Vaccine nationalism and the debate over who gets the vaccine first

Though the World Health Organisation (WHO) has warned against ‘vaccine nationalism’, a study released by Oxfam says that a group of wealthy nations that represent only 13 per cent of the global population, has already bought over 51 per cent of the vaccine stocks. The report adds that the remaining 2.757 billion doses have been bought by countries such as China, Brazil, India, Indonesia and Bangladesh.

The Oxfam report also warns that in the unlikely event that all five vaccines for which supply deals have been made public, succeed, nearly two-thirds of the world’s population will not get access to a vaccine till 2022. The chances of some of these trials failing are also higher, thus leaving more people without access to any vaccine.

Globally around 150 companies are in the race for developing a vaccine, with nine currently in phase III of testing. Out of these nine, supply deals have been made public for five vaccine candidates, being developed by AstraZeneca, Gamaleya/Sputnik, Moderna, Pfizer and Sinovac.

Health Minister Dr Harsh Vardhan has revealed that India is hopeful of getting a vaccine for COVID-19 ready by the beginning of next year. Three vaccines candidates are in different phases currently. While Zydus Cadilla and Bharat Biotech’s indigenous vaccines have completed phase I, Serum Institute has received the go-ahead from Drugs Controller General of India (DCGI) to resume clinical trials of COVID-19 vaccine in the country.

Further, the Russian sovereign wealth fund Russian Direct Investment Fund has reportedly partnered with Hyderabad based Dr Reddy’s to conduct clinical trials of its vaccine Sputnik V in India. Dr Reddy’s will also take up distribution of around 100 million doses of the vaccine in India, with the deliveries for the public use slated to start by end of this year.

India has the second-highest number of COVID-19 cases in the world, with a total of 5.02 million, second only to the United States. The country also has the highest number of recovered cases in the world, with 3,780,107 patients recovered so far.

These figures only emphasise the eagerness with which the world is waiting for a vaccine to come in that could immunise us against the virus.

A Herculean task

Ensuring that each and every one of the 7.8 billion human beings on Earth is vaccinated, will be a mammoth task. Adar Poonawala, chief executive of Serum Institute of India, had recently said that the COVID-19 vaccine will not be available to everyone soon, but that people would need to wait till the end of 2024 for a competent vaccine to reach every person worldwide. The world would also need more than 15 billion doses of the COVID-19 vaccines if they need to be delivered in two doses.

The safety and efficacy of vaccines is of significant concern. One in seven volunteers of the Sputnik V vaccine has reported side effects, such as muscle pain for 24 hours, occasional increase in body temperature and complaints of weakness. Earlier, a group of 15 scientists had sent a formal letter to Lancet voicing their concern over the accuracy of early data on the Sputnik V vaccine,

Apart from developing a safe and effective vaccine, there are numerous other challenges that need to be considered – transportation of the vaccines, especially in the case of hard-to-reach places where there are many natural barriers to cross and little infrastructure.

Supply chain needs to be bolstered up as well. As per a report by the Chief Commercial Officer, DHL on the World Economic Forum’s (WEF) COVID Action Platform, 15,000 flights and 15 million cooling boxes could be required to transport billions of doses of COVID-19 vaccine around the world. Vaccines may also need to be kept at temperatures as low as -80 degrees Celsius. The conventional supply chains distribute vaccines at +2-8 degrees celsius, currently.

Further, as per experts, there aren’t enough glass vials to house the vaccines. Vaccines cannot be stored in just any glass vials, medical vials are made using borosilicate glass, which is resistant to temperature changes and is more chemically durable. Further, parts such as ampoules and syringes would also be needed in huge quantities to ensure that the vaccines reach the global billions.

Big packaging giants have been gearing up to meet these demands.

Who will get the vaccine first

One of the biggest questions that vaccine manufacturers, healthcare experts and Governments face is who will get vaccinated first, in the event that a vaccine does successfully complete all trials.

In terms of which country gets access to the vaccines first, it would probably be the one which has got a breakthrough in developing a safe and effective vaccine, in the first place. This would also depend on the particular firms’ agreement with the country it is located in, and other countries it has made deals with.

Vaccination distribution strategies within countries are, however, likely to vary from country to country. In India, for instance, Health Minister Harsh Vardhan had said that healthcare workers, senior citizens and persons with co-morbidities would have priority for the vaccine once it arrives, irrespective of their paying capacity.

In the United States, health care expert panels are deciding on who would get next priority for the vaccine, after healthcare workers who directly interact with coronavirus patients.

Some countries such as Russia are looking to inoculate front line workers, army personnel, teachers and healthcare workers, first.

However, an international group of ethicists have criticised a WHO goal of distributing vaccines proportional to a country’s population and of prioritising healthcare workers, and adults who are above 65 years of age or have underlying conditions.

The group, which includes American oncologist and bioethicist Ezekiel Emanuel and experts from Canada, Australia, Norway and Britain, have stated in an article in the journal Science, that a more equitable option would be to focus on giving priority to countries where the outbreak is more severe.

Dubbed the Fair Priority Model, the system has three phases – the first aimed at reducing premature deaths. The experts propose the use of a health metric called standard expected years of life lost (SEYLL), which calculates the years of life lost because of the pandemic in each country.

It also aims to stem serious economic and social harms of the virus and its long term repercussions for education and economies. The third phase looks at prioritising countries with higher virus transmission rates and ensuring that ultimately all countries receive enough doses to hold community transmission.

In order to stop vaccine nationalism, global collaboration is needed. The WHO-backed COVAX is a global initiative which is aimed at working with vaccine manufacturers to provide equitable worldwide access to affordable, safe and effective vaccines, once they are approved. Around 172 economies are engaged in discussions and have shown interest in participating in COVAX.

Meanwhile, experts are hoping that countries achieve herd immunity – a stage where the majority of the people, at least 50%, of the population has achieved immunity to the virus. However, this would mean that at least half the population should be either vaccinated or already infected in order for herd immunity to work.