Egypt begins vaccination with the Covid-19 vaccine this month, as the Minister of Health announced, alongside the start of vaccination in many countries, in a promising step to overcome the global pandemic. This step encounters some challenges in obtaining the vaccine in the required quantities and distributing it fairly, whether at the global or the local level, to ensure citizens' rights to have non discriminatory access to the vaccine.

Low and middle-income countries face significant challenges in having access to the vaccine. A published report from the People’s Vaccine Alliance indicates that nearly 70 poor countries will only be able to vaccinate one in ten of their people against Covid-19 during the next year, unless governments and drug companies take urgent measures to ensure that adequate doses are produced.

In contrast, the wealthiest countries bought enough doses to vaccinate their entire population almost three times by the end of 2020. According to the report, updated data shows that the richest countries, which account for only 14 percent of the world's population, have bought up to 53 percent of the most promising vaccines so far.

There are calls for a vaccine available to all nations, without discriminating between rich and poor countries. These these calls aim to open sharing of technology among vaccine producers because this alone makes universal access to vaccines possible. They aim to encourage pharmaceutical companies working on the Covid-19 vaccine to share technology and intellectual copyright, through the World Health Organization, so that billions of additional doses can be manufactured and thus vaccines (safe, effective and of quality) can be available to everyone who needs them.

These calls also require governments to do everything in their power to make Covid-19 vaccines a "global public good", offered for free to the public, and distributed fairly and on the basis of need not purchasing power. It is necessary to note that the produced Covid-19 vaccines have relied, in many cases, on public funding for research, however companies retain exclusive rights, and keep their technology secret to increase profits. This means that the price of these vaccines has been paid twice, the first by government funding for research, and the second when governments purchase vaccines from companies.

Fear of not achieving global fair distribution prompted the World Health Organization at an early stage to launch the "The Access to COVID-19 Tools (ACT) Accelerator". The initiative is based on four pillars, the first relating to diagnostics, the second to treatment, the third focuses on vaccines (known as COVAX), and the fourth is about linking health systems. Each pillar is managed by two or three partner agencies.

The pillar concerning the vaccine -COVAX- is led by the Coalition for Epidemic Preparedness Innovations (CEPI), the Global Vaccine Alliance (Gavi), and the World Health Organization. The role of COVAX is to ensure that vaccines are developed as quickly as possible, manufactured in appropriate quantities, without compromising their safety, and distributed to those most in need. This pillar aims, by 2021, to ensure the availability of two billion doses of vaccines through the facility provided by COVAX.

Self-financing countries that join the COVAX Facility have two ways in which they can obtain vaccines, either by a Committed Purchase Arrangement or an Optional Purchase Arrangement.

- In the Committed Purchase Arrangement, the state is obligated to purchase a certain number of doses through "COVAX" in exchange for a relatively low advance amount than the optional purchase.

- As for the Optional Purchase Arrangement, it is not binding for the participating countries, as they can cancel the purchase contract, which is an attractive option for countries that have concluded bilateral supply agreements with companies producing the vaccine. In exchange for this more flexible option, countries pay a larger amount for contracting, in addition to a non-refundable "guarantee" amount -calculated on each vaccine dose- in order to protect the COVAX system itself from loss after making supply contracts with the producers.

Despite the goals and good intentions of this initiative, there are fears that it will not be able to cover the quantities required for poor countries, because it did not prevent or regulate bilateral contracts between rich countries and pharmaceutical companies, nor did it place restrictions on the size of the quantities that one state can buy, as countries with high purchasing power contracted early with the producing companies to obtain the vaccine quickly, in quantities that are sufficient and even more than their needs, and therefore the richer countries acquire large quantities at an earlier time and the poorer countries will wait their turn.

