CAJICA, Colombia – The 33 countries across Latin America, Central America and the Caribbean are taking vastly different approaches to secure, acquire and distribute COVID-19 vaccines.

A handful of the region’s wealthier countries have signed deals with vaccine suppliers or plan to manufacture them, but it is unclear how others will source or distribute vaccines to protect roughly 657 million people. Many are counting on the COVAX initiative.

“I see little order. I would like the region to work in a more coordinated way when it comes to vaccines,” said Daniel Dominguez, co-founder of Allbiotech, the Latin American Network of Biotechnology, a nonprofit headquartered in Mexico City that aims to promote the development of the biotech industry.

The challenges are particularly significant among the often-poorer countries in Central America and the Caribbean.

“They´ve got a great logistics and distribution challenge, given the temperatures of the region and its geography,” Dominguez said. “Central America’s health systems are weaker than those of the rest of the region.”

With that said, different countries are in vastly different places when it comes to tackling COVID-19.

Mexico and Argentina

The only joint initiative between two countries in Latin America to produce vaccines is between Mexico and Argentina, two of the wealthiest countries in the region. Both countries have high case counts, according to Johns Hopkins University. Argentina has reported more than 1.55 million cases and 42,000 deaths among its 45 million people and Mexico, with a population of 129 million, has had 1.34 million cases and 120,000 deaths.

The two will work together to produce AZD-1222, a chimpanzee adenovirus vectored vaccine developed by Astrazeneca plc and the University of Oxford. Liomont SA, of Mexico City, will produce the vaccine using ingredients made in Buenos Aires by Mabxience SA, which is part of Spain’s Insud Pharma Group.

“The active ingredient will be manufactured in Argentina and sent to Mexico, so that Liomont can finish the manufacturing process with the formulation, packing and distribution,” said Dominguez.

Mabxience and Astrazeneca signed an agreement in August to produce 200 million dozes of AZD-1222 for distribution to all countries in the region except Brazil. The agreement is being financed mostly by the Carlos Slim Foundation.

Like most middle-income countries, Mexico is not looking to rely on a single vaccine for its population of 126 million.

The country’s health care surveillance agency, Cofepris, has also granted emergency use authorization to Pfizer Inc./Biontech SE’s BNT-162b2, which has been branded Comirnaty, and wants to begin rolling it out before the end of the year.

“The first deal with Pfizer and Biontech aims to cover 17 million people,” said Dominguez.

For its part, Argentina’s own health care surveillance agency, ANMAT, has not yet authorized AZD-1222 even though Astrazeneca SA, the company’s subsidiary there, became the first COVID-19 vaccine developer to file for emergency use approval on Oct. 10. Argentina, which has a population of 45 million, expects to receive around 22 million doses of AZD-1222 after approval.

HLB Pharma Group, of San Isidro, filed an application on Dec. 4 to register Sputnik V, a two-shot human adenovirus vaccine developed by Russia’s Gameleya National Center of Epidemiology and Microbiology. And, on Dec. 23, Argentina became the first country in Latin America to officially register Sputnik V, according to the Russian Direct Investment Fund (RDIF), which supported development of the COVID-19 vaccine. Sputnik V was registered under the emergency use authorization procedure and approved by ANMAT based on results of phase III trials in Russia, without additional trials in Argentina.

RDIF and the government of Argentina signed a contract Dec. 10 for the supply of 10 million doses. A flight from Aerolineas Argentinas left Buenos Aires on Dec. 22 to pick up a shipment of the Russian vaccine.

Also in Argentina:

• Janssen Cilag Farmacéutica, from Mendoza, a branch of Janssen Pharmaceutica which is in turn a unit of Johnson & Johnson, has filed an application for JNJ-78436735, a recombinant adenoviral vector vaccine.

• Pfizer SRL, Pfizer’s local arm, received emergency approval on Dec. 22 for Comirnaty.

• China National Biotech Group (CNBG), a unit of China National Pharmaceutical Group (Sinopharm), has partnered with Argentina’s ELEA on a phase III trial for its inactivated virus vaccine.

Chile and Peru

Argentina’s neighbor in the southern end of the continent, Chile, has a population of around 20 million people. The country is not sparing any effort to ensure a plentiful supply of COVID-19 vaccines.

The government of President Sebastian Piñera has reached deals with Pfizer/Biontech, Astrazeneca/Oxford, Janssen and with China’s Sinovac Biotech Ltd. Sinovac has developed Coronavac, a traditional whole virus inactivated vaccine.

