Developing The COVID-19 Vaccine Is Only Half The Battle
Even if researchers' quest for the coronavirus vaccine concludes quickly — and that's a big if — the solution would still need to me manufactured, packaged, paid for and distributed.
The coronavirus, and our response to its spread, has dramatically altered our way of life, and many experts warn that our lives may never go back to normal unless we find a vaccine. But even with a vaccine, we may never go back entirely to the way we used to live.
By the more optimistic measures, it will take close to two years to develop a functional vaccine. Researchers have already started several extensive efficacy studies involving thousands of volunteers, which is the most cost-intensive part of figuring out a vaccine and the riskiest. During these studies, researchers need to wait for people in the survey to get accidentally infected with the virus, and then analyze how often those given the vaccine get sick.
Producing vaccines is an intricate process, illustrated by the fact that even after 30 years we have no vaccine for HIV. The dengue fever virus was identified in 1943 but an early vaccine was approved only last year. The fastest vaccine ever produced was for mumps, in four years.
In addition, a vaccine may not work as intended. One vaccine that sounds safe in a small group of individuals might produce side effects when investigated in a more comprehensive review. Another may hardly protect half of the people who get it from COVID-19, or provide protection but not enough to make a difference to the pandemic's evolution.
Finally, even if researchers develop a "perfect" vaccine, and soon, there are other matters we will need to address before policymakers can claim victory.
To start with, there are ethical issues, especially regarding decisions on who gets the vaccine first. Any government will have a tough time allowing a vaccine manufactured in their country to be exported while there is a problem at home. Countries where the vaccines are manufactured could hoard them or companies could also sell doses to the highest bidders. The U.S. government has promised $1.2 billion for least 300 million doses of AstraZeneca's vaccines, with the earliest doses to be delivered as soon as October.
Pandemics, just like natural calamities, almost always hit poorer communities worse.
Another issue is that countries with fewer resources may not be able to afford or access enough vaccines without price restrictions. Rich countries can thus monopolize the vaccine, potentially leaving many people in developing countries to continue to bear the brunt of COVID-19. In 2009, during the H1N1 swine flu that killed 284,000 people worldwide, richer countries were able to get the vaccines earlier than developing countries by directly negotiating large advance orders. In other words, distribution of the H1N1 vaccine was eventually based on purchasing power, not the risk of transmission.
Governments, institutions, healthcare workers and other stakeholders will have to fight similar fights to procure PPE and ventilators. Pandemics, just like natural calamities, almost always hit poorer communities worse. With fragile health systems, already burdened health care workers and insufficient equipment in low-income countries, the long-term impacts of how governments respond to the coronavirus pandemic could be overwhelming. The virus is likely to continue to disrupt global supply chains as long as countries with large populations don't get the needed vaccines.
Even where promising results for vaccines have been reported, there are considerable challenges to scaling up production and transportation. Bill Gates, whose foundation is investing $250 million to help spur vaccine development, has warned of a severe deficit of a banal but indispensable component: medical glass. Without ample supplies of this grade of glass, there will be fewer vials to transport the billions of doses that will ultimately be required.
After the vaccine has been manufactured, distributing it in countries like India will be another tricky task. India supplies 60% of the vaccine doses purchased by UNICEF every year, and the Serum Institute of India is the world's largest vaccine manufacturer, producing and selling over 1.5 billion doses every year. But Indian bureaucracy also moves notoriously slowly. In 2016, for example, about 38% of all children failed to receive their necessary vaccines in the first year of life.
Finally, there is no global entity that could finance and procure vaccines at scale. Nor is there a globally fair allocation system for such vaccines. International collaboration is important when dealing with pandemics of such magnitude. Merck, which ultimately developed the Ebola vaccine, required the help of the Canadian and American public health agencies plus the WHO.
It will be necessary to have such a global collaboration to ensure everyone who needs the coronavirus vaccine gets it.
*Javaid Iqbal is a Global Fellow at Brandeis University, Massachusetts.