Reserving coronavirus disease 2019 vaccines for global access: cross sectional analysis

Abstract

Objective: To analyze the premarket purchase commitments for coronavirus disease 2019 (covid-19) vaccines from leading manufacturers to recipient countries.

Design: Cross sectional analysis.

Data sources: World Health Organization's draft landscape of covid-19 candidate vaccines, along with company disclosures to the US Securities and Exchange Commission, company and foundation press releases, government press releases, and media reports.

Eligibility criteria and data analysis: Premarket purchase commitments for covid-19 vaccines, publicly announced by 15 November 2020.

Main outcome measures: Premarket purchase commitments for covid-19 vaccine candidates and price per course, vaccine platform, and stage of research and development, as well as procurement agent and recipient country.

Results: As of 15 November 2020, several countries have made premarket purchase commitments totaling 7.48 billion doses, or 3.76 billion courses, of covid-19 vaccines from 13 vaccine manufacturers. Just over half (51%) of these doses will go to high income countries, which represent 14% of the world's population. The US has reserved 800 million doses but accounts for a fifth of all covid-19 cases globally (11.02 million cases), whereas Japan, Australia, and Canada have collectively reserved more than one billion doses but do not account for even 1% of current global covid-19 cases globally (0.45 million cases). If these vaccine candidates were all successfully scaled, the total projected manufacturing capacity would be 5.96 billion courses by the end of 2021. Up to 40% (or 2.34 billion) of vaccine courses from these manufacturers might potentially remain for low and middle income countries-less if high income countries exercise scale-up options and more if high income countries share what they have procured. Prices for these vaccines vary by more than 10-fold, from $6.00 (£4.50; €4.90) per course to as high as $74 per course. With broad country participation apart from the US and Russia, the COVAX Facility-the vaccines pillar of the World Health Organization's Access to COVID-19 Tools (ACT) Accelerator-has secured at least 500 million doses, or 250 million courses, and financing for half of the targeted two billion doses by the end of 2021 in efforts to support globally coordinated access to covid-19 vaccines.

Conclusions: This study provides an overview of how high income countries have secured future supplies of covid-19 vaccines but that access for the rest of the world is uncertain. Governments and manufacturers might provide much needed assurances for equitable allocation of covid-19 vaccines through greater transparency and accountability over these arrangements.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: ADS received support from the Innovation+Design Enabling Access Initiative at the Johns Hopkins Bloomberg School of Public Health; the Johns Hopkins Alliance for a Healthier World; and the Open Society Foundation. JW was supported as a Global Health Equity Scholar under the Johns Hopkins Alliance for a Healthier World. Outside of the submitted work, both authors have provided unpaid advisory input to the Pan American Health Organization’s Revolving Fund for Access to Vaccines and have previously received grants for unrelated work from the World Health Organization within the past three years.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Fig 1

Premarket commitments for coronavirus disease 2019 vaccines, per capita. Vaccine courses are assumed to require two doses, except for CanSino, which proposes to be one dose per course. Johnson & Johnson/Janssen’s vaccine candidate is being tested for both a one dose and two doses course, but for purposes of this study’s analysis, is assumed to be a two dose course vaccine. The vaccine courses for the European Union include premarket purchase commitments not only by the European Union but also by the European Inclusive Vaccines Alliance

Fig 2

Projected manufacturing capacity by end of 2021 of lead companies producing coronavirus disease 2019 vaccines. Vaccine courses are assumed to require two doses, except for CanSino, which proposes to be one dose per course. Johnson & Johnson/Janssen’s vaccine candidate is being tested for both a one dose and two doses course, but for purposes of this study’s analysis, is assumed to be a two dose course vaccine. CEPI=Coalition for Epidemic Preparedness Innovations

Fig 3

Estimated remaining courses of coronavirus disease 2019 (covid-19) vaccines. The number of reserved covid-19 vaccine courses is estimated fom the sum total of publicly known, premarket purchase commitments made by that vaccine manufacturer. The remaining covid-19 vaccine courses are estimated against the target manufacturing capacity set by vaccine companies by the end of 2021. *The projected manufacturing capacity for both SinoVac and CanSino are combined here to represent China’s overall publicly disclosed manufacturing capacity of at least one billion doses. Individual manufacturing capacities for SinoVac and CanSino are not known publicly