Why was Turkey late in choosing BioNTech vaccine?

The May 20 meeting for the Coronavirus Science Advisory Board, held under the chairmanship of Health Minister Dr. Fahrettin Koca, became the scene to a “first.”

Two significant guests attended the meeting via videoconference: Prof. Uğur Şahin and Dr. Özlem Türeci, who are the founding partners of BioNTech, the firm that developed the mRNA vaccine against COVID-19

In the statement issued after the board’s meeting, the health minister announced that “an agreement of 120 million doses has been signed with BioNTech in the procurement process that started with 1 million doses.” Some “6.1 million doses [from this amount] have been delivered so far,” Koca added.

In his statement, Prof. Şahin stated that they want to bring 30 million doses by the end of June and complete 120 million doses in July, August, and September. “We will work day and night to bring the vaccine to Turkey on time,” Şahin said.

Şahin, Türeci are reassuring

Koca and Prof. Şahin’s statements from May 20 resemble a door opening to optimism after months of great uncertainty due to delays in China’s Sinovac vaccine and constantly revised objectives in the COVID-19 vaccination campaign.

There is no doubt that Prof. Şahin and D. Türeci will show the maximum effort to fulfill commitments they have made when one takes into account their identities as scientists, the competencies that have made them stand out with their inventions across the globe, and the professional measures by the company they are founding partners in.

Indeed, after months of confusion over the arrival of the Chinese vaccine, the fact that the BioNTech vaccine will come into play with a batch of 120 million doses is a brand-new situation in the equation for vaccination goals. If it works as planned, it means that 60 million people could be vaccinated, when calculated on two doses per person. Considering the Turkish Statistical Institute’s (TÜİK) data that Turkey’s population is around 83.6 million, BioNTech’s commitment reaches some 72 percent of the population.

Bearing in mind that nearly 12 million citizens were fully inoculated as of May 21 evening, it is quite possible to exceed the targeted social immunity rate by the end of next September as long as the agreement with BioNTech can be fully actualized.

Koca’s initially distant approach to BioNTech

So far, we have reported the developments from the good news chapter. But the good news should not be an obstacle to asking why our decision-makers delayed this development so much. If the BioNTech option would eventually prevail, how will the delay of this choice be explained to the public now? Couldn’t these connections be made before?

Considering that the two scientists who found this vaccine are Turkish, though they are residing in Germany, why the advantage Turkey had in this respect was not evaluated?

As we move to seek answers to these questions, the archives tell us that Koca had a somewhat distant view towards the BioNTech option at the first stage. Especially when his remarks from the end of last year are examined closely, it is possible to come across his statements that he turned to the Chinese vaccine because he found it more reliable.

We should emphasize on Koca’s answers from Dec. 8, 2020, to journalist İsmail Saymaz’s questions in daily Sözcü. In this interview, in response to the question, “Why we didn’t get the Moderna and AstraZeneca vaccines?” the minister said: “Moderna is not giving its vaccines to other countries. AstraZeneca wants to give it. I did not take it; I am keeping it waiting.” When asked why he is doing this, Koca said: “The world is still not sure that this is a vaccine that I can say to my citizens ‘You can trust it 100 percent. I want to receive this too.’ We still do not know the long-term immunity results. The world did not see the early success results.”

At this point, the minister’s remarks led up to BioNTech.

“I am saying this not only for AstraZeneca but also for BioNTech. These are mRNA vaccines. In other words, vaccines that are obtained by genetic means. They may have shown success in terms of developing antibodies and cellular immunity in short term. But the world does not know their medium-and long-term results. Because this is the first time the mRNA method is being used during a pandemic… The vaccine, whose results are known to the world, are the vaccines that we call inactive in traditional and classical methods.”

Koca was sure of local vaccine’s use at end of April

Now let’s move on to another statement from the minister. While talking to reporters at the Turkish Parliament on Dec. 1, 2020, Koca said that they were in intense talks for the Pfizer (BioNTech) vaccine. “Especially regarding the Pfizer vaccine, as our local vaccine will come into play in April and afterward, we said, ‘We are willing to buy whatever they can provide until April,’” he said.

Koca repeated the same remarks to Saymaz on Dec. 8, 2020: “[BioNTech] said, ‘We cannot give more than 1 million [vaccines].’ They said they could give us 25 million [vaccines] for 2021. We will not need the vaccine after April 2021. Because our vaccine will get involved. I said, ‘I will get how many vaccines you can give, including April.’”

When we put these two statements side by side, we see that Koca speaks with absolute confidence that the vaccine produced in Turkey will start to be used at the end of April. It would not be a mistake to say that the health minister’s vaccine procurement strategy last December was based on this assumption to a great extent.

Local vaccine to be used in September at earliest

This strategy did not yield results as expected. The domestic vaccine did not go into effect last April. As it did not, difficulties in providing vaccines, especially from China, started as well.

“Vaccine procurement is getting harder in the next two months, but it is expected that there will be an abundance of vaccines afterward,” Koca said on April 28.

On the other hand, President Recep Tayyip Erdoğan drew the line by saying, “I do not accept any problems in vaccine supply,” on April 30, two days after the minister’s remarks.

So, when can the local vaccine target, which Koca previously projected for the end of April, be achieved? Explaining during the previous evening’s statements that studies on multiple vaccines in various phases are continuing in Turkey, Koca said: “If these processes are successfully completed, [our vaccine] may be used with approval for emergency use in September. In this sense, we expect our first Turkish vaccine to be successfully brought to the agenda, and we are following it closely.”

Other countries hurried to get vaccine

Of course, while evaluating Turkey’s approach, it is also necessary to look at how other countries acted to receive the BioNTech vaccine. The article of our colleague Yıldıray Oğur, prepared by using open sources and published on May 1 in daily Karar, is extremely informative. According to the article, Pfizer, one of the leading pharmaceutical companies in the United States, and BioNTech announced that they reached an agreement for vaccine production on March 17, 2020; that is, six days after the first case was detected in Turkey.

In the following period, Pfizer – BioNTech made its first agreement with the U.S. Department of Health on July 22, then Japan on July 31, Canada on Aug. 5 and the European Union on Sept. 9. Apart from this, countries such as Israel, United Arab Emirates, Saudi Arabia, Australia, New Zealand, Malaysia, South Korea and Peru placed orders for the Pfizer – BioNTech vaccine in the summer and autumn of 2020. A great deal of these agreements was made on the condition that the vaccines will be delivered in 2021.

Undoubtedly, a realistic and grounded strategy should have diversified the sources of the vaccine supply. By following the movements of other countries in the last summer and autumn, and the introduction of multiple sources by establishing contact with BioNTech, along with the Chinese option, would have largely prevented the troubles experienced for months.

A proactive strategy in this direction would also have compensated for the enormous risks posed by an assumption that the domestic vaccine would come into effect in April. Unfortunately, we are not in a position to measure the high price caused by the delay experienced in Turkey.