The plague of vaccine nationalism

Pfizer vaccine  / Photo: Company website

Salesforce GM & Chief Medical Officer Dr. Ashwini Zenooz tells "Globes" about efforts to bring Covid-19 vaccinations to the world's developing countries.

In Israel, the US, and Europe, the Covid-19 vaccination drive has begun, and with it the countdown to the day when enough people would have been be vaccinated, so that we can remove our masks and return to normal. But what about the rest of the world? Some will use the Russian vaccine and other the Chinese vaccine and some will just have to wait in line. In order to speed up the day when the entire world has been inoculated, the global vaccine coalition GAVI has been formed.

The organization, designed to secure vaccines for the entire world, was established in 2000. The goal was to raise resources from wealthy countries to bring vaccines to the less wealthy countries. Partners in the project are the World Health Organization (WHO), UNICEF, the World Bank, the international pharmaceutical companies and local pharmaceutical companies in the participating countries, the Bill and Melinda Gates Foundation, and other philanthropists. However, most of the money comes directly from the governments of countries in the developed world. The organization also makes no secret of the fact that it sometimes exploits election campaigns to harness the cooperation of contestants in the target countries, which are supposed to administer the vaccines.

A product difficult to obtain, even for wealthy countries

GAVI is currently leading the COVAX project, for an equitable distribution of the Covid-19 vaccines. This project is unique because for the first time it is a product that even wealthy countries must work hard to obtain. The aim was to mobilize all countries to create a common pool of vaccines, which would be distributed equally to risk groups around the world, and only then to other groups according to a combination of need and ability to pay. The project also seeks to encourage the vaccine producers to allow local manufacturers in the less affluent countries to produce the vaccines themselves, in exchange for revenue royalties. Most countries worldwide (including Israel, but not including the US) are participating in the project and have allocated budgets for it according to their size and economic capacity. In the end, most wealthy countries (including Israel) decided to agree their own direct contracts with the vaccine manufacturers and reserve 90% of vaccine stocks through 2021.

GAVI has meanwhile raised $150 million to obtain vaccines for 92 countries with lower purchasing power. Although it does not currently have approved vaccines, GAVI told "Globes" that it is in talks with several vaccine manufacturers.

If and when GAVI succeeds in purchasing vaccines for the participating countries, Israel will also be entitled to benefit from the vaccine database, but this will probably not be necessary after sufficient vaccine doses have already been reserved for the majority of the country's population from Pfizer and Moderna.

From a human resources system to medicine

Two weeks ago, US cloud-based software company Salesforce announced that it would provide GAVI with its management system, through the Work.com platform that it launched last May. "We set up the Work.com platform to help businesses during Covid-19," said Dr. Ashwini (Ash) Zenooz, GM & Chief Medical Officer at Salesforce.

Work.com was launched in 2012 as a platform for human resources managers. In 2015, the system was replaced with other systems, but Salesforce still held the original software and no less importantly, the name of the attractive domain, and it decided to use it for everything related to getting back to work during the Covid-19 pandemic.

The platform has been used by medical and non-medical organizations to perform epidemiological examinations, to manage shift work, to manage volunteer activities, to monitor employee's health, and to conduct employee retraining. For medical organizations, specific applications have been proposed such as monitoring tests, inventory management of medical protective equipment, and more.

Last September, Dr. Zenooz was asked to apply the platform for vaccine management. "There are already 15 customers of the system in the US, and now the GAVI coalition will also use it. The organization has been our customer for many years and we are helping them to distribute the vaccines around the world We will now also do that for the Covid-19 vaccines."

What should a technological platform for vaccines include?

"If you get 100,000 vaccines from two manufacturers tomorrow, how do you know where each vaccine is and to which vaccine point it has gone to? How do you make appointments? How do you make sure each vaccinated person gets a second dose of the exact same vaccine? When should the next dose be administered? How do you document side-effects."

"Salesforce's Covid-19 and medical products are commercial products, but GAVI treatment is pro-bono. The company's role does not include physical tracking of the vaccine dose while traveling around the country (this tracking is done via GPS on the vaccine box which usually transmits directly to the vaccine company or the government that took responsibility for the vaccination operation), nor the temperature control."

Do you need to install the system in 190 countries? "

This is a cloud platform, and we are pleased that all countries will share the same information. Each country will define what its needs are, how many doses it orders, how many have already been used, and what happened following the vaccination. It will be possible to compare countries and learn from each other. There will probably be a certain localization, because in each country different vaccines will be approved at different times. We are talking about a volume of data that some of these organizations have never dealt with."

