Independent anti-corruption organisation Transparency International (TI) said on Tuesday that there are large discrepancies in the prices paid for Covid-19 vaccines, revealing that upper-middle income countries like South Africa paid an average of 25% more per dose for the Oxford/AstraZeneca vaccine, compared with high income economies, such as the US and the European Union.

South Africa halted the use of the Oxford/AstraZeneca vaccine, developed by the Serum Institute of India (SII), in February after its efficacy to treat the SARS-CoV-2 variant of the Covid-19 virus was called into question.

South Africa sold its Oxford/AstraZeneca doses to the African Union and was refunded by the SII for other doses that were ordered but not yet delivered.

TI’s latest report ‘For Whose Benefit?’ unpacks the development and sale of the top 20 Covid-19 vaccines and has revealed a disturbing trend of poor transparency in relation to Covid-19 vaccine clinical trials and in contracts between vaccine developers and governments.

"Analysis of prices sourced from UNICEF’s Market analysis dashboard, indicates concerning price variation both as a whole and when assessing specific vaccines. For example, for the AstraZeneca developed vaccine, the dashboard showed that on average high-income economies are paying the least at USD 6.26 per dose, second are the lower-middle income economies at USD 6.72, and the most spent on vaccines is by upper-middle economies at USD 7.81," the TI study revealed.

Of the 183 contracts analysed for 12 Covid-19 vaccines, only 7% of contracts were published through official channels and just one contract was published without redactions.

TI noted that information on pricing is incomplete in all formally published contracts other than those of the Dominican Republic and the US.

TI’s Global Health Programme head Jonathan Cushing said the study’s results made for worrying reading and carry important implications not just for the Covid-19 response, but also for future health emergencies.

“Hiding contracts from public view or publishing documents filled with redacted text means we don’t know what governments have signed up to. Given the huge amounts of public money invested in research and development around the world, citizens have right to know everything about the vaccines their taxes helped to fund,” he said.

TI suggests that all governments that have bought vaccines publish their contracts.

CLINCIAL TRIALS

TI’s study concluded that clinical trial transparency is the only way to monitor the safety and efficacy of vaccines.

It called for legislation for the pre-registration of all clinical trials and for the summary results to be published within 12 months of their completion.

TI worries that a lack of transparency could exacerbate vaccine hesitancy, with one-third of the global population already unwilling to take a Covid-19 vaccine.

“The lack of publicly accessible data creates space for misleading and potentially dangerous half-truths, disinformation, and conspiracy theories, which in turn contribute to vaccine hesitancy,” Cushing said.

TI’s study of clinical trials looked at 86 registered trials across the top 20 vaccines.

Only 45% of these trials had been announced, and of this 41% had provided only top-level results through a press release or press conference, leaving the full data unavailable for scrutiny.

Clinical trial protocols had been published for only 12% of trials, with no publicly accessible protocols for 885 of the registered trials.

“The early sharing of clinical trial protocols is important, as it enables external expert scrutiny of methodology and design integrity to highlight potential bias and can also deter the selective reporting of results,” TI said.

Cushing warned that the lack of transparency of many clinical trials combined with the huge financial incentives for producing effective treatments leaves the door wide open for selective reporting of results or outright data manipulation.

TI has urged vaccine developers to publish their clinical trial protocols on a publicly accessible registry and to announce through the media clinical trial results and data analysis published in a peer-reviewed medical journal, trial registry or as a pre-print article.

Download the full report here