In the context of seeking to achieve fair distribution of vaccines worldwide, South Africa and India submitted a joint request to the TRIPS Council of the World Trade Organization, on October 2, 2020, calling on members to agree to waive the application and enforcement of Sections 1, 4, 5 and 7 of Part Two of the TRIPS Agreement in everything related to the prevention and treatment of Covid-19.

This request, if approved, would allow WTO member countries to choose not to grant patents and other intellectual property rights related to all medicines, vaccines, diagnostic supplies for the Covid-19, and other technologies needed to combat it (such as ventilators), throughout the pandemic period. This would provide countries with a space to collaborate in research and development (R&D), manufacturing, and increase the quantities produced globally for Covid-19 vaccines. Egypt supported India and South Africa's request.

In light of the problem of inequitable global distribution, the Egyptian government is expected to be facing difficulties and challenges in securing vaccines, like other governments in middle and low-income countries. EIPR continues to closely monitor the measures taken by the government to provide and make available Covid-19 vaccines, including Egypt's participation in clinical trials of the two vaccines of the Sinopharm company, which the initiative issued a press statement about, entitled: Egypt's participation in trials of Covid19 vaccine is important, minding patient rights

As part of the process of following up and evaluating this issue, EIPR observes a number of challenges facing the process of distributing the vaccine to citizens, which require taking some measures that have not yet been taken, despite the announcement that the vaccine distribution will start during the current month of January:

- So far, no clear and timed plan has been disclosed to make vaccines available to Egyptians. There are statements by officials in Egypt about the government’s provision of vaccines, but it does not clarify whether the declared quantities will be obtained through bilateral contracts with these companies, or whether they will be obtained through the COVAX Facility, or are they based on verbal promises obtained by the government, because each of these alternatives affects the possibility of actual availability of the vaccine at the announced time.

- There is no organized and reliable way to announce information on the provision of the vaccine, as the only source of information currently on the measures taken by the state is television statements by Ministry of Health officials, or those responsible for managing the crisis, which are sometimes contradictory. For example, the Minister of Finance stated that 30 million doses of the AstraZeneca vaccine were contracted, in addition to 20 million doses of the Chinese Sinopharm vaccine, bringing the total contracted vaccines to 50 million doses, while the Minister of Health said several days later on January 2nd, 2021, the contracted vaccines include 40 million doses of Sinopharm, 20 million doses of AstraZeneca, and 40 million doses of the Gavi Alliance.

- Details of the Ministry of Health's estimates of the number of individuals expected to receive the vaccine among the priority groups have not been announced, and the distribution plan has not been announced, although the distribution will start this month. It is now necessary to present the vaccination distribution plan and explain it to the citizens, so that there is sufficient time to understand and absorb it, instead of starting directly with the distribution, without adequate preparation, resulting in chaos.

The process of distributing the vaccine requires observance of a number of basic principles. EIPR stresses the need to adhere to them to ensure a fair distribution of vaccines in Egypt:

• The vaccine should be available to all citizens, and medical staff and groups most vulnerable to complications of the virus should have absolute priority, with emphasis on equity for the most vulnerable groups in society.

• The state has to provide free vaccination to all citizens. The state is obligated by virtue of Article 18 of the Constitution to provide health services free of charge, including vaccinations, "in cases of emergency or life-threatening situations."

• There should be no discrimination between citizens in accessing the vaccine, on the basis of financial capacity or on the basis of influence, the priority of distribution is to the groups most vulnerable to complications from the virus, according to the recommendations of the World Health Organization.

• The law related to the work of the Egyptian Drug Authority, Law No. 151 of 2019, has to be adhered to, so that pharmaceutical companies submit all the results of the different stages of clinical trials (including the third phase of clinical trials) to the Egyptian Drug Authority for evaluation.

EIPR stresses the importance of equitable distribution of vaccines among citizens, and commitment to full transparency in clarifying the basis on which the vaccine will be distributed, because justice and transparency are the way to gain citizens' confidence in responding to the state's directives during the vaccination process of the Covid-19 vaccine.