Vaccine politics could end up nudging countries in the region even deeper into China’s orbit. As vaccines fail to materialise in many countries, doctors turn to cheap, widely available off-patent drugs such as Ivermectin.
It is a time-honoured custom of business that manufacturers provide certain basic guarantees to prospective buyers about their product’s quality and safety. But U.S. pharma giant Pfizer wants to turn this on its head as it sells its experimental mRNA vaccine to desperate governments around the world. For Pfizer, it’s the buyer — not the seller — that should provide all of the guarantees. And that includes countries putting up sovereign assets, such as federal bank reserves, embassy buildings and military bases, as insurance against the cost of any future legal cases involving Pfizer BioNTech’s vaccine, reports the Bureau of International Journalism (TBIJ):
In the case of one country, demands made by the pharmaceutical giant led to a three-month delay in a vaccine deal being agreed. For Argentina and Brazil, no national deals were agreed at all. Any hold-up in countries receiving vaccines means more people contracting Covid-19 and potentially dying.
Officials from Argentina and the other Latin American country, which cannot be named as it has signed a confidentiality agreement with Pfizer, said the company’s negotiators demanded additional indemnity against any civil claims citizens might file if they experienced adverse effects after being inoculated. In Argentina and Brazil, Pfizer asked for sovereign assets to be put up as collateral for any future legal costs.
One official who was present in the unnamed country’s negotiations described Pfizer’s demands as “high-level bullying” and said the government felt like it was being “held to ransom” in order to access life-saving vaccines.
Campaigners are already warning of a “vaccine apartheid” in which rich Western countries may be inoculated years before poorer regions. Now, legal experts have raised concerns that Pfizer’s demands amount to an abuse of power.
“Pharmaceutical companies shouldn’t be using their power to limit life-saving vaccines in low- and middle-income countries,” said Professor Lawrence Gostin, director of the World Health Organization’s Collaborating Center on National and Global Health Law. “[This] seems to be exactly what they’re doing.”
Protection against liability shouldn’t be used as “the sword of Damocles hanging over the heads of desperate countries with a desperate population,” he added.
Nine Latin American countries have so far agreed to buy vaccines from Pfizer: Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru, Uruguay and the Dominican Republic. The terms of these deals are unknown since all of the deals included a confidentiality clause. In the case of Argentina, the government acceded to almost all of Pfizer’s demands. But it insisted that Pfizer pay out in the event of negligence. Even that was a bridge too far for the drug maker.
It’s not unusual for governments to exempt companies of some degree of liability for the vaccines they manufacture. Since manufacturers develop the vaccines quickly and on a massive scale, governments often agree to cover some or all of the cost of compensation.
If a citizen suffers serious side effects after being vaccinated, they can file a claim against the manufacturer. If successful, it’s the government — not the company — that ends up paying the compensation. Getting paid is often easier said than done, however. Attorneys in the U.S. say that less than 6% of the claims filed in the past decade resulted in payouts.
But what Pfizer is after — and is presumably securing from many of the countries that sign on the dotted line — is additional indemnity from civil cases, says Gostin:
“[T]he company would not be held liable for rare adverse effects or for its own acts of negligence, fraud or malice. This includes those linked to company practices – say, if Pfizer sent the wrong vaccine or made errors during manufacturing.
“Some liability protection is warranted, but certainly not for fraud, gross negligence, mismanagement, failure to follow good manufacturing practices. Companies have no right to ask for indemnity for these things.”
Some may argue, in Pfizer’s defence, that it did not participate in the U.S. government’s “Warp Speed” vaccine initiative. Therefore it did not receive up-front federal funding for its research. As a private company, it is well within its rights to set whatever terms it wants in its negotiations with national governments.
