- Our last check indicates that most of the vaccine stock that can be manufactured, should emergency use authorization be secured between now and June 2021, have been secured by just 15 countries.
Randy Pausch, in The Last Lecture states, “another way to be prepared is to think negatively. Yes, I’m a great optimist. but, when trying to make a decision, I often think of the worst-case scenario. I call it ‘the eaten by wolves’ factor.’ If I do something, what’s the most terrible thing that could happen? Would I be eaten by wolves? One thing that makes it possible to be an optimist, is if you have a contingency plan for when all hell breaks loose. There are a lot of things I don’t worry about because I have a plan in place if they do.”
On the 20th of November 2020, Pfizer announced that it had put in an application to the United States Food and Drugs Authority (FDA) for the emergency use authorization of its novel COVID-19 vaccine, having previously stated that it was 94.5% effective in Phase III clinical trials and that safety requirements had been met. This was followed by other announcements from Moderna and AstraZeneca on the status of their respective vaccines. The resultant flurry on the stock markets for shares in these companies reflected the global anticipation for science to deliver where human behaviour had failed. Exciting as this news may be, the World Health Organisation (WHO) through its Director-General, Tedros Adhanom Ghebreyesus indicated that vaccines alone will not be able to bring this pandemic to an end.
On the surface, this statement will sound contradictory to many and some may see it as an anti-climax. However, in-depth reading points to grave concerns as to how finding the silver bullet may just be the beginning in itself. The point is that, even before these clinical trial results were known; several western countries had signed contracts with the leading companies to buy COVID-19 vaccine stocks. The United States, for example, has made deals worth upwards of US$6 billion with several firms for vaccine stock, whilst the United Kingdom has secured close to 100-million vials of the three leading vaccine candidates. Australia, France and Germany are known to have arrangements of their own.
Our last check indicates that most of the vaccine stock that can be manufactured, should emergency use authorization be secured between now and June 2021, have been secured by just 15 countries. This means, unless there is a significant augmentation in vaccine manufacture, close to two-thirds of the global population will be deprived of stock until after July 2021. In October, the COVID-19 Vaccine Global Access (COVAX) initiative co-led by the WHO, the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi the Vaccine Alliance was set up. It aims to ensure that access to the most effective vaccines is available to even the poorest countries of this world. However, the scheme only guarantees that the 167 signatory countries have access to enough vaccines to protect their health-care workers and the most vulnerable 20% of their populations.
For a virus-like SARS-CoV-2 which has a reproductive number of approximately 3, to effectively bring the pandemic under control and for life to return to normal, at least 75% of the population will have to be immunized to reach the herd immunity threshold. Using Ghana with a population of 31.3 million, as an illustration, this will mean that ideally, approximately 23.5 million Ghanaians will have to be vaccinated for the threshold to be reached. Yet, by the COVAX initiative, only 6.3 million Ghanaians will be eligible, leaving a shortfall of 17.2 million citizens. How we work to ensure this shortfall is bridged will be one of the biggest initial challenges. As it stands, there is very little indication that countries such as ours are coming up with strategies aimed at addressing this.
Another issue of concern is how these at-risk (vulnerable) groups will be identified. Globally, it has been shown that for every 10-year increase in age, there is a doubling of the morbidity and mortality associated with COVID-19. The aggregation of this doubling effect means that those over the age of 65-years account for about 74% of all COVID-19 related deaths. Hence, age has become a primary parameter for the establishment of vulnerability. Data available from Statista indicates that as at the end of 2019, only 3.1% (970,000) of Ghanaians were above the age of 65-years. Hence, if age was used as our primary parameter, 16.9% of these vulnerable citizens will have to be selected using other parameters such as the presence of comorbid states. This could be one of the biggest complication poorer countries may be confronted with, since chronic disease data can be patchy and many may not even be aware of their chronic disease status. Other parameters that have been used include occupation and the potential for exposure which may allow our security personnel for example to be vaccinated if there are enough vaccine stocks.
We are of the view that the criterion for the identification of these vulnerable individuals must be thought through and publicised, even though indications are that the first vaccines obtainable through this scheme may not be available until mid-2021. We hold this view because we are concerned that without a well thought through plan, the immunisation program could descend into chaos and create an avenue for corruption and backroom dealing.
Another area that we believe countries such as ours should focus on is the logistics around vaccine distribution, supply and storage. Currently, it is known that whilst the Pfizer vaccine must be stored at –70°C, Mordena’s vaccine remains stable at -20°C for up to six months and can be kept at refrigerated conditions for up to 30 days. These extremely low storage conditions are due to the need to maintain the integrity of chemical structures of the mRNA. On the other hand, the Oxford/AstraZeneca and Johnson and Johnson vaccines which are protein-based have a storage temperature range of between 2°C and 8°C. Thus, less-resourced countries may be more able to deal with the protein-based vaccines and may want to be engaging in discussions to ensure that their preferences are known.
The final challenge will come from the number of people that will be required to vaccinate at least 75% of the population should enough stock become available. Many countries have recognised this as a challenge and have amended their public health laws to ensure that more personnel can be trained in anticipation of large scale COVID-19 vaccination. In the United Kingdom, changes which came into effect on the 16th of October have been made to the Human Medicines Regulations 2012 to enable the expansion of the trained workforce who can administer COVID-19 and flu vaccines. This should be on the agenda for us too.
These bottlenecks are examples of why though the news on vaccines in the last week has been encouraging, a lot more is needed to get us out of this current situation. We need to think of the worst-case scenario and have contingency plans in place, even if we are not sure when the first vaccine vials will arrive on our shores. By so doing, we will minimise the potential for all hell to break loose and ensure that the vaccines deliver us from our current predicament.
Edited by Winifred Awa
