Stark differences among SE Asia’s vaccination strategies

Stark differences among SE Asia’s vaccination strategies

FILE PHOTO: A small shopping basket filled with vials labeled
FILE PHOTO: A small shopping basket filled with vials labeled "Covid-19 - Coronavirus Vaccine" and a medical syringe are placed on a AstraZeneca logo in this illustration taken Nov 29, 2020. (Reuters)

Moderna Inc won approval from Singapore for its Covid vaccine and signed a deal to sell doses to the Philippines, becoming the fourth supplier to get regulatory clearance in Southeast Asia.

Shots by AstraZeneca Plc, Pfizer Inc-BioNTech SE and Sinovac Biotech Ltd have also been approved by at least one country in the region as inoculations roll out. China and India are giving some free vaccines to countries like the Philippines, Myanmar and Cambodia.

Indonesia, Southeast Asia’s biggest and most populous economy, started its coronavirus vaccination program on Jan 13, with President Joko Widodo taking the first Sinovac jab. More than 784,000 people have received their first dose.

Wealthier but smaller Singapore -- the first in Southeast Asia to start an official Covid-19 vaccination program -- began inoculating healthcare workers with the Pfizer shot on Dec 30 and has given the first shot to more than 175,000 people since then. Its prime minister got his first dose on Jan 8 and has also received his second shot.

​Strategies are evolving across the region as different supply deals are sealed. In the Philippines, President Rodrigo Duterte has said he will take a Russian or Chinese vaccine, but his government’s first approval was for the Pfizer shot.

Indonesia, which is battling the worst outbreak in Southeast Asia, ended 2020 by switching up who’s on its priority list for shots -- focusing on the elderly first instead of the young as previously announced. It was the earliest in the region to receive a vaccine shipment with a Sinovac supply in December.

Some countries are also involved in vaccine development and manufacturing, a testament to the variety of strategies employed by Southeast Asian nations. Here’s how the region of more than 650 million people is dealing with differing fiscal, demographic and distribution challenges in their vaccination efforts.

THAILAND

STRATEGY:

Thailand wants to inoculate about 50% of its population by the end of this year.

It has previously said it will allow private companies and hospitals to import and sell Covid-19 vaccinations as long as those shots have been approved by the nation’s Food and Drug Administration.

Thailand’s health regulator endorsed AstraZeneca’s vaccine for emergency use, the health minister said on Jan 21. It’s the first to win approval in Thailand, which also has ordered shots developed by China’s Sinovac Biotech. Johnson & Johnson has begun the process of seeking domestic approval for its vaccine.

The country plans to distribute shots free of cost, while the imports by private firms would allow those who can afford to pay for inoculations along with non-Thais an alternative pathway to get shots. It won’t procure vaccines through the WHO-backed Covax program for now because the conditions are too strict.

The government has so far approved plans to purchase a total of 63 million doses, and the National Vaccine Institute is in talks with several manufacturers for additional supplies for delivery as early as the first quarter. These include 2 million doses from Sinovac and 61 million doses from AstraZeneca

Some of the AstraZeneca vaccines will be produced locally by Siam Bioscience Ltd through technology transfer

Not wanting to rely solely on inoculations from abroad, Thailand is also developing its own anti-coronavirus shot

An mRNA vaccine research project is set to start the first phase of clinical trials in April and the second phase in June. The vaccines may be available by end-2021 after receiving emergency-use authorisation

A DNA vaccine effort by Thailand-based BioNet-Asia is expected to start its first phase of human trials in Australia early 2021.

TIMELINE:

February, 2021: Sinovac

The country has said it plans to roll out 200,000 doses of Sinovac vaccines in February, 800,000 in March, and 1 million in April

February, 2021: AstraZeneca

Thailand has an advance agreement with AstraZeneca to secure Covid-19 vaccines, which are expected to be distributed by mid-2021, the prime minister has said

The government expects 50,000 doses to arrive in February

The government has ordered 61 million shots. The regulatory nod already given will also open the door for imports by private Thai companies for administering the doses to people who can afford to pay

The country said early January it plans to roll out locally-produced AstraZeneca vaccines in May

Under agreement with AstraZeneca, Siam Bioscience will produce vaccines at its facilities, and Thailand will receive technology transfer

Thailand’s prime minister has said the country will supply coronavirus vaccines at “reasonable prices” to Myanmar, Laos, Cambodia and Vietnam when it begins production.

