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Mexico seeks more than 200 million doses to defeat the pandemic

The Modern American Pharmaceutical Vaccine.REUTERS

Mexico is in a decisive phase of the pandemic. After adding a million infections, more than 100,000 confirmed deaths and the net loss of some five million jobs due to the coronavirus, the country’s hopes are pinned on having access to a vaccine. The Government signed a series of agreements on October 13 that formalized its intention to buy more than 198 million doses that, as some need to be applied twice, can benefit 116 million people, more than 90% of the population. The rest are missing to achieve full coverage and the country hopes to continue obtaining lots. But there is a fine print. These prototypes will only see the light if their effectiveness is proven, if it is ruled out that they have serious side effects and if their distribution is viable. The clinical trials that have begun this month in Mexican volunteers will test the CanSino prototype, the Chinese vaccine, and bring the moment of truth about the times, resources and forecasts of Mexico in the fight against the virus.

When will there be a vaccine against the coronavirus?

The government’s forecast is that the first doses will arrive in December and be applied in March 2021. The World Health Organization (WHO), on the other hand, has moderated its expectations and calculates that, despite the fact that scientists are working in progress forced, will not be available in a massive way before 2022. Martha Delgado, undersecretary for Multilateral Affairs and one of the officials at the head of the diplomatic deployment to get the vaccine, says in a questionnaire answered in writing that “there will be good news soon”, but he prefers caution due to the impact a hasty announcement would have on the population. “We have all the elements to be optimistic,” he adds.

The problems that remain to be solved

“With the vaccine we are looking for a good that does not yet exist and that absolutely everyone wants,” says Delgado. The main question is which vaccines will work and can be marketed. Pfizer announced that its vaccine is more than 95% effective, but the WHO said it takes a wide deep-freeze network to distribute it, a network that no country has so far. That caused the spokesman for the pandemic, Hugo López-Gatell, to anticipate that the purchase could not be completed if this point is not solved. It is not yet clear whether it will be acquired or not, despite the fact that the pharmaceutical company has already asked the United States to approve its marketing. In other cases, the appearance of volunteers with complications has forced to pause some clinical trials, as in the case of AstraZeneca, which has already resumed them.

Another issue is how it will be distributed. “The vaccine will be applied first to the health sector, the first line of defense against the pandemic, and to vulnerable groups. The next step should be to think about the productive groups and the healthiest population, ”says Delgado. In the case of the influenza vaccine, the response of the population was such that the first batches were sold out and there were reports of theft and irregular sales of doses. The Government’s promise is that there will be “universal and free” coverage, but it is emerging that the distribution will be gradual and it will have to face fear and misinformation that affects large sectors of the population. That will come later. The most immediate and important stumbling block is to finish testing vaccines.

The final stretch of the experimental phase: Clinical trials

A huge shipment of 7,000 Chinese vaccines and 7,000 placebos arrived by plane on November 11. There was another shipment on October 30. These are the experimental substances that will be tested between 10,000 and 15,000 adults from more than a dozen States, with an investment of 140 million dollars, which will be borne by CanSino. This trial is a priority for the Government because, unlike the other vaccines that have been tested, this one only needs one application. The agreement that Mexico signed would guarantee 35 million vaccines.

Of the hundreds of vaccines that are developed around the world, around a dozen are the most advanced and are already in phase III, that is, they are already being tested in groups of thousands of people. In this group of leaders are three laboratories with which Mexico has a formal purchase intention: CanSino, Pfizer / BioNTech and the prototype of the University of Oxford and AstraZeneca. In addition, two US pharmaceutical companies seek to carry out clinical trials in the country: Janssen, which already has authorization, and Novavax, which is processing its permit. There are also talks to evaluate Sputnik V, from Russia, and Moderna, from the United States, with Mexican volunteers. Curevac from Germany has also shown interest.

What has Mexico done to get so many possible vaccines?

“At the gates of Mexico, large projects to carry out phase III clinical research will touch because they find a good regulatory path at the local level,” says Mauricio Rodríguez, professor of Virology at the National Autonomous University of Mexico in a forum on the subject. Without volunteers, laboratories cannot advance their research. In addition to the legal flexibility to test the vaccine, the country has put successful experiences in vaccination campaigns on the negotiating table with pharmaceutical companies and, in some cases, a manufacturing industry with the capacity to produce and distribute them.

Mexico has compensated for the lags in its science and technology infrastructure with a diplomatic strategy that has been “aggressive and successful,” in the words of the Foreign Ministry. The country has entered the Covax mechanism, which has several vaccines in its portfolio and works as some kind of insurance policy, in which countries with more resources advance part of the costs of injections to finance research and the poorest receive vaccines humanely. In exchange for 320 million dollars, Covax gives Mexico access to vaccines for 25 million people. Moderna’s vaccine, with a reported effectiveness of 94%, is in this portfolio.

There were also negotiations with the laboratories. In August, the government announced a commitment to produce and distribute 250 million doses of the AstraZeneca vaccine, in partnership with Argentina and the foundation of magnate Carlos Slim. The October agreement with this project involves immunizing almost 39 million Mexicans and the rest of the doses will be distributed in Latin America. The Pfizer deal was expected to benefit 17 million people. Russia also wants to send 32 million doses (of two applications), but a deal has not been closed until the Mexican authorities give their approval.

If the agreements that are already in place are finalized, the investment will be 35,153 million pesos (almost 1,660 million dollars), with deferred payments that will be paid next year. This figure may increase if deals are closed with Novavax, Moderna or Janssen, for example. Foreign will have to agree, which has looked for several candidate vaccines; Health, which defines the technical criteria, and Finance, which will make the payments.

Having one or more vaccines will not automatically end the pandemic

Having immunity to the virus is crucial to combat the economic crisis, but specialists warn that the vaccine will not be a magic wand to return to normality. Luis Antonio Gorordo, head of Intensive Care at the Hospital Juárez, points out that the vaccine will be “a pillar” to leave the pandemic behind, but that certain measures will have to be maintained because as no prototype guarantees 100% immunity, there will be people who continue to get sick of covid-19. The doses also take time to apply and take effect in the body. In the case of the Russian vaccine, for example, you have to wait 21 days to administer the second dose and wait a little longer for it to take effect.

“I have always said that this will end a few months after the vaccine”, predicts Gorordo. His colleague Gabriel Reyes, head of the Emergency Department, anticipates that he will have to wait at least two years, counting from last March and depending on the results of clinical trials. “We have nothing certain,” adds Reyes. Other experts predict that more and more prospects will continue to appear in the coming months and years, which is why we speak of vaccines, in the plural.