Why Pfizer’s vaccine could only benefit rich countries

When the Pfizer Inc. and BioNTech SE Covid-19 vaccine Coming off the production lines, Shanghai Fosun Pharmaceutical Group Co. expects to distribute it through a complex and expensive system of airport freezer warehouses, refrigerated vehicles, and inoculation points throughout China.

Once at the vaccination centers, injections should be thawed from -70 degrees Celsius and injected within five days, or they are spoiled. Then, the Herculean journey from the warehouse freezer to the rolled-up sleeve must be restarted, to deliver the second booster injection a month later.

The map described by the company, which licensed the vaccine for Greater China, offers a glimpse of the enormous and overwhelming logistical challenges faced by those seeking to supply Pfizer’s experimental vaccine after the First “extraordinary” results that he showed during the tests of the final phase, which gives hope for a possible end to the pandemic which has lasted for nearly a year.

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That euphoria is now fading to the fact that no vaccine currently in use has ever been made using the messenger RNA technology deployed in Pfizer’s injection, which instructs the human body to make proteins that then develop. protective antibodies.

It means that countries will need to build freezer production, storage and transport networks from scratch necessary for the survival of the vaccine. The massive investments and coordination required ensure that only rich countries will have access, and even then perhaps only their urban populations.

“It is expensive to produce, its component is unstable, it also requires cold chain transportation, and has a short shelf life,” says Ding Sheng, director of the Beijing-based Global Health Drug Discovery Institute, which received funding. of the Bill Foundation. And Melinda Gates.

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The cost of implementing Pfizer’s injection will likely increase existing fears that richer countries will get the best vaccines first, despite an effort supported by the World Health Organization called Covax that aims to raise $ 18 billion to buy vaccines for the poorest countries.

It also presents a choice that developing countries currently face: pay for the expensive construction of sub-zero cold chain infrastructure for what appears to be a safe bet, or wait for a slower, more conventional vaccine that produces lots of protein. or inactivated viral particles in living cells and can be delivered through existing healthcare networks.

“If there is a protein vaccine that could have the same effect as an mRNA vaccine and there is a need to vaccinate billions of people every year, I would go for long term protein injections.” , says Ding.

Even for the wealthy countries that have reserved doses, including Japan, the United States and the United Kingdom, the delivery of the Pfizer vaccine will pose significant hurdles whenever trucks break down, power outage, essential workers fall ill and the ice melts.

Secure delivery

To safely vaccinate in mainland China and Hong Kong, Fosun will partner with the state Sinopharm Group Co., a pharmaceutical distributor with well established networks across the country. One of Sinopharm’s subsidiaries has also developed vaccines against covid-19.

Packaged in refrigerated trucks, these vials will reach the inoculation sites where they can be thawed and stacked in refrigerators at 2-8 degrees Celsius for five days before spoiling.

“The requirement for an extremely cold temperature is likely to spoil many vaccines,” he says. Michael Kinch, vaccine specialist at Washington University in St. Louis.

It is also likely to cost Fosun tens of millions of yuan, according to the chairman of the company, Wu Yifang. Fosun plans to import the vaccine in bulk and fill the vials at a local factory. It will also require more investment in production and storage.

The resulting price may be too high for many developing countries, including India, which has struggled to contain the world’s second largest coronavirus outbreak and currently has no deal to buy the Pfizer vaccine. .

‘Forget it’

Many of the country’s public health officials and the pharmaceutical industry have already expressed concern that India lacks the capacity to deliver a vaccine to its vast rural interior and a population of over 1.3 billion. of people at breakneck speed which is now expected.

“Most of these vaccines need minus 70 degrees, which we just can’t do in India, forget it,” he says. T. Sundararaman, Global Coordinator of the People’s Health Movement, New Delhi-based organization that brings together local activists, academics and civil society groups working on public health.

“Our current cold chains cannot cope with the need for measles vaccines in some districts, and that’s only for children under 3,” he says. “This is a truly insignificant number of people compared to the number who will need a COVID-19 vaccine.”

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Asked at a briefing on Tuesday whether the Indian government would seek to buy the vaccine from Pfizer, Rajesh Bhushan, secretary of the health ministry, said New Delhi was in talks with all vaccine makers. He added that India was able to “increase and strengthen” its existing cold chain capacity, but declined to immediately disclose details of the purchase.

Pfizer already has orders from some developing countries such as Peru, Ecuador and Costa Rica. It is unclear to what extent these countries plan to distribute the injections, but their small orders of less than 10 million doses suggest limited deployment.

‘Last Thousand’

Even without the problem of freezing temperatures, implementing a vaccine in a short period of time will be a “big challenge” that will require massive training of paramedics to deliver doses of two injections, he says. Pankaj Patel, Chairman of Indian pharmaceutical company Cadila Healthcare Ltd., which is developing its own injection of experimental plasmid DNA against covid-19.

This is especially true in areas where people are not easy to contact or have to travel long distances to get to vaccination centers. Past vaccination campaigns show that many simply never show up for the second injection, according to public health experts.

Growing obstacles mean some developing countries may abandon the Pfizer vaccine, despite early signs of its exceptional effectiveness.

“If we had to wait another year and have something that we can offer to as many people as possible in this country, would that be a bad compromise?” Asks Gagandeep Kang, professor of microbiology at Christian Medical College in Vellore. . , based in India, and member of the WHO Global Advisory Committee on Vaccine Safety.

“Based on the cost of the Pfizer vaccine, the logistics of ultra-cold storage, I don’t think we’re ready and I think it’s something where we have to weigh the benefits and the costs very, very. carefully, ”he said.