The scramble for Covid-19 vaccines- Is there enough for everyone?

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Nurse holding a vaccine
Nurse holding a vaccine

By Professor Aditya Goenka,  The Department of Economics, University of Birmingham.

“Canada has orders for enough vaccines to inoculate its population six times over, UK four times over, and EU about twice. The constraints on how fast vaccines can be produced… and stockpiling by richer Western countries raises the possibility that LMICs will be left out in initial roll-out.”

With the Covid-19 pandemic still running wild the news of development of Covid vaccines has been the best news emerging at the end of a transforming 2020. The development of a safe, effective vaccine and its roll-out takes on average 10-15 years but in the case of Covid, the intense Research & Development activity has led to several vaccines going to Phase III trials where they are double-blind tested in a large sample in the population with the innovative Pfizer-BioNTech vaccine being the first to be approved in a Western country – by UK.

The development of a vaccine is only the start of the process before there is large enough coverage  to effectively contain the pandemic. There are two separate issues which suggest a global coverage is desirable for the vaccine. The first is a self-interested one – genomic evidence indicates that even for countries that have controlled the pandemic there can be imported cases leading to flare-ups in the local population and thus, a global suppression of Covid is necessary. Second, is the philanthropic or humanitarian motive that there is no loss due to morbidity and mortality anywhere in the world.

How Covid-19 vaccines are being allocated across the globe

The richer, largely Western European and North American countries have hedged their bets and placed orders for the different vaccines while they were in the development stage. Thus, Canada has orders for enough vaccines to inoculate its population six times over, UK four times over, and EU about twice. The constraints on how fast vaccines can be produced, materials required for administration of vaccines, and infrastructure necessary for delivery (e.g. the Pfizer-BioNTech vaccine needs to be kept at -70 C which is below the temperature of fridges and freezers used in medical settings) coupled with the cost of the vaccines and stockpiling by richer Western countries raises the possibility that low and middle-income countries (LMICs) will be left out in initial roll-out. Thus, the control of the pandemic may fail on both dimensions.

This is only part of the story. COVAX is an initiative which brings together WHO, GAVI (Global Alliance for Vaccines and Immunisation), and CEPI (Centre for Epidemic Preparedness Innovations) to procure and fairly distribute Covid vaccines to eligible LMICs. Some of the big players – US, China and Russia – are not participating in COVAX but the EU has committed EUR 500m. However, uptake in COVAX has been slow as there is a combination of concern about the development and very fast approval of the vaccine; the better management of the pandemic; complex legal issues; waiting to see if a cost-effective vaccine is developed and that it can be procured faster and cheaper out of COVAX; and given history, not wanting to be testing ground for vaccines. Vaccines have also been developed simultaneously by China and Russia for which the clinical data is not available. Some countries such as Indonesia and Philippines that took place in the Phase III trials of the Chinese vaccines are rolling them out.  India is looking to fast track approval of the AstraZeneca vaccine. Thus, there is a complex picture emerging of access to vaccines for different countries, letting aside the complex issue of how these are going to be allocated within each country.

It is certain that even if the different vaccines in development are approved very quickly, there will not be enough to vaccinate enough people to have herd immunity. In this situation, the assuring of an excess supply of vaccines by the richer which is a rational response will cause externalities, i.e. unintended consequences, on other countries. There are also concerns that the vaccines will be prioritized to the Western countries so that they will not be available to countries that have ordered them. Surveys indicate that even if a vaccine is available, uptake at the individual level may be low in many countries especially LMICs. Thus, to control the endemic not only do we have to ensure global access but also counter the reluctance to be vaccinated.

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