No to vaccine nationalism

As we finally prepare to say goodbye to 2020, the expectations are high that 2021 will be a better year. While it is true that economies should improve, even the World Bank is warning that it will not go back to the level in pre-pandemic times. A lot will depend on the countries achieving “herd immunity” through vaccination. This is the state at which a sufficient number have been vaccinated, resulting in the COVID-19 virus totally eliminated as a health threat.

Dr. Anthony Fauci, the most trusted personality in this current pandemic, was quoted a few months ago as saying that 60 percent to 75 percent would be sufficient. In his most recent public statements, he admitted that the estimate may be too low; and the percentage needed to be vaccinated is between 80 percent to 90 percent; but that the final figure would be closer to 90 percent.

Assuming the global population is close to 8 billion people, this would require more than 7 billion people to be vaccinated. Each person requires two doses. This would require at least 14 billion doses to be available next year. Every estimate I have seen does not come close to having that many doses available in 2021.

The result is what Thomas Bollyky, director of the Global Health Program of the Council of Foreign Affairs, calls “vaccine nationalism.” The countries producing the needed vaccine will service their own requirements first. Vaccine manufacturing is an expensive and highly complicated process. Regulators in countries like the US and the EU license not just the finished vaccine but each stage of production and each facility where it occurs.

Bollyky wrote: “Making a vaccine involves purifying raw ingredients: formulating and adding stabilizers, and adjuvants (substances that increase the immune response) and packaging doses into vials or syringes. A few dozen companies all over the world can carry out that last step, known as ‘fill and finish.’ And far fewer can handle the quality controlled manufacturing of active ingredients – especially for more novel, sophisticated vaccines, whose production has been dominated by just four large multinational firms based in the US, the UK and the EU. Roughly a dozen other companies now have some ability to manufacture such vaccines at scale, such as the Serum Institute of India, the world’s largest producer of vaccines. But most are small manufacturers that would be unable to produce billions of doses.”

Some of the leading candidates for the COVID-19 vaccines are also based on emerging technologies that have never been licensed. Scaling up production capacity and securing regulatory approvals for these novel vaccines will be challenging even for rich countries with experienced regulators.

Countries who do not have the capability to manufacture these  vaccines will find it difficult to source supplies. Governments in producing countries might insist on vaccinating large numbers of people in their population before sharing a vaccine with other countries. This recently happened when the Trump administration insisted that Pfizer should first increase their supply in the US before shipping to other countries.

Delivering, storing and distributing vaccines is also a very complicated logistical problem which poor countries may not have the capability for. But if only a few countries have access to vaccines the global pandemic will not end.

The ideal solution is to organize a global approach to the distribution of these vaccines. However, if we recall the first months of the pandemic, there was a global shortage in health care supplies. The global shortage led China, then the EU and then the US, to hoard supplies of respirators, surgical masks and gloves for their own hospital workers’ use. During the first four months of the pandemic more than 70 countries imposed export controls on local supplies of personal protective equipment, ventilators or medicines. What is the prospect for global cooperation on vaccine distribution?

Bollyky continues: “More than a dozen countries and philanthropies made initial pledges of $8 billion to the Access to COVID-19 Tools (ACT), an initiative dedicated to the rapid development and equitable deployment of vaccines, therapeutics and diagnostics for COVID-19. The ACT Accelerator, however, has so far failed to attract major vaccine manufacturer states including the United States and India.”

In the US, there is a $10-billion program called Operation Warp Speed, designed to deliver hundreds of millions of doses starting January 2021. Adam Poonwalla, CEO of Serum Institute of India, says that initially any vaccine developed by them will go first to India’s 1.3 billion people. There is a European Commission effort to arrange with vaccine manufacturers for advance contracts and to reserve doses of promising candidates. China is said to be developing its own vaccines. If they succeed, the expectation is that the Chinese government will use its vaccines for its 1.4 billion population.

Bollky writes: “Vaccine nationalism is not just morally and ethically reprehensible; it is contrary to every nation’s economic, strategic and health interests. If rich and powerful countries choose that path, there will be no winners –  ultimately every country will be a loser. The world is not doomed to learn this the hard way, however. All the necessary tools exist to forge an agreement that would encourage cooperation and limit the appeal of shortsighted ‘my country first approaches’.”

The World Health Organization has set up a program that is attempting to allocated a percentage of world vaccine production to global distribution. Hopefully, 2021 will see the world cooperating to end the pandemic crisis.

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