of Health, Juan Carlos Zevallos, the mass distribution of vaccines for the rest of the population will not begin until March. ‘ In several cities of the country, between 22% and 44% of the population has already been infected; this would be one in three citizens, ‘said the holder of the portfolio, who later added that there is no evidence that those who have had covid-19 should receive the vaccine. The first 50,000 doses that will reach the Andean country will be from pharmaceutical company Pfizer and BioNTech. But they will not be the only ones, according to the official version, since 20 million dollars have already been advanced as an advance to ensure access to 18 million doses. In total, they predict a vaccination spending of $200 million. The authorities have also assured that talks have been held with four distributors to access the vaccine: from Covax, from the WHO, to AstraZeneca to Moderna and Covaxx.
Peru has acquired the first vaccines from Pfizer-BioNtech and expects the delivery of a first batch in late December or January to deliver two doses to 25,000 people in March or April, Health Minister Pilar Mazzetti told a congressional commission on Tuesday. In total, the purchase from the British consortium amounts to 9.9 million doses, of which 5.7 million will arrive in the first half of 2021. In addition, the Peruvian government is negotiating the purchase of another 26.8 million doses with Gamaleya, Covaxx, Astra Zeneca, Janssen and Sinopharma -the latter two conducting phase 3 clinical trials in the South American country-.
According to President Francisco Sagasti, the first doses will be for front-line health personnel, police, military and firefighters. For his part, Mazzetti has indicated that immunization will be free for the general population and that it could be carried out in the polling places of the general elections -schools and universities- although not during the elections, scheduled for April, but on other dates. An Act of Congress also guarantees that access to immunization against the new coronavirus will be ‘free and voluntary’ in public health facilities. According to a national urban survey of Ipsos conducted in August, 75% of Peruvians are willing to get vaccinated. However, for a couple of months there have been disinformation campaigns against the vaccine in the country. Among the sectors that oppose are neo-conservative groups, supporters of chlorine dioxide and members of Congress of the political groups Podemos Peru and Union for Peru, who promoted in November to vacate the presidency and supported the interim government of Manuel Merino.
Bolivia is one of the countries that will have priority and free access to the Covax plan, but for the moment other agreements are unknown. Last month, Health Minister Edgar Pozo said he had developed ‘fruitful contacts’ with international organizations to implement the vaccine against the new coronavirus free of charge in the first quarter of 2021 and that health workers and vulnerable groups would have priority. In addition, he said the country had ‘two to three interesting alternatives’, including Oxford and Russian Sputnik V.
By Beatriz Jucá
In Brazil, there is an intense political battle around the recruitment and approval of covid-19 vaccines. The country, an expert in immunization campaigns, may lag in the global race as politicians compete for the vaccine laurels they have decided to sponsor. The Federal Government closed deals to buy about 300 million doses by 2021. Most of them come from the great bet of President Bolsonaro: AstraZeneca’s vaccine, from which the Government expects to acquire 260 million doses over the next year. Another 40 million doses would come through Covax. But Brazil does not plan to start its vaccination plan until March. The first 15 million doses of AstraZeneca are expected to arrive in the country in January, but its authorization process could take 60 days.
This delay in the distribution of the vaccine has provoked reactions from opposition politicians and experts. The governor of São Paulo, João Doria, already has a technology transfer and dose acquisition agreement with Coronavac, the vaccine of the Chinese laboratory Sinovac, whose distribution plan was announced this Tuesday, but which has been publicly rejected by President Bolsonaro, an opponent of the governor of São Paulo. Although the drug is not yet registered, Doria announced that she will start the campaign in January. It aims to immunize 9 million people, but it needs at least a special authorization from the Brazilian health agency (Anvisa), where Bolsonaro has placed more and more allies in strategic positions.
Other governors have pressured the president so that the political dispute does not cause further delays in the vaccination campaign, have tried to buy doses on their own and one even went to the Supreme Court to request authorization for the vaccine, in case Anvisa refuses to do so. Under pressure, Health Minister Eduardo Pazuello announced on Tuesday that the country is negotiating the purchase of another 70 million doses of the vaccine developed by Pfizer. Of these, 8.5 million could arrive in the first semester. That vaccine had originally been discarded because it needs ultra-freezers that the Brazilian health system does not have, but the government claims to be working on the acquisition of refrigerators, syringes and needles. However, the official insisted on the 60-day forecast for drug approval, so the national campaign would not begin until after February.
