COVID-19 has dominated 2020 with unimaginable harm to health, economies, livelihood, and political stability. In the last few months, there have been signals of hope, possible exit ramps from this nightmare. COVID-19 vaccines, which conceivably could prevent and contain the virus and infection, currently dominate our attention. Much has been written, and while more is written every day, perspective is needed to stay grounded. Discussed below are some of the key vaccine factors to keep in mind, but we need to look much beyond to do much better in the future, engaging both the public and non-public sectors.
Vaccine R&D and the Issue of Equitable Distribution
In the recent past, a reasonable estimate for developing a vaccine was about 10-15 years. In some cases, such as HIV/AIDS, despite huge investments, there is as yet no vaccine.
Advancements in technology and scientific tools have meant that in less than one year, at least thirteen COVID-19 vaccines worldwide have made it into late-stage, large-scale clinical efficacy trials.
Some have used brand new highly complex methods such as mRNA to produce a vaccine, which unlike many conventional medicines, cannot be readily replicated by others.
Worth noting is that in the vaccine pharmaceutical and other biochemical R&D, patents often are closely held and not shared in subsequent licensing agreements (including not sharing profits with others). This is unlike what happens in many other R & D and innovation fields, where it is more common to cumulatively build upon each others’ inventions.
Where significant public subsidies to private sector R & D are involved (e.g., academic departments, private research institutes and industry laboratories), more open sharing arrangements often pertain.
The quick development of COVID-19 vaccines to a large extent have been the product of joint private-public R & D efforts in countries that recognize and have the capacity to benefit from such arrangements, including Germany, Taiwan, Singapore, United States, France, the U.K., and increasingly China and India.
Take the Pfizer/BioNTech vaccine: After rigorous analysis and data scrutiny, its vaccine is now approved and being applied in the United States, United Kingdom, and Canada and will be soon available in the EU where it has just been approved by the EMA, and elsewhere in due course.
The Moderna vaccine will also begin wide distribution, and AstraZeneca is another candidate well on the road to approval.
Russia has released additional results from a domestic clinical trial of its leading coronavirus vaccine, Sputnik V, showing an efficacy rate of 91.4 percent and is in talks with AstraZeneca to determine whether administering a combination of the two vaccines could improve efficacy.
Like Russia, China has also produced vaccine candidates that show promise although on-the-ground trial results have not been presented and prequalified by the World Health Organization.
With respect to global distribution, at this point, wealthy countries have captured more than half of the known and approved coronavirus vaccines coming on the market through 2021. For developing countries, some may be able to vaccinate 20 percent of their populations in 2021, with some only achieving wide-scale immunity until 2024. Many countries, especially poorer ones, urgently wanting to protect their citizens, have entered into an agreement with Russia and China to get access to their uncertified vaccines.
China, Russia are reportedly finding “desperate takers for unproven vaccines.”
Efforts by the global community, such as the Access to Coronavirus Tools-ACT Accelerator (ACT-Accelerator), hold out the modest promise that this imbalance may be at least in part, corrected.
One element of the ACT-Accelerator is the COVAX partnership, spearheaded by the Global Vaccine Alliance (GAVI), which is designed to establish links between wealthy governments’ interests and the interests of low-income countries. In COVAX, participating self-financing countries agree to additional contributions to fund the distribution of vaccines in the 92 eligible low- and lower-middle-income countries. But the amounts available pale by comparison to need, and there is yet, not much concrete to show for it.
That said, there is reason to hope that the virus will be contained and no longer cause an overwhelming worldwide crisis. At the same time, there is much we do not know about these vaccines, the length of effectiveness, and longer-term affects.
Vaccine Effectiveness Will Vary with Different Vaccines and Different People
We are still learning about immunity to COVID-19. Most people infected with COVID-19 develop an immune response within the first few weeks, but what is not known is how strong or lasting that immune response is, or how it differs for different people. There have also been rare reports of people infected with COVID-19 for a second time.
Until we better understand COVID-19 immunity, it will not be possible to know how much of a population is immune and how long that immunity lasts for, let alone make future predictions.
These challenges should preclude any plans that try to increase immunity within a population by allowing people to get infected and following disastrous ‘herd-immunity’ policies, such as in Sweden and for a short while also in the U.K.
For other coronaviruses – such as the common cold, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) – immunity declines over time, as is the case with many other diseases. While people infected with the SARS-CoV-2 virus develop antibodies and immunity, we do not yet know how long it lasts.
COVID-19 Vaccines Reluctance or Resistance
COVID is the first disease to have a vibrant anti-vac movement before a vaccine exists. There is mistrust in many developed and developing country populations, albeit some indications that refusal rates are declining as approved vaccines are rolled out with extensive information campaigns.
In the U.S., for example, when President-Elect Joe Biden and three previous Presidents all signaled (and have been vaccinated), basically because Dr. Anthony Fauci said he would – and he did – the acceptance rates took significant jumps.
Nonetheless, there remain many who resist vaccines because they believe unfounded claims which have been proven false after being carefully vetted by objective scientific authorities. For example, the anti-vaxxers of the past claimed that vaccination caused a full spectrum of diseases, from smallpox itself to syphilis, typhoid, tuberculosis, and cholera. These are the very same arguments used against COVID-19 vaccines.
Longstanding vaccine opponents have more recently rebranded themselves to take on COVID-19, forging alliances with religious and civil liberties groups to protest stay-at-home orders, business closures, and mask mandates in recent months. They argue that those policies, designed to stop the spread of a deadly virus, violate their rights.
