London — Trial successes from Pfizer and Moderna have buoyed hopes that a Covid-19 vaccine is coming soon. But much of the world, beyond rich nations such as the US, is counting on another company’s shot to escape the crisis.

Findings from the final stage of AstraZeneca’s vaccine studies are due to be released shortly, and the stakes for lower- and middle-income nations are immense. The shot developed with the University of Oxford accounts for more than 40% of the supplies going to those countries, based on deals tracked by London-based research firm Airfinity.

The Astra vaccine costs a fraction of the price set by Pfizer and will be manufactured in multiple countries, from India to Brazil. It should be easier to deploy far and wide than other shots that need to be stored at ultra-cold temperatures. But if the UK partners can’t match the lofty efficacy levels Pfizer and Moderna delivered or roll out their inoculation quickly, the pandemic might continue spreading death and disease in countries relying on it.

“There’s a lot riding on the Astra vaccine,” said Suerie Moon, co-director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva. For lower-income countries, “it’s huge”.

Pfizer applied on Friday for an emergency use authorisation in the US, and may begin the rollout in mid-December. While wealthy nations are in a position to receive the first supplies of the Pfizer and Moderna shots thanks to large quantities they’ve snapped up in advance, most regions are depending heavily on companies following the front-runners, especially AstraZeneca, Novavax and Johnson & Johnson. Supplies are likely to struggle to meet demand in the months after vaccines arrive, raising concerns about global access.

“The vast majority of the global population live in low- and middle-income countries,” said Mark Eccleston-Turner, a law and infectious disease specialist at Keele University in England. “It’s not just a problem for people over there, far away from us. This is a problem for most people in the world.”

A global programme called Covax has made strides in an ambitious effort to deploy future vaccines equitably around the world, getting dozens of countries to join and securing deals for 700-million doses so far.

AstraZeneca reached an agreement to supply the initiative, while a collaboration including the Serum Institute of India agreed to accelerate the production of Astra or Novavax shots for low- and middle-income nations, priced at a maximum of $3 per dose, with an option to secure more. A Covax pact with Sanofi and partner GlaxoSmithKline followed last month.

The programme is led by the World Health Organisation; the Coalition for Epidemic Preparedness Innovations; and Gavi, the Vaccine Alliance. It expects more deals in the coming weeks. Pfizer and BioNTech, along with Moderna, remain in talks with Covax.

AstraZeneca has easily been the most active in reaching supply accords. Of all the volumes committed globally, almost a third — about 3.2-billion doses — are set to come from the UK company, according to Airfinity. More than 50 lower- and middle-income countries would receive Astra and Oxford’s shot in regions including Latin America, Africa, the Middle East, Asia and Eastern Europe, along with wealthy governments too, the research group found.

If the vaccine is successful, fulfilling that demand won’t be easy. In the UK a shortfall in supplies of the shot expected by the end of the year casts doubt on how swiftly AstraZeneca will be able to immunise the public. Yet the company has said it’s confident it can begin supplying hundreds of millions of doses on a rolling basis once it gains approval.

One of the main factors behind the reliance on the Astra-Oxford vaccine is the initial price. Astra has said it won’t profit during the pandemic and the vaccine will cost between $4 and $5 a dose, though health advocates worry what the company and others will charge when the crisis is deemed over.

The US agreed in July to obtain the Pfizer and BioNTech vaccine in a deal that sets the price at $19.50 a dose, or $39 for a two-shot immunisation, a level BioNTech said could become a benchmark for developed nations. Moderna said it’s charging $32-$37 a dose for smaller deals and less for bigger purchases.

“Those prices really risk putting vaccines out of reach for a lot of the world,” said Margaret Wurth, senior researcher at Human Rights Watch in New York.

Astra-Oxford has advantages beyond cost when it comes to the rollout in low- and middle-income countries. The global scope of manufacturing eases worries about countries restricting exports, and the product should be easier to transport and store, according to Eccleston-Turner.

The jab can be kept at refrigerator temperatures, while those from Pfizer and Moderna, based on novel messenger RNA technology, require freezing for longer-term storage and transport.

That’s why so many countries are eagerly awaiting the Astra results and focusing on the next candidates, including those from China. Russia also plans to produce the Sputnik V vaccine in other countries such as India and Brazil.

“All of the wealthy countries are now fairly well positioned,” said Moon. For developing countries, “it’s not as if they have been sitting back and saying we’ll see what trickles down to us. They’ve been aggressively pursuing what they can with the means at their disposal.”



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