Chapter 1
The search for a vaccine for Covid-19 concerns all of us. But finding an effective formula is only the beginning. The long-term goal must be a global strategy that will ensure population immunity on a worldwide scale. To do that, we need to address a series of key challenges that stretch from Research and Development to ‘needle in the arm’ and beyond. And we need to do it together, to ensure the most vulnerable are not left behind.
Research
Currently vaccines take an average of 10 to 15 years to develop and manufacture. Covid-19 is compressing that process by piggybacking on previous research, eliminating or combining phases, and speeding up approvals. But there are several potential sticking points:
Novel techniques like mRNA- and DNA-based vaccines are yet to be proven in humans. Previous experience with respiratory infections shows certain formulations could do more harm than good.
There are problems recruiting enough and the right clinical trial participants, for example the elderly, who may have diminished immune systems, and those in developing countries, who may suffer multiple health issues, including malnourishment and exposure to diseases, which may affect the efficacy of the vaccine. Vaccines and populations interact differently than they do under clinical trial conditions. Moreover, different strains of Covid-19 may also predominate in these areas.
Production
Not only do we need to produce billions of doses of a vaccine, but we need the equipment and people to store, distribute and administer it. However:
There is very little spare vaccine manufacturing capacity in the world, and focusing on Covid-19 runs the risk of affecting production for other essential vaccines.
Manufacturing is already hampered by scarcity of components like glass vials.
In order to be ready for production, manufacturers need advance market commitment, which at the moment is very limited, as well as other measures to boost production in countries like China and India.
While many vaccines need to be stored between 2 and 8 degrees centigrade, nucleic acid vaccines (RNA and DNA) require a temperature of -20 degrees centigrade. Many countries lack enough suitable storage facilities, partly because of poor electricity supply.
The global shortage of health-care workers is set to increase from 12 to 18 million in the next 10 years, even as the population is set to increase, especially in developing countries.
Equitable Access or Vaccine Nationalism?
Currently access to the vaccine appears to be being determined through a bidding war. If we’re to achieve global population immunity, developing countries will need help to ensure access:
Institutions and richer countries will need to provide partial financing, or options such as bond structures, repaid to investors over time.
Frontline workers will need to be prioritised and given PPE.
1 billion residents of poor and developing countries lack any formal identity. Significant investment must be made to address this gap to keep track of who has received the vaccine.
There also needs to be work on mapping vaccine coverage, and investment in implementing Electronic Immunisation Records (EIRs) in these countries.
Proper Co-ordination
The same problem that plagues treatment development and access affects vaccine development and access: lack of co-ordination. This is perhaps our biggest challenge of all. The US presidential election in November could prove pivotal to a more inclusive and co-operative approach. In the interim, EU countries and the UK are in a position to assume greater leadership for coordinating key aspects of how any vaccine is delivered, especially in poorer countries.
Once we find an effective vaccine, ensuring global population immunity is not an impossible task. Nor is it unaffordable. But countries and stakeholders must work together, and better, to make sure the world is protected.
Conclusion
We need a radical, fast and global approach in order to provide for all nations. And we need political leadership to create this framework and drive its adoption.
High income countries (HICs) need to pool financing for manufacturing (a “Covid Buyers Club”) for “at risk” and “at scale” manufacturing in order to:
Back a portfolio of candidate vaccines rather than back a single horse
De-incentivise bilateral deals
Efficiently manage tech transfers from R&D to MNC and smaller manufacturers to avoid capacity capture by a few deals
Avoid bidding wars that raise prices
Agree that a reasonable percentage of doses wherever they are manufactured go to LMICs priority populations
A partial example of this is the European Inclusive Vaccines Alliance (IVA), which includes Germany, France, Italy and the Netherlands, and is open to other European countries that want to participate. This “buyers club” hopes to improve its position through collective action and seeks to manufacture a Covid-19 vaccine in Europe. The Alliance recently closed a deal with AstraZeneca, which will provide 27 EU countries with up to 400 million doses, at a cost of €750 million. If the vaccine makes it through the clinical development process, it will be delivered at the end of this year, with EU countries receiving doses based on the size of their population. Catalent, the US manufacturer, will produce the drug at its facilities in Italy.
Low- and lower-middle-income countries (LMICs) need to supplement their own government budget, secure aid and philanthropic funding to:
Finance advance market commitments for a portfolio of candidate vaccines rather than back a single one
Agree that a reasonable percentage of doses allocated to LMICs are reserved for priority populations
Upgrade and scale up manufacturing capacity
Prepare their expanded programmes on immunisations (EPIs)
A significant aspect of this work for LMICs is being spearheaded by Gavi and CEPI.
The search for a vaccine for Covid-19 concerns all of us. When we do get an effective and approved vaccine, the current marketplace may not deliver for developed countries, nor for poorer countries. Hence, we need a global vaccine strategy for Covid 19.
Read the full report, “Towards a Global Covid-19 Vaccine Strategy”.