Analyzing how the 7.6 billion humans on earth can get the Covid vaccine
Nearly 150 COVID-19 vaccines are currently in different stages of development, of which there are a promising dozen. As individuals it is really important to have a better understanding of the vaccine development process for us to build the trust and to know what to expect and what not to expect.
Development of a safe and effective vaccine is a critical step for us to return to our normal day today lives. Vaccines remain the safest and most effective ways to prevent many diseases. All of us are eagerly waiting for COVID -19 vaccine but we cannot rush the development of a vaccine at the expense of a safety-oversight. We cannot and should not rush into unsafe or ineffective vaccine to the world.
Any vaccine, especially the Covid vaccine, needs to undergo rigorous testing, considering that it is likely to be administered to every human on earth. The first is the pre-clinical stage, where researchers test the new vaccine candidate on cells, and then administer it to animals, such as mice or monkeys. Then a vaccine test enters Phase 1 safety trials, where a small number of people are used to test the safety and dosage to confirm its ability for immune boosting in humans. After this, Phase 2 trials begin which is administered in about 100 people of different age groups, to further confirm the safety and efficacy of the vaccine. Finally comes the Phase 3 trial, in which the vaccine has to be tested it will be tested in 1000 of people to see if they become infected, compared to the people who receive a placebo. Last but not least, the vaccine will receive approval from regulatory bodies of each country. As of now for COVID-19 there are 50 vaccines in clinical trials on humans, and around 87 preclinical vaccines are under active investigation in animals.
Delivering 7.6 billion vaccines
While many vaccines are under development there is a global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income countries. The initiative called COVAX, which has 172 countries, is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), GAVI, the Vaccine Alliance, and the World Health Organization (WHO).
CEPI is overseeing the COVAX vaccine research and development work, which aims to develop three safe and effective vaccines which will be made available to countries in the COVAX initiative. Currently nine candidate vaccines are being supported by CEPI; out of which seven are yet in clinical trials. Till date US$ 1.4 billion have been committed by the Governments, vaccine manufacturers (in addition to their own R&D), organizations and individuals towards vaccine R&D.
Gavi, Bill & Melinda Gates Foundation and Serum Institute of India (SII) have partnered to provide 100 million doses of AstraZeneca or Novavax candidate vaccines, and if successful, it will help low- and middle-income economies through the COVAX initiative, at just US$ 3 per dose. Moreover, CEPI, GAVI has another agreement with AstraZeneca, to further provide 300 million doses of their candidate vaccine,
if successful, for the COVAX initiative. COVAX is also planning for delivery of two billion doses of safe, effective vaccines that have passed regulatory approval and/or WHO prequalification by the year 2021.
Dilemma of prioritizing who receives the vaccines first
The plan is to offer the vaccine equally to all participating countries, proportional to their populations, initially prioritising healthcare workers, then expanding and also to cover vulnerable groups, such as the elderly and those with underlying health conditions. Additional vaccine doses will then be also distributed based on country need, vulnerability and COVID-19 threat. Irrespective of all the efforts, a large proportion of the world’s population is likely to remain unvaccinated in 2021.
There's a lot of argument around who should get the vaccine first and what should be the priority levels. University of Pennsylvania’s Perelman School of Medicine has come up with a priority model which has 3 phases. First and foremost in this is to reduce premature death and they have proposed using a health metric called standard expected years of life lost, that calculates years of life lost due to the pandemic in each country by comparing premature deaths with global life expectancies. The second round of distribution is to quantify and minimize the economic and social consequences of the COVID-19, and the third round is to prioritize countries with higher virus transmission rates while also ensuring all countries eventually receive enough vaccine doses to stop community transmission.
Some also argue prioritizing vaccines to those who are driving transmission, not those who are most vulnerable will be the way forward. Because compared to elderly, younger people with a much greater propensity to resume social lives at schools and in other venues are likely to act as super-spreaders of the virus. These young people have very low risk of death or even severe symptoms, which also means they are more likely to spread the virus.
What should be the public health messaging when it comes to COVID-19 vaccine?
To begin with we know that there is a certain amount of vaccine hesitancy that exists, and we need to address this first, especially for the people who are leading by demonstrating to people how these vaccines are completely safe. Experts also suggest that public health messaging regarding COVID-19 vaccination should be less about the individual, and more about the country, and the only way for the country to get it back to where it used to be.
Governments and all the public health authorities need to understand their country-specific possible barriers to vaccine uptake, ahead of the release of a COVID vaccine. Prior understanding of these obstacles will help to create right communication and implementation strategies that will address the potential issues directly and hopefully address any negative public opinion on the matter.
The pandemic has already caused the loss of hundreds of thousands of lives and disrupted many lives of billions of people. An effective vaccine is the most powerful weapon we can have which can help us get rid of COVID-19. It is critical every citizen be equipped with the right information, because in this race, nobody wins the race until everyone wins. Till we see the bright light of a vaccine, let's stay safe wear masks, maintain proper social distancing and screen as many people as we can.