INDONESIA

STRATEGY:

Indonesia seeks to vaccinate 181.5 million people -- about two-thirds of the population -- by March 2022 and President Widodo has called on the cabinet to complete the program by end-2021.

The nation expects its vaccination program to cost more than 73 trillion rupiah ($5.2 billion). It plans to be able to vaccinate 16 million people a month; the initial phase of inoculations will target more than 1.5 million health workers by the end of February.

The country will offer free vaccines to people. With about 13,000 community health centers and 9,000 hospitals across the country, the government said it will be able to complete its targeted vaccination to achieve mass immunity.

The world’s fourth most populous nation is banking on both Western and Chinese vaccines, ordering 125.5 million doses from Sinovac, 50 million from AstraZeneca and another 50 million from Novavax Inc., while developing 57.6 million of its own Merah Putih

It is set to get as many as 23.1 million AstraZeneca doses from the GAVI alliance, after requesting 108 million free doses from the global vaccine facility

Talks are also on with Pfizer for 50 million doses and loaned cold storage facilities for the vaccine

TIMELINE:

January, 2021: Sinovac

(More than 784,000 people have received their first dose.)

President Widodo got his first dose of the Sinovac shot on Jan 13 along with public and army representatives, which kicked off Indonesia’s inoculation programme

More than 784,000 people have received their first dose as of Feb 7, with over 139,000 of them completing their second shot

China’s Sinovac Biotech shipped 3 million doses of vaccines to the country in December; the local food and drug regulator approved them for emergency use in January, and has since also given the nod for its use among the elderly

Even before the regulator’s approval, the government started distributing the vaccines to its 34 provinces spread across the world’s largest archipelago

Sinovac has shipped raw material for 55 million doses to be manufactured by Indonesia’s PT Bio Farma so far. The state firm aims to produce 24 million doses a month

Bio Farma plans to also produce shots for other countries through the Coalition for Epidemic Preparedness Innovations as early as the fourth quarter, according to Indonesia’s state-owned enterprises ministry. Bio Farma will produce 100 million doses a year for CEPI.

March, 2021: AstraZeneca

Indonesia will receive an initial allocation of between 13.7 million and 23.1 million shots of the AstraZeneca vaccine in the first half through the global Covax initiative

The vaccines will arrive in stages, with 25%-35% by March and the remainder in the second quarter, according to the government. The shots can be used once the WHO approves the AstraZeneca inoculation for emergency use

Under a separate deal with the company directly, Indonesia will also get the AstraZeneca vaccines delivered in stages starting from as early as April through the first quarter of 2022. The deal also includes the option for the country to purchase an additional 50 million doses.

MALAYSIA

STRATEGY:

Malaysia is spending $504 million to buy enough shots to cover 26.5 million people, or about 80% of its population. It will start vaccinations from February, according to Prime Minister Muhyiddin Yassin. The government aims to get as many people inoculated within a year of getting the first batch of vaccines in February, Science Minister Khairy Jamaluddin said mid-January.

The first phase of vaccinations, which will begin by end of February and last until April, will focus on inoculating 500,000 frontline workers, followed by the elderly and high-risk groups between April and August. The third leg will run from May through February 2022 for those aged 18 and above, the prime minister has said.

The country will have a “slight extra” stockpile of vaccines as only those 18 years old and above will be inoculated. The excess vaccines will be administered to migrant workers, expatriates, and non-Malaysian residents, the cost of which must be borne by their employers.

Pfizer vaccines will probably be administered to those in urban areas due to the need for ultra-cold storage, while AstraZeneca vaccines will be deployed to rural areas.

Malaysia has secured 12.8 million doses of the AstraZeneca vaccine through the Covax facility and directly, enough to inoculate 20% of the country’s population, according to the government

The country has secured 25 million doses of the Pfizer-BioNTech vaccine, enough to cover 39% of the population

It has also signed agreements for 12 million doses of China’s Sinovac and up to 6.4 million doses of Russia’s Sputnik V vaccine

Solution Group Bhd. signed a deal to supply the Malaysian government with 3.5 million doses of the Recombinant Ad5-nCoV coronavirus vaccine jointly developed by China’s CanSino Biologics Inc and Beijing Institute of Biotechnology under the Academy of Military Medical Sciences. The purchase is subject to Solution obtaining product registration and market authorization of the vaccine in the country by April

The government has also been in talks with Moderna and Johnson & Johnson, according to officials

Malaysia was due to conduct its first vaccine trial involving 3,000 volunteers in late January. It would be a phase-III trial on a vaccine candidate developed by the Institute of Medical Biology Chinese Academy of Medical Sciences

Malaysia signed an agreement with China in October to be given priority access to Covid-19 vaccines that China develops.

