“Have these been paid for or at least committed to at a given price, are these acquisitions through the COVAX programme or independent of it, and most of all, of course, what is the delivery schedule agreed to in this acquisition, etc.”
Rath also noted that it is difficult to predict how many will be immunised, and when.
“The next set of uncertainties I have is whether there are credible and well-worked out plans in India to match these delivery schedules with downstream transport, uptake and actual vaccination, plans for multi-stage transport, multi-point cold storage, provision of injection accessories... , the recording-keeping needed and most of all, the skilled personnel to administer the injections.”
In Rath’s view, a certain sector of healthcare workers will likely be immunised in the next few months, as well as a certain proportion of 'first responder' people at high occupational risk of infection. “Beyond that, we are simply whistling in the wind at this stage,” he said.
The Duke analysis also found that Canada and the UK have each struck deals for over 350 million doses from seven developers.
The analysis doesn’t include Russia and China, both of which have their own vaccine programmes for their citizens.
The researchers noted that a flurry of nearly 200 Covid-19 vaccine candidates are moving forward through the development and clinical trials processes at unprecedented speed.
More than 10 candidates are already in Phase 3 large-scale trials and several have received emergency or limited authorisation.
The number of advance market commitments (AMCs) made by countries and multilateral partnerships eager to reserve vaccine supply, even before any candidates are on the market is unprecedented.
“High-income countries currently hold a confirmed 3.8 billion doses, upper middle-income countries hold 829 million doses, and lower middle-income countries hold more than 1.7 billion doses,” according to the report.
The researchers said they have not been able to find evidence of any direct deals made by low-income countries, suggesting that such countries will be entirely reliant on the 20 per cent population coverage from COVAX.
COVAX is a global initiative led by the WHO, the Coalition for Epidemic Preparedness Innovations (CEPI) and international vaccine alliance organization Gavi that aims to bring governments and vaccine manufacturers together to ensure all countries have access to COVID-19 vaccines once they become available.
Since none of these vaccines are approved, Duke researchers said some of the purchased candidates may prove to be unsuccessful, adding countries that can afford to are purchasing a portfolio of vaccines, in hopes that one or more will get through the regulatory process.