As populations around the globe grow increasingly anxious to return to work and to school, the race to develop a safe and effective Covid-19 vaccine is moving forward at breakneck speed. At present, a dozen countries are working to develop more than 160 vaccine candidates.
Countries around the world, particularly those that are less wealthy and developed, face a monumental task vaccinating millions of people for Covid-19. Photo: Charles Deluvio
The world is pinning its hope on these efforts. Indeed, the free movement of people, access to education, global economic recovery and returning to society as we know it largely depend on a global population inoculated against Covid-19.
However, while efforts to develop a vaccine are happening at an astonishing pace and scientists are optimistic that a safe and effective vaccine will eventually be found, experts caution that the success of the vaccine depends not only on its development, but also its delivery.
Getting the vaccine to the billions of people who need it presents an extraordinarily complex challenge that will ultimately determine if the war against coronavirus is won or lost. Two urgent areas of global concern include: prioritizing how countries can obtain enough doses of vaccines, and determining how to distribute the vaccines to billions of people.
Recent history demonstrates that while the poorest and most vulnerable people and countries are often most affected by global pandemics, they often lack the resources and the health infrastructure required to conquer them alone. This can lead to critical gaps.
During the 2009 influenza (H1N1) pandemic, for example, the World Health Organization (WHO) delivered 32 million doses of vaccine to 34 countries in the WHO Africa Region. However, the vaccine doses were mostly distributed after the main transmission periods and when countries were already in the post-pandemic phase.
Global public health experts largely agree that a Covid-19 vaccine should be a global public good made available for all—especially the most vulnerable. But in reality, wealthy countries are prioritizing their own populations first.
Under its “Operation Warp Speed,” the United States hopes to have 400 million doses of vaccine ready in 2021 and has invested in a number of vaccine candidates. But these are intended for domestic use only. The UK government, too, has signed deals—including one for 90 million doses of one vaccine in development and 100 million doses of another. A number of other agreements have also been made between rich countries and pharmaceutical companies.
With competition for limited resources already impacting response—demonstrated by the scramble for personal protective equipment (PPE) and ventilators at the start of the pandemic—many in the global community are calling for high income countries to avoid vaccine nationalism that restricts access for others.
Poorer countries must also have rapid, fair and equitable access to Covid-19 vaccines.
Gavi, the Vaccine Alliance, recently designed the Gavi Advance Market Commitment for Covid-19 Vaccines (Gavi COVAX AMC)—financing mechanism created for just that purpose. Co-led by Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), and WHO, COVAX is gearing up to provide 92 eligible low- and middle-income economies access to successful candidates once they become available.
The COVAX AMC aims to deliver two billion doses of vaccines to all participating countries by the end of 2021. Initially, healthcare workers will be the first to receive the vaccine. Coverage will then be expanded to 20% of the population in participating countries, prioritizing those 65+ and others with high-risk co-morbidities.
But big questions still remain. Not only about how and when the rest of the population in eligible countries will access the vaccine, but also about access for other countries. For example, many countries (mostly middle-income countries) will be left without a supply of vaccine through COVAX.
Determining exactly how all countries can secure the supply they need is a matter of urgency as once the first successful Covid-19 vaccines are approved, the global demand will certainly outpace supply—to the tune of billions of doses.
The supply chains required to produce and distribute the Covid-19 vaccine across the globe will be staggering. Billions of doses must reach billions of people—in every country on every continent in the world. This will involve several complex systems—from manufacturing and storage, to shipping and distribution—and will require unprecedented global coordination, along with robust private-public sector partnerships.
For example, vaccines will require regulatory approval from countries, as will new vaccine manufacturing plants. Then, not only do drug companies have to secure the raw materials required, they must ensure they have adequate production capacity, storage, and ancillary supplies—including syringes, needles, stoppers, and glass vials. For companies that are developing vaccine candidates through new processes—like Moderna and Pfizer—the manufacturing process also involves designing new technologies and may require different logistical considerations.
Furthermore, it is likely that some Covid-19 vaccines will require cold-chain transit from global and domestic logistics providers, along with carefully thought-out distribution strategies and storage. Amidst the demands of producing and distributing the vaccine, information systems will have to be calibrated to anticipate demand, plan supplies, project stock-outs, and ensure the flow of goods. Pharmaceutical companies, governments, and patient-centered organizations, alike, will have to contend with possible fraud, counterfeits, and corruption.
All evidence points to the development of at least one safe and effective Covid-19 vaccine in record time. Ownership over the critical task of getting this vaccine to as many people as possible—as quickly as possible—is truly collective. No one country, organization, or even region can operate alone. There are simply too many moving parts—many of them interconnected and happening at a scale rarely seen before.
However, despite the human tragedy of the global pandemic, there may be cause for cautious optimism. Leaders at every level in every country—including vaccine developers, funders, policymakers, governments, the business community, and public health bodies—must work together to clear a path forward for rapid, affordable, and equitable access to a vaccine.
Patrick L. Osewe is Chief of Health Sector Group, Asian Development Bank.