TIMELINE:

February, 2021: Pfizer

The government secured 12.8 million doses from Pfizer-BioNTech SE in a deal signed in late 2020. The country in January agreed to buy an additional 12.2 million doses

The first batch is due to arrive on Feb 26

The agreement with Pfizer is contingent on the vaccine being approved by the U.S. FDA and Malaysia’s regulator. Malaysia’s National Pharmaceutical Regulatory Agency has granted conditional approval for the vaccine, subject to further information from Pfizer, according to a local media report.

March/April, 2021: Sinovac

China’s Sinovac signed an agreement to supply 14 million doses to Malaysia, which may be ready for distribution by the end of March

As part of this deal, Pharmaniaga Bhd will supply a total of 12 million doses developed by China’s Sinovac Life Sciences Co starting in April, the health ministry said in January

1Q 2021: Sputnik V

Duopharma Co (M) will supply up to 6.4 million doses of Russia’s Sputnik V vaccines produced by Gamaleya Research Institute toward the end of March

2Q 2021: AstraZeneca

Malaysia has secured 6.4 million doses of the AstraZeneca vaccine through the Covax facility, and another 6.4 million directly

The first batch is expected in the second quarter of 2021

MYANMAR

STRATEGY:

Myanmar began inoculating its nearly 55 million population at the end of January. Before the military coup in early February, Aung San Suu Kyi’s administration had said frontline health workers and key government officials would be prioritised in the first phase of vaccinations, to be followed by vulnerable groups such as those older than 65 years.

Myanmar kicked off vaccination for the general public on Feb 5, less than a week after the coup. Interim President Myint Swe and officials from all ministries with the rank of director or above were also inoculated, along with the elderly in townships with the highest infection rates, according to the health and sports ministry. Suu Kyi, who is under detention at her residence, was also vaccinated on Feb 6, according to her party officials.

Myanmar has vowed to inoculate 38.4 million people older than 18 by the end of this year.

The previous government had also been cooperating with GAVI, the vaccine alliance, to get shots for 20% of its population through the Covax facility. The Southeast Asian nation was also planning to allow the private sector to import World Health Organization-approved vaccines later this year.

Other than the AstraZeneca deal it has signed, Myanmar also expected vaccines from Chinese developers to arrive in early 2021, with some doses from the Covax facility expected before April 7.

TIMELINE:

January, 2021: AstraZeneca

(At least 103,142 health workers and volunteers have received shots)

Myanmar ordered 30 million doses of the AstraZeneca vaccine produced under license by Serum Institute of India to vaccinate 15 million people. The country expects the first batch of this order to arrive in the second week of February

The country expects an additional 27 million doses from the Covax facility from March

It nevertheless began vaccinations at the end of January, with a separate 1.5 million doses that were donated by India having arrived Jan 22

The nation inoculated 103,142 health workers and volunteers as of Feb 2, official data show.

PHILIPPINES

STRATEGY:

The Philippines plans to buy 148 million vaccine doses to inoculate up to 70 million people this year, or more than half of its population. But it is negotiating for 178 million doses, enough to inoculate 92 million people, to take into account possible delays in deliveries, according to the finance secretary. The government seeks to vaccinate its entire population of more than 100 million by 2023.

The nation is eyeing 82.5 billion pesos ($1.7 billion) in vaccine purchases that it plans to fund with financing from multilateral agencies, state-owned banks and companies and bilateral sources, vaccine czar Carlito Galvez said.

A number of mayors in Metropolitan Manila have separately drafted plans to provide shots to their constituents while waiting for guidelines on how local government units can purchase the vaccines.

Priority for vaccinations will be given to medical frontliners and workers in industries deemed critical, including low-income groups and those identified as at risk.

The government has signed deals for 30 million doses of the Covovax vaccine from the Serum Institute of India, and for 17 million doses from AstraZeneca

It is also in talks with Pfizer, Johnson & Johnson, Sinovac Biotech and Russia’s Gamaleya, according to Galvez

Gamaleya had offered 25 million doses

The country plans to buy 25 million doses from Sinovac, expecting the first shipment to arrive as early as February. It has allowed the Chinese company to hold clinical trials in the nation for its coronavirus vaccine, which President Duterte prefers to be inoculated with, officials said

The Philippines has signed a preliminary agreement with Moderna following negotiations for as many as 20 million vaccine doses. A final supply deal with Moderna will likely be finished in February

The nation is also expecting to receive fewer doses from the World Health Organization-backed Covax Facility, Galvez said

China will donate 500,000 coronavirus vaccine doses to the Philippines

Pfizer and AstraZeneca have been approved for emergency use by the local FDA, while Gamaleya and Sinovac have applied for the same authorisation

India-based Bharat Biotech International Ltd has applied for emergency use authorization in the Philippines for its coronavirus vaccine, ABS-CBN News reported, citing the Food and Drug Administration head.