According to government officials, the country has put in place supply deals to cover more than its entire population. Chile is also taking part in COVAX to secure access to an additional 8 million vaccine doses.

Peru has also reached agreements with Pfizer for almost 10 million doses and with COVAX for another 13.2 million doses of various vaccines. Also, Sinopharm and Johnson & Johnson are running trials for their vaccines. In mid-December, Peru suspended the phase III Sinopharm trial that involves about 12,000 people for a few days after a volunteer experienced some unexpected side effects.

Other neighboring countries, including Bolivia, Uruguay and Paraguay that have smaller populations, are relying on deals with multiple companies or COVAX.

Brazil

In Brazil, the largest country in the region with around 213 million people, COVID-19 and vaccinations have been a very political issue despite the country having the third highest case count in the world at 7.3 million and more than 188,000 deaths. Populist President Jair Bolsonaro has opposed mandatory vaccination campaigns and has been at loggerheads with multiple state governors.

The result has been a fractious approach to vaccination, with each of the country’s 26 individual states setting their own agendas and priorities, working out their own deals with vaccine developers and planning their own vaccination campaigns.

For instance, 10 different states, including Bahia and Parana, plan to use Sputnik V. The latter plans to produce the vaccine locally. In turn, the state of Sao Paulo has already started manufacturing Sinovac’s Coronavac even as it completes phase III trials. The Butantan Institute, a biotech research center, will be in charge of manufacturing and distributing Coronavac. Sinovac has already sent enough materials to produce about a million doses.

Anvisa, the health care regulator, issued guidelines in early December for emergency marketing approvals of COVID-19 vaccines. Anvisa Director Gustavo Mendes said during a press conference in early December that Sinovac, Johnson & Johnson, Pfizer/Biontech and Astrazeneca/Oxford could all apply for emergency use authorizations.

Pfizer has not yet been able to reach a deal with Bolsonaro’s government, which plans to source AZD-1222 and manufacture it domestically also through Butantan and the Oswaldo Cruz Foundation (Fiocruz), from Rio de Janeiro, former minister of justice Eugenio Aragao told BioWorld.

“Based on the technology order agreement and the technology transfer, we are responsible for the development of the vaccine originally created at the University of Oxford and licensed to the pharmaceutical company Astrazeneca,” said Fiocruz President Nísia Trindade Lima on Dec. 22.

Fiocruz, which expects to start a vaccination campaign during the second week of February, said it should be able to deliver about 700,000 doses by the end of that month.

Colombia and Venezuela

Colombia has confirmed plans to purchase Pfizer/Biontech’s Comirnaty, has a deal with Astrazeneca and is participating in COVAX, but those deals are not likely to be enough.

“The agreement with the pharmaceutical company Pfizer for the acquisition of 10 million doses has been closed,” said President Ivan Duque on Dec. 18. “The agreement with the pharmaceutical company Astrazeneca for the acquisition of 10 million doses has also been closed. And we have also closed our agreement, through the COVAX platform, to acquire 20 million doses.”

With 40 million doses confirmed, the country would theoretically have enough vaccines to cover about 40% of a population that has the third highest case count in the region with 1.53 million reported cases and 41,000 deaths.

And Colombia faces an added and unique challenge. The country is home to about 1 million Venezuelans that have fled political instability in their own country. Duque has said people living illegally in Colombia will not receive vaccinations.

For its part, Nicolas Maduro’s regime in Caracas, Venezuela, has placed its hopes on Sputnik V, which is currently undergoing phase III trials there, although the government has released very little information about the progress of the trials or any data from them.

Central America and the Caribbean

North of Colombia, the often-poorer countries in Central America and the Caribbean have high hurdles to overcome.

The Central American countries of Guatemala, Belize, Honduras, El Salvador, Nicaragua, Costa Rica and Panama are home to about 50 million people while the Caribbean encompasses 13 countries and 12 territories (including Venezuela) that are home to 44 million people. Most of those countries are part of COVAX, which would provide vaccines for 20% of the populations of recipient countries.

Cuba is the only country in Central America and the Caribbean that claims to be developing its own vaccines: the monovalent vaccine Soberana 1 and the conjugate vaccine Soberana 2. (Soberana is the Spanish word for “sovereign.”) Both are currently undergoing phase I/II trials, although very little information or data related to either vaccine have been released. Still, the island nation expects it will be fully self-sufficient in terms of vaccination.