Do you anticipate challenges in the fair distribution of vaccines? "In the meantime, I am impressed by the cooperation between the private and public sectors over this process, but we are not sure that everything will be really sweet and clean all the time. I expect there will be surprises from some countries, but I estimate that GAVI is prepared for that." "This is not the first epidemic we have encountered that has involved the so-called 'vaccine nationalism." In the swine flu epidemic, the wealthy countries bought up all the stock. The World Health Organization raised resources but failed to get enough vaccines for less wealthy countries. In my opinion, this is the right way to deal with the epidemic, and it will set a precedent. If we succeed in bringing two billion vaccinations to all the member countries in GAVI, then the people at highest risk will receive protection."

"I believe that in the coming months we will see more companies bringing vaccines to market, and then our challenge will shift from the question of how to get the vaccines to how to bring them to people. Whenever a large company works with a local company to produce the vaccines in the territory of the country that needs the vaccine, at a lower cost, it encourages me".

Remote medicine is not just video

"As a technology company in the medical world, Salesforce used to ask, 'how do we bring the retail experience, the Amazon experience to the medical world," said Zenooz. "How do we get the medical consumer where he is, instead of moving him to where the medical services are concentrated. Covid-19 has turned this conversation from speculation to the fact that it is impossible without it. Anyone who does not have access to the consumer in his home will not be able to survive in the medical field."

The company itself has set up secure call centers for home calls, information management centers for monitoring devices, and centers for managing the delivery of medicines "Remote medicine can't just be video," Zenooz explained. "Information should be brought from the patient, and treatment should be brought to him.

Today we feel that the tools developed during Covid-19 (not just by us) allow us to be prepared for any disaster - not just for the next pandemic, but for any case where people lose their access to the healthcare system."

You are conducting the vaccination drive in several major US states. What is the degree of response to them so far?

"Compared with Israel which so far seems to be vaccinating with great enthusiasm, we see in certain areas of the US a lack of trust, mainly from the Black and Hispanic populations. Even health system workers from these populations are asking questions. These are sectors that have suffered and still suffer severe discrimination from the US healthcare system. There were the unethical experiments performed by Dr. Marion Sims on female slaves in the southern US in the 19th century, which only happened 150 years ago, not so long ago."

"We need to make sure that there is credible and clear communication between the healthcare system and these populations. In places where there was credible and clear communication, we immediately see an increase in responsiveness. For example, when asked how the vaccine was approved so quickly, they are relieved to hear that the research began 30 years ago and only the current application is one year old."

"In communicating with the public, it is not possible to rely only on doctors, certainly not on doctors who come from outside the community. Sometimes the local news channel, the clergyman, or in a certain neighborhood people must rely on the neighborhood hairdresser. I follow what is happening in Israel and it seems that the information campaigns are very good."

Really? "

Here, your Ministry of Health has clearly said - put on masks. In the US they did not even say that clearly.Your Ministry of Health has recommended desirable actions and it also presents visually, to those who have more difficulty with words. I think there is trust in the leadership. It was a fact that people cooperated with the lockdown and good control of the disease was achieved, and when they saw that the reopening wasn't good, they closed again, and the lockdown was effective again. I feel that trust was created."

Trust? Us?

"We really liked the illustrations. You seem to have real success in the media."

Who funds the vaccine coalition?

"GAVI's activities have led to vaccinations for childhood diseases being given to most of the world's children today. The centralized buying by the organization helps to obtain low prices for the poor countries from the pharmaceutical and vaccine companies. These in turn are pleased that some coordinate the activities for them in these complex countries and save them from marketing vaccines in each and every country."

"Along with this welcome activity, the organization has received no small criticism over the years, especially for the extent of its influence by private parties, such as the Bill Gates Foundation, and for allowing pharmaceutical companies to sell its vaccines at high prices, compared to older and less expensive vaccines. The argument is that the organization is thus taking care of the interests of the pharmaceutical companies at the expense of maximizing the interests of the local governments."

"The counter-argument is that without the business access and profit to the pharmaceutical companies, it would have been difficult to achieve the results achieved so far. The business approach, the pro-pharmaceutical companies, is considered to be influenced by Bill Gates and the foundation he founded. The Gates Foundation is the largest donor to the organization, after the UK government, which is responsible for about 25% of the organization's budget. The US government is the third-largest donor".

Published by Globes, Israel business news - en.globes.co.il - on December 31, 2020

© Copyright of Globes Publisher Itonut (1983) Ltd. 2020

Pfizer vaccine  / Photo: Company website
Pfizer vaccine / Photo: Company website
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