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Time to discuss COVID-19 vaccine allocation priorities, Gates says

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As industry, academic groups and governments accelerate the development of COVID-19 vaccines there is a need to come to agreement on the allocation of limited supplies, Bill Gates said Thursday.

In a public note, Gates said it will cost billions of dollars to manufacture COVID-19 vaccines and suggested that the investments should be made before safety and efficacy has been demonstrated.

The Bill & Melinda Gates Foundation is “working with CEPI, the WHO, and governments to figure out the financing,” Gates wrote. CEPI, the Coalition for Epidemic Preparedness Innovations, is funding nine COVID-19 vaccine development programs.

He did not reference a commitment he made April 3 on “The Daily Show” to finance vaccine manufacturing at-risk. “Even though we’ll end up picking at most two of them, we’re going to fund factories for all seven, just so that we don’t waste time in serially saying, ‘OK, which vaccine works?’ and then building the factory,” Gates said on the television program. Gates Foundation officials have declined to provide any information about the commitment.

“The reality,” Gates wrote, “is that not everyone will be able to get the vaccine at the same time. It’ll take months -- or even years -- to create 7 billion doses (or possibly 14 billion, if it’s a multi-dose vaccine), and we should start distributing them as soon as the first batch is ready to go.”

“The reality is that not everyone will be able to get the vaccine at the same time.”

Bill Gates

The EU, European governments, Japan and countries in Latin America, Africa and Asia -- but not the U.S. or China -- have signed onto a pledge to make vaccines available globally on an equitable basis. They have not, however, agreed on principles for allocating vaccines when supplies are limited, or made specific commitments (see “Europe, Japan to Pledge $3B for COVID-19 Vaccines, Promise Equitable Global Access”).

Gates noted that there is broad agreement that health workers should get vaccines first, but there is no consensus on who should be second or third in line.

He proposed that low-income countries should be among the first to receive COVID-19 vaccines “because people will be at a much higher risk of dying in those places.”

Gates noted that vaccine manufacturers usually “sign a deal with the country where their factories are located, so that country gets first crack at the vaccines.” He added that it is “unclear if that’s what will happen here” and expressed the hope that mechanisms can be found to make COVID-19 vaccines available to the whole world on an equitable basis. He also expressed support for Gavi, the Vaccine Alliance, a public-private partnership that distributes vaccines to developing countries.

It is not only fair, but it is in the self-interest of wealthy countries to ensure equitable access to vaccines so that poor countries don’t become safe havens for the virus, Seth Berkley, CEO of Gavi, asserted in a commentary published in The New York Times.

The world cannot rely on production from wealthy countries, according to Berkley. “What we will need,” he wrote, “is a technology transfer to manufacturers around the world if we have any hope of having adequate quantities and global access.”

At least one developing country manufacturer, The Serum Institute of India Pvt. Ltd., has committed to manufacture large quantities of COVID-19 vaccines and make them available to the developing world at low prices (see “India Emerging as Major COVID-19 Vaccine Manufacturer”).

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