By Federico Rivas Molina and Rocío Montes
Argentina has obtained 47 million doses of vaccine against covid-19 (22 million purchased from AstraZeneca and 25 million from Sputnik V from the Gamaleya Institute), enough to immunize 60% of its population. The Government of Alberto Fernández is also negotiating with Pfizer and Janssen, two companies that are already conducting clinical trials in the South American country, the first since August and the second since November.
On Thursday, the president announced the signing of an agreement with Russia that expects 300,000 people to be vaccinated by the end of the year and another 10 million between January and February. To give confidence to the population, Fernandez said he will be the first to receive Sputnik V immunization in the country.
In addition, last August, AstraZeneca and the University of Oxford announced an agreement with the Casa Rosada to produce in the Argentine laboratory mAbxience the active principle of its vaccine, a step prior to its packaging in Mexico and the distribution of doses in Latin America. Deliveries are expected to begin early next year. The Executive announced days ago the start of a vaccination plan for risk groups during the first half of January. Alberto Fernandez said he hoped that by March some 10 million people would be vaccinated, for a total population of 44 million.
Chile intends to begin vaccination against covid-19 in the first half of 2021, according to President Sebastián Piñera, in the framework of a plan that contemplates the immunization of 15.2 million people. Around Christmas the first 25,000 doses of the American laboratory Pfizer will arrive, which would bring in another 25,000 doses immediately. In addition, another 2 million doses from the Chinese laboratory Sinovak will arrive before January 15. In total, there will be just over 2 million vaccines in the initial stage, which will be voluntary and free. There will be three priority groups: health workers, transport workers, and the armed forces and law enforcement.
‘We have reached agreements or signed contracts with many laboratories, among the most promising in the world such as Pfizer, Sinovac, Johnson & Johnson, AstraZeneca and others. In addition, we have been part of Covax for months now, ‘explained Piñera, who was caught on a beach on Saturday sharing with other people without wearing a mask and, in the face of controversy, chose to declare himself in court. If the vaccination plan works as planned by the Government, 5.8 million people will be vaccinated by the first quarter of 2021. These are figures that fuel hope in a country that has failed to control the pandemic and whose contagion figures have forced the authorities to tighten measures.
From Thursday, the entire capital will be quarantined on weekends and travel to other regions will be prohibited for the inhabitants of Santiago de Chile.
Storage and distribution difficulties
The fact that some messenger RNA vaccines, a fragment of the virus’s genetic code, must be stored and distributed at less than 70 degrees Celsius, such as Pfizer-BioNTech, will make it difficult for people to go directly to the doctor and get vaccinated, but vaccination centers with mega-freezers will have to be built, as is already being done in Germany, for example. Something that, in countries with fewer resources, such as India, or others in Asia, Africa and Latin America, will not be an easy task. Where funding instruments are lacking and access to the population is difficult, concrete gestures of international solidarity will be needed, according to the WHO, which estimates that vaccinating 20% of the Latin American and Caribbean population would cost more than $1 billion.
For this case, the air transport sector has been prepared for the transport of the vaccine, and distribution will depend on where the vaccine is manufactured, and it will be possible to combine its transport by plane with part on the road, depending on the destinations. The most important ‘will be to guarantee air connectivity’, as a large part of the merchandise is transported in the warehouses of passenger aircraft, comments to the World, Javier Gándara, president of ALA, the Association of Airlines, covering some 80 companies operating in Spain.
For Iata, the international air transport agency, the biggest challenge is to have temperature-controlled storage facilities available, collaboration between the parties involved, connectivity and the security of these products.
Latin America will face a major challenge to guarantee the immunity of its population against Covid-19. Logistics and government decisions will be critical to generating the equity that is required for low-income people to be vaccinated in the world’s most unequal region.
Main source: https://elpais.com
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