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For Covid-19 Vaccines, Some Are Too Rich — and Too Poor

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Poor and middle-income nations, largely unable to compete in the open market, rely on a complex vaccine sharing scheme called Covax. A collaboration of international health organizations, Covax was designed to avoid the inequities of a free-market free-for-all. But its deals come with strings attached, and health advocates are questioning its transparency and accountability.

By the middle of next year, South African officials hope to secure their first vaccine doses under Covax, even as they negotiate to buy supplemental supplies from drug manufacturers. But in a country where luxury estates are walled off from sprawling squatter villages, many expect the newest vaccines to remain a privilege for residents who can pay out of pocket or through supplemental insurance — a program that disproportionately benefits white people.

“You’ll be able to stride into your local private pharmacy and pay a couple hundred rand (about $15) and say, ‘Hit me baby,’” said Francois Venter, a researcher at the University of the Witwatersrand in Johannesburg.

The best chance that many South Africans have to get vaccinated anytime soon is to volunteer for a clinical trial and test unproven vaccines on their bodies. But that arrangement has raised ethical questions.

First is whether countries like South Africa, which is supporting trials by four drugmakers, should be guaranteed doses if the trials succeed. The government hasn’t received such a guarantee. And at any rate, such an arrangement would be ethically murky, since it would punish countries that participate in unsuccessful trials.

This month, as Britain prepared to begin its vaccination campaign, dozens of people walked from their shacks in Masiphumelele township, south of Cape Town, to the gates of the Desmond Tutu Health Foundation.

They waited outside for hours, under the shade of a gum tree, for a chance to enroll in a clinical trial of the Johnson & Johnson vaccine.

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