“The anti-vaccine movement has been going for years and years without a big audience, so the anti-mask thing, which has become very common now, suddenly gives the anti-vaccines an audience,” said Jonathan Berman, a physiologist who authored a book on vaccine opponents. “You see anti-maskers adopting tactics from the anti-vaccine movement, and you’ve seen anti-vaccine ideas fall into the anti-mask rhetoric.”
Other falsehoods designed to dissuade acceptance of future COVID-19 vaccines on social media claim that the vaccines will modify your DNA and accuse Bill Gates of injecting people with location trackers.
Quarantine in the COVID-19 Era: How to Address the Issue of Who Can Travel Safely at Home or Abroad
The practice of quarantine began during the 14th century to protect coastal cities from plague epidemics. Ships arriving in Venice from infected ports were required to sit at anchor for 40 days before landing.
These antecedents have morphed into the World Health Organization (WHO) practice of issuing paper “yellow cards” that act as an international certification of vaccination, primarily to be used when entering a country that has enhanced health risks to travelers.
This will not work for COVID-19.
During 2020, in trying to deal with the emerging virus threat, countries and regions instituted travel restrictions that were not focused on individuals but on location. Reliance on such approaches will undergo change in 2021 because multiple vaccines will become available in massive numbers and many countries will engage in large vaccine distribution programs. Individually, as regional blocs, or otherwise, strong pressures for the resumption of travel and trade will be created, probably accompanied by some form of vaccine certification requirements.
Pursuing the WHO “yellow card” certificate for COVID-19 would be impossible to scale up for the world’s billions.
Potential alternatives include digital certificates which can rapidly and safely be distributed and verified at borders, and/or added onto biometric passports or other smart ID cards that already contain a chip confirming the identity of the holder.
To be sure. there will be new technological advances that provide reliable means of verifying vaccinations and testing information.
What Should Be Done
With this burst of good prospects, we now need to be much better at making use of medical and institutional surveillance, diagnostics, preparedness, and response capacity at both the national and regional levels.
We need to develop common and more globally effective vaccine trial requisites and establish everywhere the capacity to confirm safety and efficacy results beyond the current FDA and EMA protocols.
We need agreement on a worldwide communications strategy supporting widespread vaccine adherence (e.g., including all G-20 countries and communication authorities) and a universal, modern (such as fifth-generation broadband cellular technology-5g) vaccination/testing certification approach.
Finally, we need to go beyond GAVI to establish a global mechanism matched with resources to ensure worldwide equitable distribution of vaccines.
But these are only the tip of the larger health challenge. Current global players will need to change and to be made “fit-for-purpose”.
The World Health Organization (WHO) will have an important role to play, but its financial, logistical, staff makeup and capacity, and enforcement authority limitations mean it cannot do it alone, nor should it.
The World Trade Organization (WTO) decisions are critical determinants in terms of intellectual property protections for COVID-19 vaccines and therapeutics, and potential impact on future research and development to combat new sources of infection. Special COVID-19 treatment was recently taken up by the WTO’s “Trade-Related Aspects of Intellectual Property Rights Council” (TRIPS), the mechanism by which an avenue for HIV/AIDS medications for developing countries is provided, but at this point, unresolved.
Note that the TRIPS Agreement came into effect on 1 January 1995 setting out minimum standards for the protection of intellectual property, including patents on pharmaceuticals. Under that agreement, since 2005 new drugs may be subject to at least 20 years of patent protection in all, apart from in the least-developed countries. At the time of writing, there is still no consensus at WTO on the proposal put forward by India and South Africa to waive intellectual property rights on COVID-19 vaccines.
Other international organizations such as the Food and Agriculture Organization, the World Organization for Animal Health (OIE), the World Intellectual Property Organization (WIPO), regional and trade and security alliances, academia, and research institutes, all have voices to be taken into account.
Indeed, in the wake of our most recent and still ongoing pandemic, it is increasingly apparent that the existing system of global health is no longer fit-for-purpose and needs a make-over to handle the ever-growing repertoire of old and new challenges.
Ours is a complex, multipolar world, where the key actors on the global health stage are no longer entirely from what might be called the West. Shaping new global health actions will require bringing a wider range of stakeholders, be they countries, regions, or the “other relevant institutions”, such as the private sector.
In fact, amounts spent by the private sector, combining profit and not-for-profit entities, are vastly larger than what is coming from the public sector. Technical expertise, as well as research and development of new drugs, devices, and medical procedures, lie far beyond public sector capability.
Technical fields outside the health sector per se, such as information technology, artificial intelligence, and biological and electronic combinations, are merely the tip of the iceberg in terms of what needs to be taken into account.
Advancements in technology, booming populations, increased mobility, the expansion of trade in health goods and services, and rapid growth and development of formerly low-income countries and emerging markets all speak to a need for fresh thinking. Not only are new problems being posed all the time, but new solutions are constantly on the horizon, though often arising from less conventional sources than might have been traditionally looked to.
The COVID-19 pandemic crisis should be the impetus for the establishment of a new global health structure.
This is a moment in world health history when we go forward collectively, one in which “a rising tide will lift all boats”—or none. It will require a concerted effort by all global actors, public and private to find common ground. But this would be a New Year’s Resolution good for everyone.
EDITOR’S NOTE: The opinions expressed here by Impakter.com columnists are their own, not those of Impakter.com. — In the Featured Photo: TRIPS Council launches a new notification system and discusses incentives for technology transfer (2019) Source: WTO