Chili. How he negotiated vaccines before positioning himself as a global benchmark

SANTIAGO, Chile – When the world presses desperately for Covid-19 vaccines, Chile world leader: it is between fifth and sixth place among the best positioned countries in terms of the number of doses applied per million inhabitants. Beyond the debate on the effectiveness of Sinovac, one of those chosen by Chile, the massiveness of the campaign surprises and the question settles. How did it come to overtake the United States, the United Kingdom, Germany and so many others?

The number of daily infections, with disturbing recordings these days, This contrasts with a vaccination plan that is only exceeded by countries like Israel and the United Arab Emirates, as evidenced by the ranking of the organization Our World in Data. The goal is reach 80% of the population – i.e. around 15 million people – at the end of the first half of 2021 to obtain the coveted collective immunity in June.

To date, the country records more than 30% coverage with two doses delivered and almost 50% of the target population has already received at least one. In total, they were applied 12 million doses, according to the official report.

What is the secret to the success of Chile’s vaccination plan? Without a doubt, this influenced strong commitment to Chinese manufacturer Sinovac. The clinical trials were funded by the country and were also conducted in its own laboratories, which facilitated availability. The deal was to receive 60 million doses to immunize its inhabitants for three years.

In the last hours, Gao Fu, director of the Center for Disease Control and Prevention of China, put the protection of his vaccines into perspective. After the global controversy broke out, the executive he should have gone out to clarify his words and said that “it was all a misunderstanding”. He said he was aiming for the duration of immunity, not its short-term effectiveness.

The Chilean government has also addressed the issue and it was the Minister of Science, Andrés Couve, who was responsible for defending the Sinovac vaccine. “First, the quality is very good. Second, it has a good security profile. Finally, it generates an immune response in as many people as possible, ”he said.

However, Chile preferred more than one option. It also has contracts with other manufacturers such as Pfizer-BioNTech, which has already shipped 2,088,450 doses and committed a total of 10 million.

Quick reaction was another key. In March 2020, when the first case of coronavirus was detected in Chile, President Sebastián Piñera insisted to his ministers on the need to immediate dialogue with laboratories and probing their progress in inoculation. Thus, the Institute of Public Health (ISP) began to dialogue with pharmaceutical and biotechnology companies, took advantage of the ground prepared in advance – worked by scientific collaborations and direct links – and approached two companies specific: Sinovac y Pfizer.

With the first, the link between the company and the Millennium Institute in Immunology and Immunotherapy (IMII), led by biochemist Alexis Kalergis, researcher at the Pontifical Catholic University (PUC), was capitalized. In 2019, and before the arrival of Covid-19, the two organizations were already considering the possibility of collaborating for the development of vaccines against respiratory viruses.

With little known about SARS-CoV2, in February 2020, Sinovac summoned the Chilean university to collaborate on the development of its vaccine. Talks continued and in May an understanding agreement took shape. The PUC agreed to participate in the clinical trial and Sinovac requested funding from Chile. The institution’s rector, Ignacio Sánchez, directed meetings with government and businessmen.

“What did we get in return? Two things: first, the ability to access 20 million doses per year for three years. Secondly, a 25% discount was assured of a value that was not clear what it was going to be, but it would be around 6 to 12 dollars per dose, ”said Sánchez, whose university transferred the agreement to the health ministry in September to start managing vaccine procurement with the Chilean foreign ministry. The strong commercial link between the two countries also appeared as a suitable backdrop.

In the case of Pfizer, the first steps were taken in July of last year when it was presented to the Piñera government. a “membership” proposal to guarantee the sale of up to 10 million doses. However, and after overcoming some concerns from laboratories about certain clauses in Chilean legislation, the ISP authorized the use of the drug in December. A month later, approved the AstraZeneca vaccine, which committed 4 million doses.

They also subscribed agreements with the Covax program for 7.6 million vaccines and with the Canadian-Chinese company CanSino Biologics for 1.8 million in the future.

“Chile had the vision to anticipate and secure vaccines. We have a long and beautiful tradition of strength and, for this reason, this mass vaccination process will not only have to continue, but it is an urgent and necessary process, ”Piñera said weeks ago.

For Metropolitan Technological University public policy expert Rafael Pizarro, experience with immunization issues ended up being a crucial aspect. “There is a continuity of what was an expanded program in 1978 and therefore the country has a plan that has resources and is devoting significant effort in that direction. Chile in this case has a level of seriousness and worldwide recognition, which makes it a privileged client of laboratories and research centers which develop vaccines ”, held in dialogue with LA NACION.

And he added: “He also has a established and regulated purchasing system, and has experience in international tenders. Many of the vaccines in the national immunization program are purchased abroad and Chile draws up major financial and stock market tenders year after year, then it maintains a permanent relationship with the laboratories and research centers which produce, market and distribute the vaccines. Chile has advantages over other countries because it has a is a good payer and avoid levels of corruption ”.

Chile has advantages over other countries because it has a transparent and reliable system, is a good payer and avoids levels of corruption.

However, for infectologist Jaime Labarca of the Catholic University, the effect of vaccination to flatten the contagion curve will be delayed due to the characteristics of the vaccines used. “We are faced with a major disagreement between vaccination and the number of infections, but that too you can probably answer that the Sinovac vaccine is less effective with one dose than the Pfizer, for example. It takes a second dose, a while for the antibodies to build up. The large number of the infected population consists of people who have not yet been vaccinated because you are young or have received a single dose of Sinovac. What we have detected is that the elderly and the chronically ill have reduced their presence in hospitals and intensive care units ”, he pointed.

We know of a big mismatch between vaccination and the number of infections, but this may be because the Sinovac vaccine is less effective with one dose than Pfizer.

The rapid rise in cases forced the government to tighten measures and reconfigure a relaxed strategy over the summer. Today Chile has its borders closed for at least a month and 70% of its population confined. A few days ago, it reached 9,000 daily infections, a figure that urgently needs to be reversed.

“There has been a decrease in the country’s restrictive measures. Permits have been generated to go on vacation to different regions with greater freedom. Beaches, parks, shopping centers, restaurants, casinos and gymnasiums have been opened. We had a few months in which a message of tranquility was transmitted, which was perceived by the public as if the Covid-19 had disappeared “, said Ignacio Silva, infectologist and academic at the University of Santiago.

During the month of March, and according to a report by ICOVID Chile -an initiative led by the University of Chile, the Pontifical Catholic University of Chile and the University of Concepción-, the growth in infections nationwide was 43.7%.

The problem, too, is that April started off with an even darker outlook with a intensive care unit (ICU) hospitalization record. In the metropolitan area, home to Santiago and accounting for half of the country’s total population, the number of patients has increased by 43% in just 15 days, and ICU hospitalization in the region has reached 38% in the two last few weeks.

“The government’s strategy to increase beds has certainly saved lives, because it is. But you can’t fight exponential growth by adding a finite number of beds every day, because at some point that growth will overwhelm you. Intensive care beds are not the same, they have special medical equipment and physical space. In Chile, last year, the lethality of Covid-19 pathology in the intensive care unit was between 18% and 20%, with the global average being 50%. But it turns out that if this bed is activated outside the ICU, this mortality can reach 70% and 80%, ”explained molecular biologist Tomás Pérez-Acle, deputy director of the Fundación Ciencia & Vida.

As two sides of the same coin, Chile ranks as a model country because of its speed of vaccination, but the number of infections does not give a truce. These days, the country oscillates between an extreme worry and an already palpable hope.