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Friday, March 29, 2024

Vaccine challenges

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"Things will not be easy but we will, sooner or later, get them right."

 

Let us be clear about things. With the world under lockdown for a year due to COVID-19, we have had enough experience and expertise to guide us out of this situation. Having infected more than 111 million causing 2.4 million deaths worldwide, COVID has plunged the entire planet to a near standstill resulting in hollowed-out economies across the board. It is time to get out of the sinkhole before we get sucked even deeper.

Of course, adhering to the health protocols has mitigated the spread of the virus. There is no denying that outbreaks can happen in many countries. Disruptions to the global economy and normal day-to-day living will probably remain for some time before the world gets to attain what scientists describe as herd immunity.

Which is why from Day One, the global effort has been to produce a vaccine to prevent severe infections, deter viral transmission and drive immunity to respectable levels. But developing and producing a vaccine in record time is not enough. It has to be affordable, accessible and injected (deployed) to as many of the world’s populations in the shortest time possible. That is the biggest challenge of our time which only a unified and concentrated global effort can achieve in an ethical and equitable manner.

A health policy paper authored by noted scientists and public health specialists published in LANCET, the prestigious medical journal, outlined the basic issues and challenges facing such a global effort noting that the basic components of this initiative, namely, development and production, pricing (affordability), allocation (accessibility) and deployment are so inter related that failure in one can derail the anticipated global rebound and degrade public confidence.

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As the paper correctly noted, developing and producing the vaccine is not enough. It has to be of such efficacy and scale as to be affordable and readily available for deployment to the farthest ends of the earth to enhance such trust and confidence needed to get the world moving again. Things will not be easy. In fact, they can be so complicated and tortuous that it will take active intervention by international institutions like the WHO, WTO and UNICEF not to mention NGOs like COVAX (Covid 19 Vaccine Global Access Facility) and GAVI (The Vaccine Alliance) and CEPI (Coalition for Epidemic Preparedness Innovations), the global foundation funded by business and philanthropic organizations to finance independent research projects to develop vaccines against emerging infectious diseases, among others, to get things right.

The role of CEPI in the COVID-19 vaccine development program has caught the eye of a number of observers including anti-vaccine activists specially since it was co-founded and co-funded by the Bill and Melinda Gates Foundation and the WellCome Trust which counts a number of Big Pharma companies as benefactors. The buzz is that CEPI’s operation has compromised the integrity of the WHO as the monitoring, consultative and audit institution of record on global health issues and concerns even as it has, in the case of the COVID-19 vaccine, promised "equitable access" to the vaccines during outbreaks.

That buzz is taking on wings, as observers noticed that a good number of the 289 experimental vaccines under development have been funded interchangeably by CEPI and the Bill and Melinda Gates Foundation. Be that as it may, this is not the time and the place to entertain such thoughts. What matters now is for us to urge these developers to proceed with all deliberate speed in getting their products injected to as many people as possible. The sooner, the better.

In any event, there is every reason to hope that in the next two or three years we will finally get back to the robust economic and social life we enjoyed before the pandemic albeit with marked changes in the manner by which peoples and nations interact with each other.

It is worth noting, for example, that of the 26 vaccines in advanced stages of development, six

(Pfizer/BioNTech, Moderna, AstraZeneca/Oxford, SinoPharm, SinoVac, Sputnik/Gamaleya) are being ramped up in production and two more (Johnson and Johnson/Jannsen and NovoVax) about to finish with Stage 3 trials. The problem is this is just the start of the long and tortuous journey to get the jabs safely to as many people as needed.

To achieve global control of COVID-19, these vaccines have to be produced at such a scale as will deter widespread transmission. This year the target is to have at least 20 percent of the global population vaccinated –a tall order by current production standards. Reports have it that nine developers have promised to deliver 700 million doses each this year while 10 others are looking at ramping up to one billion doses each. Whether such can be achieved at all is problematic to say the least given the need to have the basic ingredients (reagents, syringes, glass vials, etc) in such quantities as required in place at the limited production facilities. To ramp things up, the WHO and WTO are looking at fast tracking collaboration agreements between the vaccine developers and local (national) producers by relaxing licensing arrangements and technology transfer rules. That may take some time.

Added to such a production constraint is the need to ensure that the vaccines are priced affordably and allocated responsibly and equitably – issues which can put a squeeze on the global vaccination effort no end. Already, countries like the Philippines are finding it hard to get even one dose of any of the authorized vaccines in place for one reason or the other. Untangling those knotty problems as outlined not to mention local (national) concerns such as the availability of facilities and personnel to undertake the job will truly make things harder than expected. The problem is, the longer things get tangled up, the more problematic things become as the public’s trust and confidence in the vaccination program gets degraded. Vaccine acceptance even in developed countries has become a critical issue. As the paper noted, vaccine acceptance has been critical in a country’s COVID-19 response effort. It was highest in countries which have been quite successful like Vietnam (98 percent), China (91 percent), Denmark (87 percent), and South Korea (87 percent), and lowest in those still reeling from the virus such as Serbia (38 percent), Croatia (41 percent), France (44 percent), Lebanon (44 percent), and Paraguay (51 percent).

Indeed, public acceptance is a challenge we forget.

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