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Bhutan’s vaccine strategy focuses on COVAX facility, Indian manufacturing and international procurement

With a large number of Community Transmission cases in Thimphu and Paro and cases also found in Punakha, Wangdue, Bumthang, Dagana, Haa, Trongsa there is now an even greater urgency to get the vaccine.

Health Minister says Bhutan going for any vaccine available

Health Minister Dasho Dechen Wangmo said that given the global situation of many countries competing to get vaccines Bhutan has no choice to choose a particular vaccine over others be it Pfizer, Moderma or the recently approved Oxford-AstraZeneca one.

She said that Bhutan has to get its hands on whatever it can get and so the country has to be prepared to receive any of the above three or all three vaccines.

She said for example if Bhutan is getting the Pfizer vaccines then the JDWNRH and the two regional referral hospitals already have the deep freezers required to store it at very cold temperatures (-70 degree centigrade) and if the freezers technically cannot be deployed further then the frontline people could get that vaccine in these places.

Lyonpo said that in her Wednesday meeting with the National Immunization and Technical Advisory Group (NITAG) team members she asked them to do an assessment of the vaccines and prioritize.

She said that the main focus apart from getting the vaccine is the implementation process and the infrastructure in place to roll it out.

Lyonpo said that a draft plan will be ready on the above in terms of vaccines and their roll out keeping in mind the international developments and this plan will then be approved.

In terms of vaccine procurement, the minister said that it may be a mix of the government procuring it directly and also getting it through the UNICEF since all of Bhutan’s vaccines come through UNICEF. She that in case of the COVAX facility the drugs would probably come via the UNICEF too.

Bhutan has registered with the Global Alliance for Vaccines and Immunization’s (GAVI’s) COVAX facility and Bhutan will be getting vaccines for 20% of our population through it. This is however contingent to the GAVI’s operationalization or activation of the COVAX facility.

The minister said that in terms of the finances for the vaccine the Finance Minister has prioritized resources.

When asked if everyone in Bhutan would be vaccinated the minister said it will depend on how much vaccines Bhutan can get. She said that whenever vaccines come in it will be given as per the phase 1, 2 and 3 based on priority.

She said that as of now vaccines will not be given for children of the age 12 and below as the medical literature on this is not yet out.

The Health Minister in an online meeting with the Vaccines Preventable Disease Program under the Ministry of Health (MoH), on Wednesday got an update on Bhutan’s engagement in the COVAX facility – a mechanism to secure COVID-19 vaccines through the support of Global Alliance for Vaccine and Immunization (GAVI) led triple alliance – and at the same time to chart plans for the COVID-19 vaccination framework and strategy.

The minister tasked the team to technically advise and work on the vaccination modality.

The immunization and vaccine program of the ministry was directed to expedite the procurement process and put in place the cold chain and transportation systems that would be necessary for a smooth vaccination program once the vaccine arrives in the country.

Lyonpo tasked the NITAG and VPDP to closely follow the developments regarding the AstraZeneca vaccine which is being developed by Oxford University and AstraZeneca in partnership with the Serum Institute of India which has been approved for mass use by the government of UK.

The minister told The Bhutanese that she had asked them to follow up on this vaccine as this vaccine is a part of the COVAX facility.

India and global procurement

The Transparency Advisory Group (TAG) under the Ministry of Health said that Bhutan is doing everything it can to get the vaccines as soon as they are available on a large scale in the market.

TAG said that very few countries have started formal vaccinations and as of today, no vaccine has been identified to be brought into the country.

“Nevertheless, we are quite ahead and ready to get any vaccines when available globally,” said TAG.

The TAG said that Bhutan is also keeping an eye on the vaccine related developments in India. “We will be engaging our diplomatic channels with India as soon as they have a vaccine produced to inoculate their population,” it said.

An advantage for India is that it is the world’s largest manufacturer of vaccines and its companies like Serum Institute of India will be pumping out millions of doses for global companies. 

The Oxford-AstraZeneca vaccine which received approval from the UK government on Wednesday is being mass produced in the Serum Institute of India with already 50 mn doses ready and the capacity to produce a 100 mn doses a month by February 2021.

