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  • In May of 2020, the United States government struck a deal.

  • $1.2 billion would go to the British drugmaker AstraZeneca,

  • to speed up their Covid-19 vaccine research.

  • In exchange, AstraZeneca promised the US 300 million doses

  • if the vaccine made it through safety and efficacy trials.

  • Earlier that month, the United Kingdom signed a similar deal with the same company,

  • to secure 90 million doses.

  • These types of transactions, where a country makes a deal directly with a company,

  • are called bilateral deals.

  • And in 2020, rich countries made a lot of them.

  • Those billions of dollars helped fund research

  • that brought us the world's leading Covid vaccines in record time.

  • But that money also determined where those vaccines would go.

  • By January 2021, 96% of the Pfizer-BioNTech vaccine doses

  • that were scheduled to be produced by the end of the year, had already been bought.

  • And 100% of Moderna's.

  • Countries representing 16% of the global population

  • held over half of the doses from the most promising vaccine developers.

  • Basically: rich countries got vaccines. Poorer countries didn't.

  • In Brazil and India, health systems are being pushed to the limits

  • at the same time that the US is quickly opening up vaccinations for anyone.

  • "That's making the pandemic last longer.

  • It's allowing infections to rage, and new variants to arise,

  • and at the end of the day, more people are dying than need to be."

  • The same deals that helped develop vaccines,

  • are making it harder to get them around the world.

  • Now what?

  • "What's happening now, with the Covid-19 vaccine inequality,

  • isn't at all unprecedented."

  • In 2009, the World Health Organization declared Swine Flu a pandemic.

  • "We are all in this together."

  • After securing their own vaccine deals, these nine higher-income countries

  • pledged 120 million doses to the WHO for lower income countries.

  • But they only started sending those donations after they realized

  • the outbreak wasn't as serious as everyone initially thought.

  • "For years, we've seen how technology is rolled out in rich countries,

  • and it takes decades for them to trickle down to poorer countries."

  • The problem starts with the vaccine market itself.

  • Getting a vaccine from development, to manufacturing, to distribution

  • is a multi-step process.

  • By making bilateral deals with developers and suppliers early on,

  • rich countries got in line here: at manufacturing.

  • But there was no guarantee that any given vaccine would work,

  • or get past regulators to reach the market.

  • If a vaccine fails shortly after funding, those billion-dollar investments are lost.

  • So, to offset that risk, countries invested in multiple options and suppliers,

  • often securing enough doses to cover their populations several times.

  • As of March 2021, Canada had secured over 300 million doses:

  • Enough to cover their population five times over.

  • And the deals the US made were enough to cover its population at least twice.

  • Which worked out for them,

  • because even though they secured 300 million doses of AstraZeneca a year ago,

  • as of April, it still hasn't been approved for use in the country.

  • But the Pfizer and Moderna doses that the government pre-purchased

  • are still enough to cover most of the population.

  • Most countries can't afford to make multiple high-risk investments early on,

  • so they wait until the vaccine is further along in the approval process.

  • And by then, they're already at the back of a very long line.

  • Peru, for example, made a bilateral deal with AstraZeneca,

  • but won't see those doses until at least September.

  • "Those that purchased first, or made the biggest orders,

  • or invested into the research and development, are standing at the front of the line.

  • Which is why the US has gotten 240 million doses of vaccine so far, at least,

  • and most of the poorer countries in the world don't have 240 million doses combined."

  • So, is there a way to get a lot of money here,

  • without creating a priority line over here?

  • Maybe.

  • One program underway is designed to work as a sort of middleman,

  • between countries and the drug companies making vaccines.

  • It's called Covax.

  • It's an initiative formed by three global health groups,

  • including the World Health Organization.

  • And its main objective is to provide vaccines to 92 middle- and low-income countries

  • that were shut out from making their own deals.

  • "Covax is kind of like the Paris Climate Agreement of the vaccine world.

  • So it's this multilateral effort, with almost 200 countries that have joined.

  • And the idea is that everyone has access to Covid-19 vaccines,

  • regardless of the country's GDP."

  • It does this using a two-part system.

  • The first part allows high-income countries to buy into and access multiple vaccines at once.

  • So, instead of one country giving $2 billion directly to AstraZeneca,

  • they'd give the money to Covax, which would use it to fund several different vaccines.

  • This way, if one or two of them failed early on, it wouldn't be a total loss;

  • the other vaccines in the portfolio would make up for it.

  • It's a multilateral system that's much lower-risk for those countries than a bilateral one.

  • The idea is that Covax could use that larger purchasing power

  • to negotiate deals with manufacturers and developers on a global scale,

  • which would drive the costs down, and fund vaccine development.

  • The second part buys vaccines for lower-income countries.

  • It's funded by donations from wealthier governments and charities.

  • The US alone has pledged $4 billion to this fund.

  • As vaccines become available, Covax hands them out to every country at once,

  • so rich countries and poor countries all get a fair share.

  • At least, that's the idea.

  • "The biggest problem with Covax is these bilateral deals we talked about."

  • For Covax to work as intended, it needs most countries to be using its multilateral system.

  • But Covax was formed a month into the pandemic,

  • when many countries had already invested in bilateral deals.

  • So the incentive for rich countries to join Covax was low.

  • But without them, Covax might be underfunded.

  • So it let them have it both ways:

  • Rich countries could join Covax, and keep their bilateral deals

  • that would get them more vaccines, faster.

  • "And those basically undermined Covax,

  • because they put themselves at the front of the line,

  • ahead of the access that countries will get through this collective agreement."

  • The US, for example, has donated the most money to Covax,

  • but is also still at the front of the manufacturing lines,

  • waiting for its own doses.

  • The US and UK have both promised to donate some surplus doses to Covax,

  • but neither country has said when.

  • "This means rich countries, like the US, decide who gets what, when.

  • Instead of some global collaborative process of vaccine allocation."

  • Experts are skeptical Covax will meet its original goal

  • of delivering 2 billion vaccine doses by the end of 2021.

  • As of April, they've only purchased around half that amount,

  • and delivered 45 million doses.

  • "So they've reached a huge number of countries,

  • but nowhere near enough to cover even frontline health workers,

  • or other essential workers, in most of the countries that these vaccines are going to."

  • Meanwhile, as of April, the US has already administered over 200 million doses.

  • "What Covax is setting out to do is hugely challenging.

  • They probably won't meet their own first targets.

  • But they are getting vaccines into countries

  • that probably wouldn't otherwise have them this quickly."

  • Vaccine inequality is bigger than just bilateral deals.

  • It's in every step of the process,

  • from limited manufacturing to cold-chain distribution;

  • even debates around the intellectual property of vaccines.

  • Our current system is not a well-oiled machine at all,

  • and there's a lot of work to do if we want to be better prepared for the future.

  • "One of the things that we've learned about pandemic preparedness is,

  • you can't really build it after the fact. And that's still what we're doing."

In May of 2020, the United States government struck a deal.

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How rich countries are making the pandemic last longer

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    joey joey に公開 2021 年 04 月 28 日
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