As 172 Countries Join COVAX Vaccine Plan, Malaysia Still Talking To WHO

By Ashswita Ravindran | 18 September 2020

The COVAX Covid-19 vaccine access plan co-led by WHO requires upfront payments from self-financing participant countries.

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KUALA LUMPUR, Sept 18 — Malaysia is still communicating with the World Health Organization (WHO) over a global COVAX Covid-19 vaccine access plan, as the deadline for participation comes up today.

A total of 172 countries have already engaged in discussions to potentially join COVAX that is co-led by WHO — a pooled procurement mechanism for new Covid-19 vaccines that aims to provide participating economies fair and equitable access to vaccines by pooling purchasing power from these nations across a range of candidate vaccines — according to an August 24 statement by COVAX coordinators.

The 172 economies comprise 80 higher-income countries that will finance the Covid-19 vaccines from their own national budgets, while the remaining 92 low- and middle-income countries will receive financial support to access the vaccines. Singapore is part of the 80 higher-income economies, while Asean countries Cambodia, Indonesia, Laos, Myanmar, the Philippines, and Vietnam are among the 92 lower-income countries that will be supported by COVAX. This group of 172 countries represents over 70 per cent of the global population, with representatives from each continent, said COVAX coordinators.

“We are still communicating with WHO,” Health Minister Dr Adham Baba told CodeBlue yesterday, when asked if Malaysia has committed to joining COVAX before the September 18 deadline.

Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib suspects that one of the main reservations that Malaysia, an upper-middle income country, may have with regards to joining the COVAX initiative could be due to funding that has to be provided upfront to finance the global effort in securing a vaccine.

“The government may have decided that it cannot afford to do so, especially since there is no definitive vaccine yet available,” Azrul told CodeBlue.

“To be cautious is good, but Malaysia risks being accused of riding on the coattails and benefitting from the efforts and investment of others, rather than stepping up for the collective good and doing its part.”

The COVAX facility expects large up-front capital to quickly end the acute phase of the coronavirus pandemic, saying that commitments from high-income and upper middle-income countries are needed to procure about 950 million doses through COVAX and to ensure that the vaccines can be delivered as quickly as possible by underwriting manufacturing costs. This is because vaccine manufacturers would be making early, at-risk investments in manufacturing capacity for large-scale production of Covid-19 vaccines. COVAX says US$18.1 billion is needed to cover these manufacturing costs and to procure and deliver the vaccines to low- and middle-income countries.

Besides that, Azrul also pointed out that if it means that Malaysia has to introduce co-pay frameworks for the middle 40 per cent (M40) or top 20 per cent (T20) socioeconomic groups to ensure a better coverage of a vaccine, then it should be done.

“We can’t take the approach of standing back and watching while others take the risk. Our absence in this global solidarity and cooperation will be noted and remembered. But our presence and participation in the initiative will be appreciated.”

Azrul Mohd Khalib, Chief Executive of the Galen Centre for Health and Social Policy

COVAX — coordinated by GAVI, an international vaccine alliance; the Coalition for Epidemic Preparedness (CEPI); and WHO — is a platform that will support the research, development, and manufacturing of a wide range of Covid-19 vaccine candidates that aims to deliver two billion doses of safe and effective vaccines by the end of 2021, which should be enough to protect high risk and vulnerable people, as well as frontline healthcare workers.

The nine candidate vaccines that are currently being evaluated for inclusion in the COVAX facility are as below:

  • Inovio, United States of America: Phase One/Two
  • Moderna, United States of America: Phase Three
  • CureVac, Germany: Phase One
  • Institut Pasteur/Merck/Themis, France/ United States of America /Austria: Preclinical Phase
  • AstraZeneca/ University of Oxford, United Kingdom: Phase Three
  • University of Hong Kong, China: Preclinical Phase
  • Novavax, United States of America: Phase One/Two
  • Clover Biopharmaceuticals, China: Phase One
  • University of Queensland/ CSL, Australia: Phase One

The COVAX Advance Market Commitment (AMC) is a financing instrument that aims to support the participation of 92 lower and middle-income countries, based on the 2018 and 2019 World Bank’s Gross National Income (GNI) data, in the COVAX facility.

Among the participating nations listed as low-income include North Korea, Nepal, Afghanistan, Central African Republic, etc, while countries listed as lower-middle income countries include India, Indonesia, Myanmar, the Philippines, Bangladesh, Cambodia, Egypt, Pakistan, Sri Lanka, and Vietnam, among others.

The 80 higher-income economies will finance the vaccines from their own public finance budget, while 92 low and middle-income countries will be supported by AMC if it achieves its funding targets. The 80 higher-income countries include Australia, Japan, New Zealand, Singapore, United Arab Emirates, the United Kingdom, and many more. The United States and China were not listed.

Australia, among the 80 potentially self-financing countries, has committed AU$80 million (RM241.21 million) to the COVAX facility, despite striking a deal with two Covid-19 vaccine manufacturers — AstraZeneca-Oxford and CSL Limited, an Australian-based biotechnology company — for a total of over 84 million vaccine doses.

