From Early Purchase to Lack of Infrastructure: Vaccination Plans in Latin America

RIO DE JANEIRO, BRAZIL – On Tuesday, December 8th, the same day that 90-year-old Briton Margaret Keenan was officially administered the first coronavirus vaccine by a Filipino nurse, in the two largest Latin American metropolises, Mexico City and São Paulo, an outline was provided on how the local authorities intend to protect the health of their citizens amid the novel coronavirus pandemic, a first step in a long immunization process in the region.

While some countries have sealed agreements with several laboratories to secure vaccines for their entire population, others place their hopes in the Covid-19 Global Access Fund (Covax), a form of consortium driven in part by the World Health Organization (WHO), whose goal is “to expedite the development and manufacture of vaccines against covid-19 and ensure fair and equitable access to them for all of the world’s countries.”

In addition to financial resources, the Covax plan also guarantees the poorest nations a form of access or advance purchase commitment (AMC) financed with international development assistance funds. But each government is free to purchase dose packages on its own.

According to data analyzed by EL PAÍS, Chile is one of the countries with the largest pre-acquired stock of vaccines, but three quarters of them are from China’s Sinovac, which is still awaiting the end of trials to prove efficacy. Ecuador and Mexico, the countries with the most diversified purchasing portfolio, have sealed agreements with two of the suppliers that today seem to be more advanced (the Oxford/AstraZeneca and Pfizer consortiums).

Brazil is divided between AstraZeneca, Coronavac, and the Sinovac vaccines. Argentina and Venezuela are mainly betting on the Russian Sputnik V from the Gamaleya laboratory, which announced a very high efficacy, while at the same time raising doubts among the scientific community due to the lack of transparency in the process.

Meanwhile, countries like Bolivia, El Salvador, Haiti, Honduras, Nicaragua and several Caribbean islands will be provided with Covax doses, since, according to the Pan American Health Organization (PAHO), “under economic criteria they are the poorest countries or because of their low population, they have greater access difficulties.”

There is a heated political battle in Brazil over contracting and approving vaccines against Covid-19. The country, with extensive experience in mass immunization campaigns, may lag behind in the global race as politicians compete for credit for the vaccines they have decided to sponsor. The federal government has closed deals to purchase some 300 million doses in 2021. Most of these come from President Jair Bolsonaro’s favorite: the Oxford/AstraZeneca vaccine, from which the government hopes to purchase 260 million doses over the next year. Another 40 million doses would come through Covax. But Brazil had initially only planned to begin its vaccination plan in March: the first 15 million doses of the AstraZeneca vaccine are expected to reach the country in January, but its authorization process could take 60 days.

This delay in vaccine distribution has prompted reactions from opposition politicians and experts. São Paulo Governor João Doria currently has a technology transfer and dose acquisition agreement for the Coronavac, the vaccine from the Chinese Sinovac laboratory, whose distribution plan was announced on Tuesday but was publicly rejected by Bolsonaro, the Governor’s political opponent. Although the drug has not yet been registered, Doria announced that he will start the campaign on January 25th. He intends to immunize nine million people, but needs to have at least a special authorization from the National Health Regulatory Agency (ANVISA ), in which Bolsonaro has recently placed political allies in strategic positions. Other governors have pressured the President to prevent the political dispute from causing further delays in the vaccination campaign; they have attempted to buy doses on their own, including appealing to the Supreme Court to request authorization for the vaccine should ANVISA refuse to grant it.

However, Minister of Health Eduardo Pazuello began discussing the possibility of starting vaccination earlier, still in December, should he succeed in acquiring doses of Pfizer’s immunizer through an emergency system. On Tuesday, he announced that the country is negotiating the purchase of another 70 million doses of this vaccine. Pfizer’s drug had originally been discarded because it required deep-freezers, not available in the Brazilian health system, but the government claims to be working on the purchase of freezers, syringes and needles.

Mexico has agreements of intent to purchase 198 million vaccines, although this month it should only get 250,000 doses from Pfizer. The initial goal was to immunize 2.6 million people in a first vaccination round, between December and January, but the flow will take longer, with shipments of one million doses per month during the first quarter of 2021. For his part, President Andrés Manuel López Obrador pledged that the vaccine will be free and universal for all 127 million Mexicans.

Pfizer’s product is expected to be approved mid-month, days after U.S. regulators have authorized it, and the Chinese CanSino vaccine will also be given the go-ahead in the coming weeks. Mexico negotiated the purchase of up to 34.4 million doses of Pfizer; 77.4 million from Oxford/AstraZeneca, 35 million from CanSino and 51.5 million through the Covax initiative in October, with which it may have access to the Moderna vaccine, the most expensive among those available. Russia wants to ship up to 32 million doses to the country, although formal talks regarding the purchase have not yet taken place. In addition, the Jansen laboratory has already initiated phase 3 trials of its prototype in Mexico, while the Novavax and Curevac trials are also in progress in the country.

In Central America, Costa Rica and Panama are the most advanced countries in their efforts to immunize the population against the pandemic. Costa Rican President Carlos Alvarado’s government has signed a contract with the Pfizer/BioNTech consortium to manufacture the vaccine against Covid-19. Three million doses of this vaccine are expected to be supplied, which would protect 1.5 million of the country’s 4.9 million inhabitants. Panama’s Laurentino Cortizo in November announced an agreement with Pfizer to acquire four million doses of the vaccine, in a 4.2 million inhabitants country.