TIMELINE:

1Q 2021: Sinovac, Sputnik V

Vaccinations could start as early as the first quarter of 2021 using Sinovac and Russia’s Sputnik V shots, according to Galvez

Sinovac, Sputnik V are yet to receive the local FDA approval.

1Q 2021: Pfizer, AstraZeneca

At least 5.6 million coronavirus vaccine doses produced by Pfizer-BioNTech and AstraZeneca are expected to arrive in the country within the first quarter through the Covax facility

The country will also receive as early as May 2.6 million doses of AstraZeneca vaccines purchased by local companies which pooled about 800 million pesos to buy 3 million shots.

SINGAPORE

STRATEGY:

The city-state has set aside roughly S$1 billion ($750 million) for vaccines, tapping the likes of Arcturus Therapeutics Holdings Inc, Moderna, Pfizer and Sinovac for supplies. It estimates it should have enough for its around 5.5 million-strong population by the third quarter of 2021.

The city-state is prioritising healthcare workers, the elderly and those in jobs or settings where risk of a super-spreading event is high -- such as the construction, marine and process sector, including migrant workers. For the elderly, it began with seniors aged 70 and above.

Singapore aims to vaccinate the entire adult population, though this will be voluntary. Vaccines will be free for all Singaporeans and long-term residents. It is setting up vaccination centres across the island.

TIMELINE:

December, 2020: Pfizer

(More than 175,000 people given first dose)

Singapore started vaccinations on Dec 30, 2020

Prime Minister Lee Hsien Loong got a first dose of the vaccine on Jan 8, making him the first member of cabinet to get the coronavirus vaccine shot

The government said more than 175,000 people have received their first dose of the Covid-19 vaccine as of Feb 2. Roughly 6,000 have received their second vaccine dose

The city-state received its first shipment of the Pfizer-BioNTech vaccine on Dec 21

Those who have received shots include staff working in healthcare, frontline and essential services, as well as staff and senior citizens in nursing homes. Some employees at the National Centre for Infectious Diseases have also received their second dose.

Pilot vaccinations for senior citizens started Jan 27.

March, 2021: Moderna

Singapore granted interim authorisation in February for Moderna’s Covid-19 vaccine to be used in the city-state. Moderna is the second vaccine to be authorised in Singapore

Singapore’s Ministry of Health said that the country will roll out the Moderna vaccine for individuals aged 18 years and above when shipments of the vaccine arrive

If there are no disruptions to the schedule, the first shipment should arrive around March.

Early 2021: Arcturus

Arcturus and Singapore’s Economic Development Board have entered into a supply agreement for the right to buy the ARCT-021 vaccine

Arcturus may ship the first batch of the Covid-19 vaccine it’s developing with local scientists early 2021

Results so far show that the vaccine could be effective as a single dose, the Straits Times reported, citing a professor who co-developed the vaccine with Arcturus.

VIETNAM

STRATEGY:

Vietnam is working on developing vaccines and will collaborate with suppliers when doses are available, according to a spokeswoman at the foreign affairs ministry.

It signed a deal with AstraZeneca to acquire about 30 million doses of the Covid-19 vaccine, Deputy Health Minister Truong Quoc Cuong said during a government briefing in January

It has also been negotiating to buy vaccines from Pfizer and companies from Russia and China, Cuong said

Vietnam has four companies and institutes working on developing vaccines. Nanogen Pharmaceutical Biotechnology began its human vaccine trials Dec 17. The Institute of Vaccines and Medical Biologicals started human trials Jan 21, according to the health ministry.

TIMELINE:

1Q 2021: AstraZeneca

Under the deal with AstraZeneca for about 30 million doses, Vietnam expects to receive vaccines each quarter this year, the deputy health minister said Jan 4

In addition, Vietnam expects to receive between 4.9 million to 8.25 million AstraZeneca vaccine doses through the WHO-backed Covax program during the first and second quarters, according to a government posting citing Covax.

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