STAT reported last September 12 that the development of the AstraZeneca-Oxford Covid-19 vaccine had resumed, four days after the company paused a large UK study. Its Phase Two/Three trial in the UK was halted as one of the participants was suspected to have a serious adverse reaction. However, Oxford University has announced that the adverse reaction that was seen in a volunteer in Britain during the trial was considered unlikely to be associated with the vaccine, as there was insufficient evidence to say for sure if the illnesses were or were not related to the vaccine.

The UK, which has ordered a total of 340 million doses of potential coronavirus vaccines from six manufacturers — the AstraZeneca-Oxford vaccine, BioNTech-Pfizer, Valneva, GSK-Sanofi, Novavax, and Janssen — has also committed to COVAX, calling it as an “insurance policy” in case they don’t benefit from any of the bilateral deals.

Furthermore, Azrul pointed out that the level of urgency to secure a coronavirus vaccine should not be dependent on the number of Covid-19 cases in the country. He also said that an investment should be made into a vaccine with as high coverage as possible to ensure the population is protected from future outbreaks, especially those who are immuno-compromised or unable to be vaccinated.

“It is absolutely necessary for Malaysia to have its own plan ready concerning the procurement, deployment at scale, and sustainability of its Covid-19 vaccine supply.”

Azrul Mohd Khalib, Chief Executive of the Galen Centre for Health and Social Policy

“You can bet that in addition to being part of the COVAX initiative, other countries such as Thailand, Singapore, Australia, and New Zealand have already put together their own plans in readiness to put them into action the moment a viable, safe, and effective vaccine becomes available,” Azrul said.

Channel News Asia reported that Singapore’s approach will be to protect those at higher risk or people who may be more likely to be exposed to infection first, while progressively expanding the coverage to the population, once a Covid-19 vaccine becomes available.

As of September 17, Malaysia has recorded a total of 10,052 positive Covid-19 cases with 128 deaths, much lower than Singapore, which has also participated in the COVAX initiative, with over 50,000 confirmed positive Covid-19 cases and 20 over deaths.

Dr Adham told CodeBlue last September 3 that Malaysia had no plans yet in joining COVAX as he said that Malaysia is waiting for more information on the global plan, pointing out that the current available information and data about the COVAX facility is still unclear, including the implementation of the COVAX facility, clinical data on the vaccine that will be developed by manufacturers, and the governance structure of the COVAX facility, among others.

Malaysian health experts have urged the Ministry of Health (MOH) to get Malaysia to join this global initiative. They pointed out that it could be a difficult task to select a specific pharmaceutical company or a country to make a bilateral agreement with, while stressing that a wrong bet placed could cost the government dearly.

Azrul, like the health experts, also highlighted that there is no guarantee for better results if Malaysia goes it alone or makes separate bilateral deals, as he pointed out that going it alone may be possible for larger countries like the US and China with economies that are able to fund, develop, and produce their own vaccines for their own population.

“It would be dangerous for Malaysia to step out of the umbrella of the COVAX initiative, into an environment where it would be every country for itself,” the Galen chief executive said.

“Why is Malaysia resistant to joining an initiative which is working to ensure equitable access to a Covid-19 vaccine?”

Azrul Mohd Khalib, Chief Executive of the Galen Centre

The Trump administration has firmly said that it will not join COVAX, even though health experts from the US have said that it is a risky gamble taken by the White House as it could limit America’s access to vaccine candidates developed by other countries.

There are currently seven vaccine candidates that have moved into clinical trials with human participants in the US, while three vaccine candidates have moved into the crucial Phase Three development phase. The third and final stage of a vaccine trial is essential to determine the efficacy of the vaccine on if it can prevent infection among participants. The vaccine candidates that are in Phase Three clinical trials include the AstraZeneca-Oxford vaccine and BioNTech-Pfizer vaccine.

China’s CoronaVac vaccine developed by Sinovac Biotech is currently undergoing its Phase Three clinical trial and has reported to have not observed any serious adverse reaction, indicating that the vaccine is safe.

Last month, Science, Technology, and Innovation Minister Khairy Jamalaluddin told the Dewan Rakyat that Malaysia is in talks with China over potential access to a Covid-19 vaccine. However, it was noted that the Covid-19 vaccine from China’s state-owned pharmaceutical company, Sinopharm, could cost US$145 (RM604.51), which is 36 times more expensive than AstraZeneca-Oxford, which is reportedly planning to sell its vaccine at the cheapest price point of US$4 (RM16.71) per dose.

When asked about the consequences that may be seen if Malaysia does not join COVAX, especially in terms of international relations, Azrul said nothing will happen as every country has the right to decide what is in the best interests of its people and countries should not be punished for taking actions independent of the global majority.

However, Azrul did question why Malaysia is not supportive towards an objective to achieve equitable access to vaccines.

“Almost every single country in the world has now signed up to be part of this initiative. Does Malaysia know something that the rest of the world does not?”

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