There are around a 100 COVID-19 vaccines under development by various countries around the world with two of them ahead of the pack and showing promising results in trials.
One of them is the Oxford University vaccine that is already in the stage three of mass human trials as announced on 15th July after earlier trails also went well. A Lancet article showed the vaccine to be safe for humans in initial trials though mass testing is needed. Pharmaceutical company AstraZeneca has also agreed to mass-produce this vaccine, once it is ready.
Another one is by the US Biotech company Moderma which said its initial tests were a success on 15th July and it is going in for final stage of human trials from 27th July.
There are other companies and countries who are also in advanced stages.
However, the big question is that once a vaccine is out if Bhutan can get any or at least significant amounts of it, given the massive global demand and also if Bhutan can afford it if it is highly priced.
The Health Minister Dechen Wangmo said that the government is looking at this, and so Bhutan is pushing for getting any eventual vaccines as a member of the Global Alliance for Vaccines and Immunization (Gavi).
“We are working for vaccine allocation to Bhutan,” said Lyonpo.
Lyonpo said Bhutan has signed a contract with Gavi to be part of the Gavi movement and also a recipient of any vaccines including that for COVID-19.
Gavi is a public-private global partnership that aims to ensure immunization coverage in poor countries.
It brings together donor countries, WHO, developing countries, the vaccine industry, World Bank, UNICEF, research bodies, Bill and Melinda Gates Foundation, private philanthropists and civil society.
The Health Minister said that Bhutan has also indicated its participation in the COVAX Facility as a mechanism designed to guarantee rapid, fair and equitable access to COVID-19 vaccines worldwide.
Under the COVAX Facility 75 countries have pledged to finance the vaccines from their own public budgets and also support 90 other lower-income countries through voluntary donations.
COVAX is co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO, working in partnership with developed and developing country vaccine manufacturers.
The goal of COVAX is by the end of 2021 to deliver two billion doses of safe, effective vaccines that have passed regulatory approval and WHO pre-qualification.
These vaccines will be delivered equally to all participating countries, proportional to their populations, initially prioritising healthcare workers then expanding to cover 20% of the population of participating countries. Further doses will then be made available based on country need, vulnerability and COVID-19 threat.
In addition, in June Gavi launched the COVAX Advance Market Commitment (AMC), a financing instrument aimed at incentivising vaccine manufacturers to produce sufficient quantities of eventual COVID-19 vaccines to ensure access for developing countries. The AMC has already raised close to USD 600 mn against an initial target of USD 2 bn from high income donors as well as the private sector.
The WHO said significant progress has been achieved by the COVAX partners to date, with seven of the nine candidate vaccines supported by CEPI already in clinical trials. A memorandum of understanding with AstraZeneca also commits them to supply 300 million doses of COVID-19 vaccines to COVAX.
Lyonpo said Bhutan is also taking up the issue of future supply of vaccines bilaterally through the Foreign Ministry with Bhutan’s traditional developmental partners. Here the effort is to seek vaccines directly or at least funding to get vaccines.
The Health Minister said this pathway had already been used to secure testing kits.
Lyonpo said that currently most of Bhutan’s vaccines come through UNICEF and so Bhutan’s multilateral partner agencies like UNICEF and WHO will also be used to get the vaccines.
The Health Minister said that various efforts have to be made by Bhutan at the international level too.
She said that once the vaccines come in then it will be prioritized for the more vulnerable groups and the ministry is looking into this. She said priority will be for those who have co-morbid conditions or are disabled which number around 60,000.
She said then priority will also be given for senior citizens and young children under the age of five.
The minister said that a challenge in getting the vaccines maybe the low case load in the country and so Bhutan may not be a priority but still efforts would be made.
Lyonpo said there is no definite time period by when a vaccine will come as it has to finish clinical trials, go through quality assurance and certain other procedures.
She said that the hope is that some vaccines may be available by September or October this year.
The minister said that the government has already allocated funds for the MoH with regard to COVID-19 and once a vaccine comes on the scene Bhutan would use these funds and allocate more resources to secure the COVID-19 vaccines.
A matter of concern for the vaccine development reported by Financial Times is that
a study from King’s College London, which has yet to be peer-reviewed, showed recovered patients’ antibodies declined significantly within months of infection, raising the critical issue of how long a vaccine could prevent people catching the disease.
A faster drop in antibodies could mean more doses of the vaccine may have to be repeated.
The key will to be to see how the antibodies drop or plateau in the longer phase three trials of the vaccine.
The worse case scenario for Bhutan is if there is vaccine hoarding by developed countries and others.