Coronavirus vaccine: production, distribution, and equity

Posted: Friday, September 11, 2020. 11:45 am CST.

By Aaron Humes: Dominic Bailey of BBC News has written an extensive discussion of the next steps in producing and distributing a successful vaccine against coronavirus SARS-nCov-2, which causes COVID-19.

While many of those who get the virus recover successfully, albeit with some lasting complications, many of the most vulnerable, including those with pre-existing conditions and old age, die or are left heavily debilitated.

As Bailey notes, “If or when scientists succeed in making a coronavirus vaccine, there won’t be enough to go around. Research labs and pharmaceutical companies are rewriting the rulebook on the time it takes to develop, test, and manufacture an effective vaccine. Unprecedented steps are being taken to ensure the roll-out of the vaccine is global. But there are concerns that the race to get one will be won by the richest countries, at the expense of the most vulnerable. So who will get it first, how much will it cost and, in a global crisis, how do we make sure nobody gets left behind?”

Bailey notes that under regular circumstances, vaccines to fight infectious diseases take years to develop, test, and deliver and their success is not guaranteed. Only one human infectious disease – smallpox – has been completely eradicated and it took two centuries. Others are warded off by vaccination.

In the case of coronavirus SARS-nCov-2, human trials are already underway for multiple vaccines, and the usual lead time of five to ten years has been pared down months while manufacturing is scaled up, resulting in risking billions of dollars to hit the jackpot.

Both Russia and China have developed vaccines for distribution, the former en masse in October, the latter for its military, but neither has been listed by the World Health Organization (WHO) among its list of vaccines in phase three clinical trials done on humans.

Some of these leading candidates hope to get their vaccine approved by the end of the year – although the WHO has said it does not expect to see widespread vaccinations against Covid-19 until the middle of 2021.

Governments, meanwhile, are hedging their bets to secure potential vaccines, making deals for millions of doses with a range of candidates before anything has been officially certified or approved. But not all countries are in a position to do likewise.

Organisations such as the Médecins Sans Frontières (Doctors Without Borders), often on the frontline delivering vaccines, say locking in advanced deals with pharmaceutical companies create “a dangerous trend of vaccine nationalism by richer nations”.

And the WHO’s assistant director-general responsible for access to medicines and health products, Dr. Mariângela Simão, says we need to ensure vaccine nationalism is held in check: “The challenge will be to ensure equitable access – that all countries have access, not just those who can pay more.”

A global vaccine plan known as Covax involves 80 rich nations and economies aiming to raise US$2 billion by the end of 2020 to buy and distribute a potential vaccine worldwide, not including the United States. At least 92 lower income countries in Africa, Asia, and Latin America, would also get “rapid, fair and equitable access” to Covid-19 vaccines.

Having a wide portfolio of vaccine trials signed up to their programme, they are hoping at least one will be successful so they can deliver two billion doses of safe, effective vaccines by the end of 2021.

Vaccine makers are mostly pledging to keep costs effective. While pharmaceutical company Moderna, for example, is reportedly selling access to its potential vaccine at between $32 and $37 a dose, AstraZeneca has said it will supply its vaccine “at cost” – or a few dollars per dose – during the pandemic.

But patients receiving the vaccine are unlikely to be charged in most cases. The UK will use its vaunted National Health Service scheme; Australia has pledged to offer free doses to its population; humanitarian organizations will not lay charges, and in the U.S., the shot should be free though the service will not be.

But who gets it first? That depends on individual countries according to Sir Mene Pangalos – AstraZeneca’s Executive Vice President.

As the initial supply will be limited, reducing deaths and protecting health care systems are likely to be prioritized.

Countries signed up to Covax, high or low income alike, will receive enough doses for 3% of their population – which would be enough to cover health and social care workers. As more vaccine is produced, allocation is increased to cover 20% of the population – this time prioritizing over 65s and other vulnerable groups. After everybody has received 20%, the vaccine would be distributed according to other criteria, such as country vulnerability and immediate threat of Covid-19.

The ideal vaccine has a lot to live up to, says Bailey. It needs to be affordable. It needs to generate strong, long-lasting immunity. It needs a simple refrigerated distribution system and manufacturers must be able to scale-up production rapidly.

There is also the question of the target population. Vaccination programmes usually target children, so agencies will have to plan how to reach people that normally are not part of the immunization program.

As the world waits for the scientists to do their bit, many more challenges await. And vaccines are not the only weapon against coronavirus.

“Vaccines are not the only solution,” says Dr Simao. “You need to have diagnostics. You need to have a way to decrease mortality, so you need therapeutics, and you need a vaccine. Besides that, you need everything else – social distancing, avoiding crowded places and so on.”

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