May God help Turkey with the COVID-19 vaccine

23.12.2020

Turkey has failed in ordering the COVID-19 vaccine.

There are multiple reasons for this, including the country’s foot-dragging on placing orders, its failure at risk management by not hedging its bets and relying on a single vaccine and its overconfidence in the production of its own vaccine. Allow me to explain.

It was evident by the end of this summer that, only 10-12 vaccine companies among over 100 candidates would be leading the vaccine race and that more than one vaccine would prove to be effective and safe by the end of 2020.

But there were also many questions that remained unanswered worldwide. Which of the two techniques used in vaccine production is better? Those that are based on inactive virus or the new type, vector, also known as the mRNA? How many doses would be required per person? How long would the immunity provided by the vaccine last? And most importantly, which companies would finish the race for vaccine production first?

If the answers to these questions had been apparent, every county would have been able to calculate its own needs easily. 

When there is uncertainty ahead, there is a clear path to follow and that is not placing all of one’s eggs in the same basket, in other words, spread out all risks. 

That is to say, the distribution of vaccine orders among companies leading the way in production, and signing contracts for more vaccines than what is required in total.

However, one piece of glaringly evident information was that everyone was after the vaccine. There was a need for swift action.

All countries with purchasing power were quick to move. Except for Turkey.

For example, the EU did the following. It planned to form a vaccine ordering package that included at least six different vaccines with at least two, but preferably three vaccines produced by each techniques. It was a simple strategy.

About three months ago I had written about this and asked from which vaccine companies, with which delivery schedules and how many millions of doses Turkey would purchase of the vaccine. I also asked which technique used in vaccine production Turkey would opt for and which precautions it had prepared to minimize risks.

Let us see the orders placed by countries as of the end of November in terms of number of doses and types of vaccines.

  • Canada – 6.5 times the population, 6 different vaccines
  • The U.K. – 5.4 times population, 7 different vaccines
  • The EU – 4 times the population, 6 different vaccines
  • The U.S. – 2.5 times the population, 6 different vaccines
  • Japan – 2.3 times the population, 3 different vaccines
  • Mexico – 1.7 times the population, 4 different vaccines
  • India – 1.6 times the population, 3 different vaccines
  • Brazil – 1.2 times the population, 3 different vaccines
  • Indonesia – 0.8 times the population, 4 different vaccines
  • Turkey – 0.6 times the population, 1 vaccine

The date for placing orders for the vaccines is also important as delivery takes place based on a first come first served basis. 

The EU by the end of October already signed vaccine contracts for doses twice its population. Here are the Union’s orders:

  • Aug. 27 – 400 million doses (Astra Zeneca)
  • Sept. 18 – 300 million doses (Sanofi-GSK)
  • Oct. 8 – 200 million doses (Johnson&Johnson)
  • Nov. 11 – 300 million doses (Pfizer-Biontech)
  • Nov. 17 – 405 million doses (CureVac)
  • Nov. 25 – 160 million doses (Moderna)

Total (as of Nov. 30) – 1.765 billion doses 

This data is shared on the EU website the day the agreements are signed. Has Turkey’s Health Ministry been following these developments?

While the EU placed the orders listed above, it initially held one-on-one talks with 28 member countries and compiled their demands before concluding a contract. Why has the Turkish presidential system, which was touted as having the ability to work efficiently, acted so late?

While costs change according to orders, the price for the Moderna vaccine is about $25 and $20 for the Pfizer/Biontech vaccine. As for the Astra Zeneca vaccine, the rate is around $ 2-6, because this large company has vowed to sell the vaccine at cost without profits until the pandemic is over.

What are the countries, which made contracts for large numbers of vaccines going to do if they are left with extra shots on their hands? They will most likely be very happy.

Because this will simply mean they won the battle against the pandemic. They will try and sell the vaccine to countries that are waiting back in the queue. If that doesn’t work, they will donate the vaccines to countries with limited resources. 

They are ready to incur a risk worth a few billion dollars in order to quickly overcome this calamity that has wreaked havoc on human health and economy. 

For Turkey to catch up to the level of, say Mexico, it should have signed contracts with four companies for 150 million doses by the end of November. But Turkey signed only one contract with China’s SinoVac for 50 million doses at the end of November.

I am not mentioning Turkey’s contract signed on Dec. 9 with Pfizer/Biontech for 25 million doses as that was done after November.  In any case, this vaccine is likely to arrive at the end of 2021 as stated by Health Minister Fahrettin Koca, as Turkey is at the tale end of recipients.

Let us ask a few questions such as what sort of vaccine procurement strategy has Turkey had? Why has it failed to sign deals with Western companies that are producing the most reliable vaccines in the world? What will happen if problems are encountered with the Chinese vaccine? Initial reports from the government indicated that this vaccine would not be administered to the population 65 and over, as it had not been tested for this age group. Has the Chinese vaccine been tested on every age group?

Now Turkish authorities are holding talks with Russia for its Sputnik V vaccine, which was approved by authorities in August when testing program was not yet even initiated. It is currently in its third phase of testing and the application of the vaccine in Russia began on Dec. 5. However, it is not being administered to those above 60.

I am disappointed upon reading the interview by Sözcü newspaper with the Health Minister Koca. Here is why.

“Inactive vaccines… are traditional and natural vaccines. We know about their short, medium and long-term effects… I say this not just for Astra Zeneca, but Biontech, too. These are mRNA vaccines… in other words, their medium and long term results are not known.’’

So here we see that Turkey’s top health official does not find the mRNA vaccines reliable. This is just an assumption and there is no scientific data supporting it. As far as I know, no country makes vaccine contracts on such an assumption. If they are not reliable, then why is Turkey purchasing the Biontech vaccine that is produced with the mRNA technique? Yes, the medium and long-term effects of COVID-19 vaccines are not known. But this is also true for inactive vaccines. Moreover, Astra Zeneca is a vaccine produced with the inactive technique, not with the mRNA.

When asked why Turkey has failed to purchase the Moderna vaccine, Koca says that  “Moderna does not sell to foreign countries.”

Moderna is a U.S. company, and as shown in the list provided above, it does sell vaccines to foreign countries. If Turkey had acted in a timely manner, it could also have acquired them.

Koca also said that Turkey “would not need to import vaccines after April 2021, because by then, Turkey’s own vaccine would be available.’’ 

I hope that an effective and reliable domestically produced vaccine becomes as soon as possible and Turkey uses only that. But it is a risky approach to act on the assumption that a domestic vaccine will be available in May. Even the world’s largest pharmaceutical companies, which have a capacity that far exceeds the one producing vaccine in Turkey, are unable to provide exact dates for rolling out effective and reliable vaccines.

National authorities should not make plans on the assumption that any single vaccine will be available at a certain date, even if the producer is from their own country.

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