In Vaccine Race, Middle Income Nations Are At A Disadvantage. Just Ask Peru.

Peru is scrambling to get access to COVID vaccines as cases spike.

But the Latin American nation is in a tough slot.

The first problem is its relative wealth. Peru is classified by the World Bank as "upper middle-income." So it has some money to spend on vaccines but not nearly the financial resources of the U.S., the European Union or even wealthier neighbors like Brazil or Chile. But it's not poor enough to qualify for free doses from COVAX, the global program aimed at assuring equitable access to vaccines.

Peru is now trying to hammer out individual deals with the handful of pharmaceutical companies that currently have vaccine to sell.

"Peru has been trying to negotiate with all almost all the main vaccine producers," says Ernesto Ortiz, a senior manager with the Duke Global Health Innovation Center. "But for different reasons, some of those negotiations have been more difficult than others." Ortiz, who grew up in Peru, visited the country in January.

Political instability has also complicated things. In November when other countries were signing deals for vaccines that might be coming down the pipeline, Peru had three different presidents over the course of one week.

"That has affected quite a bit the negotiations [with pharmaceutical companies] because of changes of personnel," Ortiz says. "Now with the pressure increasing, the government has been trying to activate the negotiations again and is desperately trying to sign with someone."

Cynthia Arnson, the head of the Latin America program at the Wilson Center in Washington, D.C. says Peru is not alone. She sums up the frantic quest for vaccines in the region this way. "Every country is out on its own," Arnson says. "And they're competing against advanced, industrial countries for limited supply."

The stakes are high because of Peru's current COVID outlook. "Right now, the transmission in the community is very, very, very high," says Cesar Ugarte, an assistant professor of medicine at the Universidad Peruana Cayetano in Lima. "The ICU beds are now totally full. The oxygen in some facilities has run out. We are starting to see a situation like in May, June, July when the last peaks were here."

Ugarte runs trials on COVID diagnostic testing equipment. He says among his 15-member staff, three are currently in isolation due to the virus.

Since the beginning of January, the daily tally of coronavirus cases has quadrupled in Peru. This week the government tightened lockdown restrictions across much of the country. The state of emergency order shut down businesses, barred flights from Brazil and even shuttered churches in the predominantly Christian nation. "El confinamiento," or "the confinement" as it's called, also prohibits most residents from leaving their homes for more than one hour per day.

President Francisco Sagasti on Sunday called the pandemic the worst health and economic crisis to hit Peru in 100 years. "We only have two ways to stop a pandemic," he said in the address to the nation. "The first is the vaccine. The second is by protecting ourselves and others from the virus." The second option hasn't been working very well.

And so far the only COVID vaccines that have arrived in the country have been for clinical trials. The first shipment of doses purchased for general distribution is expected to arrive next week from the Chinese-government backed pharmaceutical company Sinopharm. The shipment of 1 million doses will be used for health-care and other essential workers but is a tiny portion of what the country of 33 million people will need to contain the virus.

Peru has also signed a contract with AstraZeneca to purchase 14 million doses of its vaccine but those deliveries won't arrive until September at the earliest. The South American nation appeared to be on the verge of signing a deal with Pfizer but so far hasn't been able to reach a final agreement.

Officials from Peru's ministry of foreign affairs are also in negotiations with Moderna, Johnson and Johnson, CureVac from Germany, and Gamaleya (the Russian makers of the Sputnik V shot) to try to secure enough vaccine to inoculate the entire population in the coming year. The government set aside $135 million in October or roughly 3% of the nation's annual budget to purchase vaccines through COVAX. Officials say the country is paying an additional $25 million for the initial shipment from Sinopharm.

But at best, COVAX promises to provide 20% of a country's required doses. Even under a best case scenario COVAX wouldn't deliver those doses until the end of 2020. Thus Peru has been left to try to reach deals with the handful of international pharmaceutical companies.

The problems in Peru reflect issues across Latin America.

Maria Elena Bottazzi, the co-director of the Texas Children's Hospital Center for Vaccine Development in Houston, says most countries in the region finds themselves at the mercy of outside forces to get a vaccine.

"Latin American countries are in a very, very difficult position, right now," says Bottazzi who's originally from Honduras. "First of all, we don't have a lot of vaccine manufacturing availability in the region except maybe for Brazil." She adds that there's limited capacity in Mexico, Argentina and Cuba. "But we don't have a lot of ecosystem to produce our own vaccines." So as the pandemic continues to get worse most countries are "left waiting to see who is going to provide them with vaccines," Bottazzi says.

To try to improve their bargaining power, Peruvian officials hosted COVID vaccine trials for multiple pharmaceutical companies including CureVac, Sinopharm, AstraZeneca and Johnson and Johnson.

That move appears to have worked in sealing deals with AstraZeneca and Sinopharm.

Cesar Ugarte at the Universidad Peruana Cayetano adds that the vaccination campaigns can't start soon enough. He says people are exhausted from the extended lockdown and even people who should know better are putting themselves at risk of getting exposed to the virus.

"We found nurses and doctors celebrating birthdays in the hospital without masks and with a birthday cake, blowing the candles. It's frustrating," he says. "But also I try to understand. We are humans. We are a social animal."

As President Sagasti said over the weekend, Peruvians have lost more than just loved ones and jobs to the pandemic. "We have also lost the freedom to hug each other, to hold hands, to visit our friends and family," the president said. "It's difficult, I admit it." He promised that Peru will get the vaccines it needs to immunize its entire population by the end of 2021. His ability to keep that promise could depend on companies outside of Peru and forces outside of Peru's control. [Copyright 2021 NPR]