Is it possible to distribute a Covid-19 vaccine fairly and effectively?

By lockdown_exit - 15th Mar 2021, 12:00 am - That was the week that was

Is it possible to distribute a COVID-19 vaccine fairly and effectively?

The last week examined Vaccine Equity and Debt Relief, How New Technology Might Disrupt the Vaccine Market, Expanding Vaccine Manufacturing Globally, Vaccine Distribution and affirmed that the World still had some distance to travel in its fight to battle the Covid-19 pandemic.

The COVID-19 pandemic is one year old

With the anniversary of the WHO announcement of a global pandemic falling this week, the global media hailed the astonishing success of the scientists and researchers in bringing a vaccine to market successfully in such a short space of time - some 303 days. With new vaccine research and development often taking between 5 and 10 years to come to market, the impact of not one but several successful COVID-19 vaccines becoming available in such a short time has astounded many experts and offers hope that the world can get a controlling handle on managing the COVID-19 pandemic sooner rather than later.

More jabs, more jobs

This is witnessed by the OECD feeling a whole lot better about the global economy’s prospects this year. In its latest Economic Outlook released on Tuesday, the Organisation for Economic Co-operation and Development (OECD) boosted its forecast for global economic growth this year to 5.6 percent – more than a full percentage point higher than its December estimate ('More Jabs, More Jobs' - AlJazeera) though it added "a lot will depend on the race between vaccines and emerging variants of COVID-19."

A first ever leaders' meeting of the Quad group of countries (which includes USA, Japan, Australia and India) said it planned to announce financing agreements to support an increase in manufacturing capacity for coronavirus vaccines in India. The financing agreements will focus on companies and institutions in India manufacturing vaccines for American drugmakers such as Novavax and Johnson & Johnson. The aim of the initiative is to reduce manufacturing backlogs, speed vaccination and defeat some coronavirus mutations. The quicker you can vaccinate the more you can overcome these challenges. Some of the additional vaccine capacity created in India (which would come online later in the year) would be used in vaccination efforts in Southeast Asian countries.)

A Rethink on How to Improve Global Vaccine Manufacture?

Richard Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations (CEPI) told STAT the group will launch its strategy and goals this week. It is aiming to find ways to unblock vaccine production bottlenecks without harming non-COVID vaccine production.

He said CEPI is looking at how to end the COVID pandemic, the existing institutions that have been set up and how they might be improved for future pandemic preparedness. Hatchett said "We started out considering next-generation vaccines as just offering attributes for the long-term: low cost, single dose, thermal-stable products. However, the introduction of the COVID variants forces CEPI to think about multivalent vaccines that protect against several strains of the virus, or vaccines that can be easily turned from one strain to another." This means CEPI will soon put out a call for proposals for fully protective betacoronavirus vaccines. There are at least 20 groups around the world moving in that direction and the plan is to put out a major initiative - hopefully by the end of the month." Hatchett highlighted an issue. Most types of vaccines depend on a relatively narrowly defined set of critical inputs.  These can be classed as consumables or raw materials that each vaccine depends on. The bags, the stoppers, the tubing - all chemical raw materials, however, CEPI is getting signals from individual vaccine manufacturers that they are skating on relatively thin ice in terms of supplies of these consumables as they battle to ramp up manufacturing. Upstream providers of these critical supplies are talking about lengthening back-order times as they are seeing larger orders so they are concerned they might need to stockpile consumables to meet the need.

An illustration of this point is Japan, where the COVID-19 inoculation campaign is moving at a glacial pace, hampered by a lack of supply and a shortage of specialty syringes that underscore the enormous challenge it faces in its aim to vaccinate every adult by the year’s end. Since the campaign began three weeks ago, just under 46,500 doses had been administered to frontline medical workers as of Friday. At the current rate, it would take 126 years to vaccinate Japan’s population of 126 million. Supplies are, however, expected to increase in the coming months.

