Inoculation blues

While the first coronavirus wave had the world glued to news about vaccine development, the realization amidst the second wave that vaccines may be unable to defeat Covid in 2021 (or even beyond, due to supply and affordability concerns among low-income and poor countries) puts one in a sobering mood. Rich nations are in line first, but even after a month of approvals, less than 10 million folks, mostly in China, US, UK and Israel, had received their first jabs by December 31 (source: Our World in Data).

At this pace, the world will take over 60 years to immunize everyone against Covid-19. But of course the pace will pick up in coming months, albeit not much in poor countries that will remain out of picture for a while. Once India starts immunizing its people – their government has set a target to vaccinate 300 million people (health workers, essential workers, elderly and those with chronic diseases) between January and August – the figures will look better. Approval of Chinese vaccines may aid other developing countries.

Over at home, the government is under no real public pressure on vaccine procurement. The missing foresight that only vaccines can gradually get things to normal is going to cost the economy down the road. The vaccination approach has been haphazard at best. First, the government missed the boat to pre-book promising early-stage vaccines that were being built in the West for at least 20 percent of its adult population. It would have cost a fraction of what it will now cost in commercial or bilateral market.

There were obvious financing concerns and a risk of bad contracts. But other countries took the risk and they are now in a good position to start immunization soon. As for financing, Pakistan was hardly short of multilateral funding to secure critical supplies. Pakistan did become part of global COVAX initiative in summer, but so did 90+ other low and middle-income countries. Under this UN scheme, these countries would get vaccines, over time, for at least 20 percent of their populations. But it could take years – for instance, the largest global vaccine maker in India will first provide vaccines to locals and then to COVAX.

Vaccine-related news coming out of Islamabad lately has been a confusing influence. Around the time when UK and US started approving vaccines, here at home in early December the government announced a grant of $150 million to procure the vaccine. While it made clear that healthcare workers and elderly people would be the first to be vaccinated, it wasn't obvious which companies had been short-listed or which ones had shared their trial data with authorities. By mid-December, the allocation was raised to $250 million, but clarity was still missing on the short list, quantities, procurement timeline, etc.

Then all of a sudden, just before the year ended, the government announced that it would procure 1.2 million vaccines from China’s state-owned company Sinopharm, with a target to inoculate about half a million health workers by March 2021. This caught many by surprise, as Pakistan’s decision to buy this vaccine came on the same day as this vaccine was granted conditional approval by Chinese government. The vaccine is said to have en efficacy of about 79 percent, which offers a high level of protection.

Previously, health officials here were noncommittal on approval of any vaccine, Western or Chinese, unless trial data assured them of vaccine’s safety, efficacy, etc. It isn’t immediately clear if such data were shared prior to this decision. The decision seems to have strategic implications. However, the uncertainty is somewhat mitigated by the fact that the UAE and Bahrain have already authorized the same Sinopharm vaccine in their countries. Meanwhile, as countries like India are doing widespread dry-runs for vaccine administration, the federal government has its work cut out to fine-tune relevant infrastructure.

Along with the news on procuring Chinese vaccines came the government announcement that private sector would be encouraged to buy vaccines themselves and sell it to people in the market. Was this the government’s way of telling members of the general public that they were on their own? Probably not – but if the private sector became the dominant player in the vaccination sphere (for the elite, it already is!), it will accentuate already-dire inequalities in Pakistan. Beware, for it may have unintended consequences.