Dear Editor,
I begin with a quote from Dr Jeremy Farrar (Director of Wellcome Trust, UK) of which I am in complete agreement, “…there is no value in just vaccinating one country or one population, vaccines must be available to the whole world at the same time as promised by many politicians. If we continue vaccinating only people in rich countries, while allowing the virus to continue to spread unchecked in other parts of the world, then new variants will emerge in these parts of the world against which our vaccines and treatments may no longer work. And these new variants will inevitably spread around the world. Then we are all be back to square one.”
This points to a very real problem facing low- and middle-income countries – equitable and timely access to SARS-CoV-2 vaccines (SARS-CoV-2 is the virus which causes COVID-19). I have read in this newspaper that Guyana will have access to vaccines through the COVAX initiative coordinated by the Global Alliance for Vaccines and Immunization (GAVI). COVAX is a fantastic initiative aimed at enabling vaccine equity in the world however its procurement of approved vaccines through vaccine manufacturers ultimately depends on availability. Added to this, is the challenge of allocating vaccines, when they become available, to the 172 countries seeking vaccine access especially if supplies are limited. So, what happens if vaccine manufacturers opt out as a supplier or don’t honour their contracts? South Africa faces this dilemma with Moderna’s decision not to distribute its vaccine there and while Pfizer conducted clinical trials there, they will not receive adequate supplies. Further, one of the largest vaccine suppliers of the COVAX alliance is the Serum Institute of India (with manufacturing costs lower than North America) which is supposed to make 100 million vaccine doses available to low- and middle- income countries. However, a Reuters article stated on January 3rd that the Serum Institute seeks to meet local demand before exporting.
The People’s Vaccine Alliance (includes Amnesty International, Frontline AIDS, Global Justice Now and Oxfam) writes that 90% of the population in 67 low- and middle-income countries risk not getting vaccinated this year unless the developed world and vaccine producers ensures equitable access. I think this is a reasonable conclusion as the developed world has bought enough of the vaccine supply to vaccinate their population three times and more; these comprise approved vaccines (such as the Pfizer/BioNTech, Moderna and Oxford/AstraZeneca vaccines) and others in the development pipeline and in regulatory review. While I am in no doubt that the technology is present to allow for production of the vaccines to vaccinate most of the world’s population eventually, the current global demand is so high that it will most likely exceed supply for 2021. Added to this is the challenge of more contagious forms of the virus emerging as it seeks to outsmart our immune system. To defeat the virus and achieve herd immunity (when a high percentage of the population is immune to a disease making the spread from person to person unlikely), calculations with the simplest of models, show that 60-72% of the population needs to be vaccinated with a vaccine that is 100% effective; with a vaccine that is 80% effective, 75-90% of the population and for lower efficacies, the entire population needs to be immunized. The achievement of herd immunity presents a huge challenge especially if new variants and strains emerge which may render current vaccines ineffective or reduce their efficacy. This enforces the urgent need for immediate vaccination whiles vaccines are still effective.
I think it would be prudent (if this hasn’t been done already) for low and middle-income countries to look at alternative vaccines (to main ones currently approved) in the pipeline not only for timely vaccination on a large scale but for future vaccination campaigns. Vaccines leading the race (showing greater than 90% efficacy in clinical trials, are safe and have published peer reviewed results of their clinical trials) and approved for Emergency use in Canada, the US, EU and other countries are the Pfizer-BioNTech and Moderna vaccines while the Oxford/AstraZeneca vaccine is approved for use in the UK, India and other countries. However, the world cannot be reliant on only a few manufacturers only to satisfy immediate demands, at a rapid pace, particularly if their priorities lie in first vaccinating their local population or their supply has already been bought.
Consideration of alternative vaccine supplies for future vaccination campaigns is also advantageous if the Coronavirus ends up like seasonal influenza (flu). There will be need of a yearly vaccine supply as the seasonal flu targets specific strains and subtypes, twice per year, for immunity against these selected strains/subtypes in circulation; target strains/subtypes is recommended by WHO from their Global surveillance programme. Overall, the emergence of new SARS-CoV-2 variants and potential future strains necessitates the need for rapid mass vaccination with the goal of obtaining herd immunity, but this is very challenging on a global scale with the very real problem of inequitable distribution of vaccines. The COVAX initiative seeks to help solve this problem of vaccine inequity but ultimately the decider of who gets what and how many is heavily dependent on the supply (availability), suppliers and who is prioritized. According to the WHO, to date, 39 million doses of vaccine have been administered in at least 49 higher-income countries while 25 doses have been given in one of the lowest income countries. This worrisome situation was voiced by Dr. Tedros Adhanom (WHO Director-General) on January 18th where he said, “I need to be blunt, the world is on the brink of a catastrophic moral failure, and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.” So, while the developing world waits on COVAX perhaps it may be worthwhile to examine alternative vaccine sources both for immediate and future long term needs (if that is not being done already) as research shows continuous evolution of SARS-CoV-2 which may require continuous vaccine alteration.
Yours faithfully,
Jacquelyn Jhingree, PhD.