The answer lay, in part, in bending existing pharmaceutical norms. President Joe Biden has persuaded rivals Merck and Johnson & Johnson to collaborate in the manufacture of J&J's new COVID-19 vaccine. Enabling a faster manufacturing scale-up, increasing production of vaccine doses and enabling even more ambitious dates to be set for vaccinating the country.

Let's create a new global surveillance network for new pathogens

Stat News invited a number of epidemiological experts to a zoom seminar to discuss where next. They all stressed we need to define What is the end goal here? - suggesting it should be: Get to zero cases, Stop hospitalisations and deaths and Get to an acceptable number of cases. They all agreed a resurgence in COVID-19 cases at the end of the year was likely and said the world needs to know now how to respond to this. If those surges are just cases and not hospitalisations and deaths because vaccines are preventing people from getting really sick - do we want to shut down society again? If a resurgence comes with hospitalisations and deaths, at what level do we raise the red flag and say we're shutting things down again. Contingency plans need to be developed right now

We don't get to normal in one country and that's it. The pandemic needs ending all over the world if we want to get back to life as it was before, the whole world needs to be vaccinated so we have a long way still to go. Now is the time to spend a few billion in building up global surveillance networks for new pathogens, expanding the existing testing infrastructure and bulking up global vaccine manufacturing capability - if it is not being down now (when we know how damaging and disruptive a pandemic can be) will it ever get done? Another pandemic could be upon us at any moment and we're be off-guard once more and many will die.

Nobel Prize economists call for vaccine equity and debt relief

Proposals in a new interim report from the Institute for New Economic Thinking's Commission on Global Economic Transformation, co-chaired by Joseph Stiglitz and Michael Spence call for:

Urgent help for poorer countries to recover from the economic ravages of the pandemic -Vaccine equity and measures to promote vaccine equity - Debt relief - Bolstering fiscal resources for cash-strapped nations

The report urges nations to suspend or modify intellectual property protections for COVID-19 jabs, treatments, tests and products to accelerate vaccine production, get more people inoculated sooner and stay ahead of COVID-19 mutations. 'The world is not going to be safe from the pandemic itself until the pandemic is controlled everywhere in the world, so in that sense, it's even in our own self-interest that there be a rapid dissemination of the vaccines and other medications, the mass tests that help control the pandemic,' Joseph Stiglitz added.

To help give poorer countries more 'fiscal space' to combat COVID19 and its fallout, the report advocates a large issuance of Special Drawing Rights (SDRs) as a low-cost way of bolstering the international reserves of states during a time of extreme fiscal stress. This will enable developing countries to engage in much-needed public expenditure with less concern for the effects on the external balance. It would be a deep and timely debt restructuring

Will the COVID-19 pandemic and new technology disrupt the vaccine market?

Is there a once in a generation opportunity for the world emerging off the back of the global pandemic? Is new Mrna technology, upscaling vaccine manufacturing onto a global scale - stimulating developing economies, helping the world target and possibly eradicate global diseases which threaten economic prosperity - malaria, tuberculosis, cancer, HIV Aids? Has the impact of government intervention in creating a COVID-19 vaccine inside a year (not 10) shown how science-led growth can save lives, build stronger  foundations for a healthier workforce and improve the quality of life. In the Financial Times review of the vaccine manufacturing market it asks:

  • Could the global pandemic propel the vaccine market to become a much bigger part of the overall pharmaceutical market than before? Bill Gates said if we can take the new technological platform (Mrna) and apply it to other markets, like cancer, the possibilities become mind-boggling. Ten times the R&D, ten times the spend, global scale of cases - a form of global pandemic too.
  • An estimated $6.4 trillion in economic output was lost last year and another $4.4 trillion would be lost this year, the development cost of vaccines is a rounding up number in comparison.
  • Setting up a global infrastruture with manufacturing capability on a global scale may not make private sector sense (if some sites are manufacturing at a sub-optimal level) but in the times we are in now they show their worth ten times over.
  • Could this be the catalyst to a new form of vaccine market development ramped up onto a global scale?