Image Courtesy of Anadolu Agency
By Katherina Lister
By the end of 2020, Latin America and the Caribbean had over 15 million confirmed cases of COVID-19, causing nearly 500,000 deaths. Despite these disastrous numbers, the end of 2020 brought hopeful news: in December, the Pfizer-BioNTech COVID-19 vaccine finally made its debut in Latin America. The shipment, which arrived in Mexico City, contained 3,000 doses. For a country with a population of over 127 million, this shipment was just a drop in the ocean. Months after this first vaccine milestone in Latin America, there have been numerous challenges in both acquiring and distributing vaccines to the population. These issues have arisen due to troublesome contract negotiations, global shortages, and vaccine nationalism. This pandemic is a shared global tragedy, yet the story of the COVID-19 vaccine supply in Latin America is a poignant reminder of global inequity.
Vaccine Access
In the second week of January 2021, the head of the World Health Organization (WHO), Dr. Tedros Ghebreyesus, stated that 42 countries were currently administering COVID-19 vaccinations. Of these 42 countries, 36 were countries defined as high-income, with the remaining 6 being middle-income ones. These numbers highlight a growing global concern regarding COVID-19 vaccinations: lower-income countries will not be able to vaccinate their population anytime soon due to issues in accessing the vaccines. Richer countries have been rapidly purchasing the world’s supply of vaccines, limiting global supply. In addition, this “vaccine nationalism” has driven up prices, making it increasingly challenging for poorer nations to obtain them.
Imbedded in the process of vaccine acquisition is regulatory approval. Across Latin America there are currently seven vaccines approved for use: AstraZeneca, CanSino, Covishield, Pfizer-BioNTech, Sinopharm, Sinovac, and Sputnik V. However, any given Latin American country has only one or two of these vaccines approved, diminishing the pool of potential vaccines. Furthermore, Western vaccinations are not readily available, leading Latin America to turn to China and Russia for their vaccines. This has allowed China and Russia access to a multibillion-dollar vaccine market previously dominated by the United States. However, some Latin Americans are hesitant about the Chinese and Russian vaccines. A poll by Datafolha taken in December 2020 showed that, in Brazil, 47% of people said they would take the Chinese Sinovac shot, compared to 74% for vaccines made in the US. Nevertheless, this general reluctance towards Chinese vaccines has not had a negative impact on overall uptake considering the shortage of vaccine supply in Latin America.
The main focus for countries now is to form contracts with pharmaceutical companies in order to secure more vaccines in the coming months. In addition, due to the high incidence of coronavirus in the region, many clinical trials for potential vaccines are taking place in Latin America. Therefore, another access route through which the population has been vaccinated is through clinical trials. However, not all of these trials prove effective in widespread vaccination and they can therefore not be relied upon as a means to vaccinate a significant proportion of the population.
Distribution
Added to the difficulties of vaccine acquisition, Latin America faces several barriers distributing the vaccines it does possess. Disorganised infrastructure and inaccessible rural populations help to explain the difficulty experienced in extending the vaccine beyond the urban setting. Many of the approved vaccines must be stored at low temperatures. This leads to issues in areas that do not have the required freezers and equipment. Furthermore, a lack of transparency by governments in the rollout of the vaccine has made it difficult to not only track vaccine quantities, but also to determine who has actually received them. Many Latin American countries have both public and private healthcare infrastructure. Therefore, when the public government takes charge of vaccine contracts, their fragmented logistics are laid bare when it comes time to distribute. This has further damaged distribution and resulted in corruption and the establishment of black markets for vaccines.
By the end of February 2021, the country in Latin America with the highest COVID-19 vaccinations administered per 100 people was Chile at 16.78, according to data taken from Our World in Data. Next in line were Brazil and Panama at 3.67 and 2.07, respectively. The remaining Latin American countries either fell below 2 or had not started administering the vaccine. These statistics demonstrate how most of the Latin American region falls far behind leading Western countries such as the United Kingdom (28.57), United States (20.41), and the European Union (6.82).
It will take time for the vaccine to start to bring life back to normal in Latin America. A threshold for herd immunity in the population must be reached. This is when enough people are vaccinated to provide protection for those who are not. Herd immunity occurs when the disease cannot freely spread amongst the population given a certain percentage of people vaccinated. Jorge Martin Rodriguez, professor of public health policy at Javeriana University in Bogotá, says it will most likely not be until 2022-23 for Colombia to reach the point of herd immunity. With a population of 650 million people, the Latin American region must prepare a long-term plan for the distribution of the vaccine.
Future Success
According to the WHO, it is imperative to have global coordination in vaccine access and distribution. This will prevent new strains from being formed and harboured in different parts of the globe, strains which would otherwise extend the timeline of the pandemic. To address this issue, the WHO has formed a global initiative, COVAX, for equitable access to COVID-19 vaccinations. COVAX is a voluntary plan in which countries can join resources to acquire vaccines. Member countries will also gain help in developing their political and logistical infrastructure to distribute these vaccines. This would allow for a coordinated, global approach to vaccine acquisition and distribution. For countries in Latin America struggling with their vaccination programme, joining COVAX could save hundreds of thousands of lives.
Using the slogan “no one is safe, unless everyone is safe,” the COVAX plan would distribute vaccinations to member countries in proportion to population size. Once a benchmark of 20% of population vaccinated is reached for each member country, a risk profile would be formed. Those countries deemed at high risk of COVID-19 would continue onto further phases of vaccine distribution. Dr. Ghebreyesus of WHO emphasised their message of global coordination saying, “I urge countries that have contracted more vaccines than they will need, and are controlling the global supply, to also donate and release them to COVAX immediately.” Under COVAX, Latin American countries can also continue to engage independently with pharmaceutical companies to provide further vaccines.
Beyond the politics and contract negotiations, regardless of where these vaccines come from, they save lives. Latin American countries are desperate for more vaccines as the pandemic wreaks havoc on political stability, corruption, food insecurity, and national health programmes. Plans such as COVAX, further contract negotiations, and infrastructure development can help Latin America improve its COVID-19 vaccine effort to help slow the pandemic in the region.
Katherina Lister is a fourth-year Medical student at King’s College London. Half-Colombian, Half-American, she is passionate about access to medicine in Latin America and the Latinx community of the United States.