The vaccine is not only much cheaper than the Pfizer vaccine, but also much easier to transport and refrigerate making it easier to use in developing countries.

TAG said that the global timeline for the vaccine was declared as mid-2121 earlier and as of now there hasn’t been any update on it. 

However, the TAG is uncertain when the COVAX vaccines will arrive not just for us but also for the entire world.

Apart from COVAX TAG said that because there is a global demand for it, sticking to a particular brand would only entail more procurement and logistics issues. Therefore, Bhutan is open to procuring all that are accredited by the COVAX Facility. 

Bhutan had paid advance money to a South Korean company for test kits and it is assumed that a similar strategy will be in place for vaccines where Bhutan will have to place advance orders and make advance down payments.

COVAX gets 2 bn doses lined up

In an important development on the COVAX Facility front the organization has recently lined up nearly two billion doses of several promising vaccine candidates, and laid the groundwork for further doses to be secured through contributions from donors.

These agreements mean that all COVAX’s 190 participating and eligible economies will be able to access doses to protect vulnerable groups in the first half of 2021.

At least 1.3 billion donor-funded doses will be made available to 92 economies eligible for the Gavi COVAX AMC, targeting up to 20% population coverage by the end of the year. Bhutan would come under the 92 countries category.

The recent announcement by COVAX on deals and dose-sharing mean COVAX can plan for the first deliveries of vaccines in the first quarter of 2021, with the first tranche of doses – enough to protect health and social care workers – delivered in the first half of 2021 to all participating economies who have requested doses in this timeframe.

This would be followed by further delivery of doses to all participants in the second half of the year – targeting supply of doses equaling up to 20% of participants’ populations (or a lower amount if requested by the participant) by the end of the year. Additional doses to reach higher coverage levels will then be available in 2022. 

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 met its urgent 2020 fundraising target of US$ 2 billion, but at least US$ 4.6 billion more is needed in 2021 to procure doses of successful candidates as they come through the portfolio. 

The last two weeks have seen a number of pledges made to Gavi for the COVAX AMC, bringing the overall amount raised to US$ 2.4 billion.

In an interview to the paper in July this year the Health Minister Dasho Dechen Wangmo 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 Dasho Dechen Wangmo said this pathway had already been used to secure testing kits.

Lyonpo had 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.

Earlier Clinical microbiologist and Technical Advisory Group member, Dr Tshokey said some vaccines like Pfizer/BioNTech requires minus 70 degree freezers which even if the government buys, will be logistically very difficult and although COVID-19 vaccines are all competent, it will be hard to know which one will make good impression on the public or will have a good market.

The ministry and the government are assessing the effectiveness and practicality of the vaccines.

Dr Tshokey had said to protect the community, 100 percent vaccination is not required. If at least 65-75 percent of the population are vaccinated, then the rest will be protected through community protection.

Vaccine in phases

Ministry of Health is ready with approved guidelines as to how COVID-19 vaccine will be allocated in the country when the vaccine comes. The vaccines will be given in four phases.

Phase 1 will be health workers, active frontlines, elderly population and those with diseases. Phase 2 is passive frontliners (media), students of 12 years and above and staff of schools and colleges. Phase 3 is pregnant women and children less than 12 years. Phase 4 is rest of the population.

The Pfizer vaccine has already received emergency use authorization with UK as the first country on 2nd December followed by others like, Bahrain, Canada, Saudi Arabia, Mexico and Israel which has already innoculated around 12 percent of its population. 

The European Union on 21st December gave official approval for BioNTech and Pfizer vaccine to be used across the 27-nation bloc, after the European Medicines Agency said the vaccine meets safety and quality standards.

Singapore received its first shipment of COVID-19 vaccines on Dec 21 making it the first country in Asia to take in the vaccine developed by Pfizer and BioNTech.

India’s Drug Controller on 3rd January approved two applications before it which are vaccines developed by Oxford University and AstraZeneca (Covidin) and another called ‘Covaxin’ developed by Bharat Biotech and the Indian Council of Medical Research (ICMR).

However,  ‘Covaxin’ has not completed phase 3 trials.

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