Will Pakistan get enough COVID-19 vaccines?

“If we are lucky to find a vaccine at $6-10 per dose, we would need a total of $540 to 900 million to acquire 90 million doses. Notwithstanding the existing allocation of $150 million and some vaccines as aid, it means that we are going to need much more money.”

Will Pakistan get enough COVID-19 vaccines?

Before we answer this question, we need to know how many vaccines we need. Pakistan has set a target to vaccinate 70 million people, out of its population of more than 220 million, to achieve “herd immunity”. Most of the COVID-19 vaccines in the market require two doses to be administered to each person. This means that we need at least 140 million doses, not taking into account any wastage.

The next question we should ask is how many different vaccines there are in the market. So far, at least seven vaccines have been approved, out of which five have been approved for use outside their country of approval, including those by Pfizer, Moderna, Oxford-AstraZeneca, Sinopharm and Sputnik V. A number of other vaccines are in advanced stages of approval, including those by Johnson & Johnson, Novovax, CanSino and Bharat Biotech.

Pakistan’s choice of vaccine will depend on three factors: price, storage and transportation requirement, and availability.

The approximate per-dose price for Pfizer is $20, Moderna $10-50 (depending upon the quantity ordered), for Sputnik V less than $10, and for AstraZeneca $3-4. The price of Sinopharm’s vaccine is unknown but news reports suggest around $145 for two doses (or roughly $72.5 per dose). The price of Sinopharm seems excessive and it is not clear if Pakistan can get a discounted rate.

The vaccines by Pfizer and Moderna need ultra-low temperatures to be stored. For instance, Pfizer’s vaccine needs to be stored at -75˚C, whereas that of Moderna needs -20˚C. This poses a serious challenge for developing countries like Pakistan, which have unreliable or mostly absent cold chains. Therefore, this handicap would prevent the wide usage of these vaccines in Pakistan. On the other hand, the Russian and Chinese vaccines as well as the one by AstraZeneca can be stored at standard refrigerator temperatures, making them much more suitable for us.

The availability of vaccine, however, poses the most significant challenge. The manufacturers of all these vaccines have mostly booked their entire capacity for 2021 already. Some of them are now planning to further ramp up their capacity very quickly. Even the companies that are still in the final stage of vaccine trials have started to book orders from customers around the world.

Looking at price and storage requirements, the Oxford-AstraZeneca vaccine seems to be the most suitable choice for Pakistan. However, AstraZeneca has gone into a partnership with Serum Institute of India for the supply of this vaccine to our entire region – South Asia. There is no reason to believe that Serum Institute would not prioritise Indian requirements over export orders. The rivalry between India and Pakistan is not going to help either. Sources suggest that while Serum Institute has indicated availability of the vaccine for exports by the third quarter of 2021, the volume that it would be able to provide to Pakistan remains unclear. There is also a chance that this stipulated timeline is not followed.

This leaves Pakistan with the Chinese and Russian vaccines only.

Incidentally, this is not a Pakistan-specific problem and instead a challenge faced by all low-income countries, which are struggling to acquire sufficient quantities of vaccine. Out of a total of 7.2 billion doses booked so far, 5.2 billion have been booked by high or upper middle-income countries, whereas 2 billion doses have been booked by lower middle-income countries, including 1.5 billion by India alone. So far, the low-income countries have booked no significant volumes of the vaccine.

Nevertheless, it does not absolve the state of its responsibility to provide enough vaccines for its citizens and that too in a timely fashion.

What has Pakistan done so far in this regard?

We have so far adopted a three-pronged strategy. Firstly, we have joined the COVAX alliance, which is aimed at facilitating equitable access to COVID-19 vaccine. Secondly, the government is developing its own plan to acquire the vaccine and administer it through the public sector healthcare system. And lastly, the government has allowed the private sector to import the vaccine so that they can also provide them to those who can afford.

COVAX is an alliance formed through efforts of the UN, WHO and GAVI. The Alliance is planning to make 2 billion doses available by the end of 2021 for high-risk and vulnerable populations. Out of this, 1.3 billion doses will be financed by donors and provided to 92 low and lower-middle income countries including Pakistan, targeting up to 20 per cent of their population, while the rest of 700 million doses will be made available to 80 wealthier nations that have joined COVAX, on a self-financed basis. Although COVAX, owing to its sheer size, has been able to secure some sizeable contracts for vaccine supply, it is not clear if it will be able to meet its ambitious target within the stipulated time. So far, COVAX has committed 50 million doses to Pakistan, which still leaves us with another 90 million doses to procure to meet the target of 140 million vaccine doses.

For government’s own vaccine procurement, Pakistan has so far allocated $150 million to provide vaccines for the most vulnerable 5 per cent of the population. Reportedly, the government is also negotiating with development partners to get another $100 million. So far, the government has only confirmed booking for one million doses of the Sinopharm vaccine. In addition, China has also announced providing 0.5 million doses to Pakistan free of cost. These 1.5 million doses would be enough only for 750,000 people or 1 per cent of the targeted population.

The price of the Chinese contract is unknown but if it’s anywhere close to $72.5 for a dose, then it would have taken $72.5 million or almost half the allocated amount. If, however, the Chinese have given the vaccine on a discount, it might have left us with more money.

Although the government’s permission to allow private sector import of the vaccine is a good step, it is unlikely that the private sector would get a significant vaccine supply in 2021.

If we are lucky to find a vaccine at $6-10 per dose, we would need a total of $540 to 900 million to acquire 90 million doses. Notwithstanding the existing allocation of $150 million and some vaccines as aid, it means that we are going to need much more money.

Pakistan needs to act fast, mobilise financing and secure supply contracts from Chinese, Russians and those manufacturers that are in advanced stage of trials to get a timely supply of the vaccine. Then comes the challenge of vaccinating the massive target of 70 million people.

In short, Pakistan may get enough vaccine, but it is likely to take more than a year. Given the current situation, it seems that Pakistan is not likely to meet its vaccination target before the second half of 2022.