In El Salvador, President Nayib Bukele announced an agreement with AstraZeneca laboratory to purchase two million doses of a vaccine against Covid-19 in the first half of 2021.

Guatemala, the most populous country in the Central American isthmus, with over 17 million inhabitants, has 3.3 million vaccines secured through the Covax facility.

Honduras and Nicaragua, considered the two poorest countries in the region, have no clear plan to acquire the antidote against the coronavirus, but they focus their hopes on the international community to subsidize them. To this day, Central America’s main option, after having recently been heavily battered by Hurricanes Eta and Iota, is the Covax initiative. In Nicaragua, uncertainty over vaccines is greater, due to the obscurantism of the Daniel Ortega and Rosario Murillo regime.

In Colombia, authorities have chosen to combine a multilateral strategy with several bilaterals – the details of which have not been disclosed. The country, with almost 50 million inhabitants, is part of the Covax facility whereby ten million people will have secured immunizations, probably in the second half of 2021. In addition, Bogotá maintains confidential bilateral negotiations with six laboratories whose vaccines are at least in phase 3 development stage (Pfizer, AstraZeneca, Janssen, Sinopharm, CanSino and the Serum Institute of India). In these cases, they expect to secure another five million doses for the first half of 2021, which would complete the first round of vaccination against Covid-19.

In Venezuela, Nicolás Maduro plans to start a massive vaccination against Covid-19 from April and has secured the immunization for at least ten million people. The Venezuelan government has chosen the product developed by its ally Russia: the Sputnik V, which since October has provided test doses to 2,000 Venezuelan volunteers. Thus, Venezuela was the first country in Latin America to try this drug challenged by the scientific community due to a lack of transparency and data inconsistency regarding its first two phases of development by the National Gamaleya Center, as published in The Lancet scientific journal. The results of this phase or who received them are still unknown.

Venezuela reported that it will not only vaccinate but also take part in vaccine production in a Caracas plant. Although the president is optimistic about the arrival of Russian vaccines, the basic immunization plan is in question. The country was left out of the Covax program because of the debts it has accumulated with the W.H.O.: US$11 million since 2017. This could be an additional obstacle to securing credit lines for the purchase of vaccines against Covid-19.

The government of Ecuador states that it will start immunizing front line healthcare professionals and the elderly living in nursing homes in January. According to Minister of Health Juan Carlos Zevallos’ plan, massive distribution of vaccines to the rest of the population will not start before March. The first 50,000 doses to reach the Andean country will be provided by the Pfizer/BioNTech consortium. The authorities also state that there have been negotiations with four distributors to have access to the vaccine: WHO’s Covax, AstraZeneca, Moderna and Covaxx (a division of the American United Biomedical).

Peru has purchased the first vaccines from Pfizer/BioNtech and expects delivery of a first batch in late December or January in order to administer two doses to 25,000 people in March or April, Health Minister Pilar Mazzetti told a Congress committee on Tuesday. In addition, the Peruvian government is negotiating the purchase of another 26.8 million doses from Gamaleya, Covaxx, Astra Zeneca, Janssen and Sinopharma – the last two are conducting phase 3 clinical trials in the country.

Bolivia is among the countries with priority and free access to the Covax plan, and so far there is no news about other agreements. Last month, Health Minister Edgar Pozo said he had developed “fruitful contacts” with international organizations to implement the novel coronavirus vaccine free of charge in the first quarter of 2021, and that healthcare professionals and vulnerable groups would be prioritized. Furthermore, he said the country had “two or three interesting alternatives”, among them the Oxford vaccine and the Russian Sputnik V.

Argentina purchased 47 million doses of Covid-19 vaccines (22 million from AstraZeneca and 25 million from the Sputnik V, Gamaleya Institute), enough to immunize 60% of its population. Alberto Fernandez’s government is also negotiating with Pfizer and Janssen, two companies that have already conducted clinical trials in the country, the first since August, and the second from November.

Last August, AstraZeneca and Oxford University announced an agreement with the Casa Rosada to produce the active substance of its vaccine in the Argentine mAbxience laboratory, a step before its packaging in Mexico and distribution in Latin America. The deliveries are expected to start early next year. The President announced days ago the beginning of a plan to vaccinate risk groups during the first half of January. Alberto Fernández said he expected that by March ten million people out of a total population of 44 million will be vaccinated.

Chile intends to start vaccination against Covid-19 in the first half of 2021, as announced by President Sebastián Piñera, within the framework of a plan to immunize 15.2 million Chileans. Around Christmas time, the first 25,000 doses of the U.S. laboratory Pfizer’s vaccine will land, immediately followed by another 25,000. In addition, before January 15th, another two million doses will be delivered by the Chinese Sinovac laboratory. In all, there will be more than two million vaccines in the initial stage. Vaccination will be voluntary and free of charge, and there will be three priority groups: healthcare workers, transport workers and the Armed Forces and police.

“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. Additionally, we have been part of the Covax for months,” said Piñera. If the vaccination plan works according to the Government’s plan, 5.8 million people will be immunized in the first quarter of 2021.

Source: El Pais

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