But these arguments are largely spurious. Pfizer did have an advance purchase agreement with the U.S. government worth $1.95 billion, which will have covered most, if not all, of the research costs. On top of that, Pfizer’s vaccine partner, BioNTech, received €375 million in subsidies from Germany’s Ministry of Health. Perhaps most important of all, Pfizer’s total abdication of responsibility for its own acts of negligence, fraud, mismanagement or failure to deliver does not inspire confidence. And given Latin America is one of the regions worst hit by Covid, the optics could not be worse.
A Big Boon for Other Vaccine Manufacturers
Some nations in the region are looking elsewhere for supplies, in particular to Russian, Chinese and British-Swedish manufacturers.
- In December, Brazil’s Senate approved the purchase of 100 million doses of the AstraZeneca-Oxford vaccine, which are set to arrive in the first half of 2021. National health regulator Anvisa has also approved a second request for emergency use of Chinese firm Sinovac’s shot, to be produced locally.
- Argentina has agreed to purchase 22 million doses of the AstraZeneca-Oxford vaccine. Most of them will be produced domestically. An Argentinean lab is churning out 18 million doses a month of the vaccine, reports El País. But they cannot be used yet due to lack of basic supplies, such as filters, sterile bags and vials, at the Mexican laboratory responsible for finishing the product. Argentina is also hoping to purchase 10 million doses of the Russian-produced Sputnik V vaccine.
- Mexico has struggled to secure an adequate supply of vaccines. The flow slowed to a trickle in early February 2021, largely due to a slowdown in shipments of supplies. Pfizer has so far delivered none of the 34 million doses Mexico has reserved. Mexico is also awaiting the arrival of 24 million doses of Sputnik V, 35 million doses of the Sinovac vaccine and is also hoping to finally begin production of the AstraZeneca vaccine in the coming weeks. To date the country has approved five vaccines — Pfizer, AstraZeneca, Sputnik V, CanSino, and SinoVac — but as of February 8 had only administered 718,000 doses.
Five LatAm countries — Uruguay, Salvador, Guatemala, Honduras and Cuba — still hadn’t received a single vaccine from overseas as of last week, according to the BBC. Cuba has produced its own vaccine, dubbed Soberana 02, which is currently waiting for domestic approval.
At least 10 Latin American countries have signed contracts with AstraZeneca. The Russian Direct Investment Fund has also reached agreements with at least six Latin American countries to supply more than 60 million doses of Sputnik V. Other countries have said they are considering both Sputnik V and the Sinovac vaccine, not just because they are cheaper and easier to store but also due to the less onerous contractual terms.
As such, vaccine politics could end up nudging countries in the region even deeper into China’s orbit. China is already the most important trade partner for four South American economies: Brazil, Chile, Peru, and Uruguay. For the British-Swedish firm Astra Zeneca Pfizer’s scandalous sales practices could also represent a much-needed fillip after its own recent trials and tribulations trying to sell its product in the EU as well as the trouble it’s been having at its factory in India.
In the meantime, as Latin America waits for the vaccines to materialise, doctors in the region have turned to cheap, widely available drugs that have shown promising results in the treatment of Covid. They include Ivermectin, a “well-studied, well tolerated,” (in the words of an FT article from 2013) off-patent anti-parasitical. According to a meta-analytical breakdown of 18 studies, the drug could cut the number of deaths from Covid-19 by as much as 75%.
But the jury is still out. Many front-line doctors want to prescribe it but healthcare bureaucrats are dragging their feet. But in Latin America there are always ways of getting around things.
In Argentina Ivermectin has been widely used in some provinces despite still awaiting national approval. In January, the Secretariat of Health of Mexico City and Mexico’s Institute of Socal Security (IMSS) allowed Ivermectin to be prescribed to outpatients with Covid. Ivermectin, the Secretariat said, had significantly reduced patients’ viral load, with very few adverse effects. A day later, an official group of health experts condemned the decision, arguing that there’s no scientific evidence that the drug is effective, and called for its immediate repeal.
To their credit, both the Secretariat and IMSS have stuck to their guns. With virtually no vaccines currently available, what alternatives are there anyway?