To the delight and relief of millions around the world (and the stock market), Pfizer and Moderna have announced vaccines for COVID-19, with astonishingly high effective rates. Now, there is a race to produce and sell as many shots as possible. Despite the tricky path ahead does that really mean the pandemic is over?
Unfortunately, it might not be as simple as that. If it was challenging to create a vaccine, it is a greater challenge to roll it out to the over 7 billion people on Earth. The scale of the challenge is one that we have never faced before.
Eradication vs Elimination
The first question to answer is do we want to eradicate COVID-19, or simply eliminate it? As Our World in Data put it, “The eradication of a disease is permanent and global, while the elimination of a disease is an achievement restricted to a specific geographic area.” Eradication is a much bigger challenge, one that we have only managed to do for two diseases: smallpox and rinderpest.
Elimination, by contrast, is an easier objective. A report published by London’s Imperial College COVID-19 Response Team estimated that 50-70% of the population needs to be resistant for the virus to stop spreading. That would mean the end of the pandemic, but not of COVID-19. Like Measles, Mumps and Polio, COVID-19 would very much be present in hotspots around the globe, but it would not cause a complete economic meltdown as it currently has.
Essentially, elimination refers to the concept of ‘herd immunity’, where enough people are immune to the virus. The quickest way to do so is through a mass vaccination programme. However, to vaccinate enough of the world’s population is going to be a massive challenge. That’s down to three major reasons: politics, economics and human nature.
Politics of Vaccination
Like all other areas of the modern world, healthcare is rife with political interference. When COVID-19 first broke out, we saw each nation deal with it in its own way. There was no global response. Vaccination too is likely to face a similar fate.
Russia’s vaccine Sputnik V is a perfect example. Russian President Vladamir Putin has encouraged nations to buy Sputnik V, even though he hasn’t been clear enough about the process. The vaccine is yet to face the scale of mass testing Pfizer and Moderna’s has. The Russian Health Ministry has claimed an effective rate of 92%, but those results are reportedly based on just 20 participants.
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The head of the Russian Direct Investment Fund, Kirill Dmitriev, though has backed the vaccine. According to Reuters, he said: “we are showing, based on the data, that we have a very effective vaccine,” adding that it was the sort of news that the vaccine’s developers would talk about one day with their grandchildren.
Large scale testing aside, it is also common for vaccines and research to be peer-reviewed by global experts, which Sputnik V has not been. Despite those concerns, nations like India, Brazil and Egypt have already ordered doses of the vaccine. In fact, India has already begun clinical trials of the vaccine.
Another key challenge is political will. As we have seen with mask-wearing, a basic public health measure became a political flashpoint because it clashed with libertarian political ideologies. For example, at the October 7 Vice Presidential Debate, Democratic candidate Kamala Harris said she would take a vaccine recommended by health experts, “but if Donald Trump tells us that we should take it, I’m not taking it.”
Research published in JAMA Network also found that political leaders have a huge role to play in vaccination efforts. “Average willingness to receive a vaccine was lowest when endorsed by Trump, at 52%, but only slightly better for Biden at 55%. Uptake was stronger when endorsements came from the U.S. or global public health institutions, improving to 58% for the WHO and 59% for the CDC,” the report found.
As one of the authors, Sarah Kreps put it: “We can see here a clear policy prescription that these individual political leaders should really stay out of this conversation. There are real public health consequences to insinuating themselves in the discussion.”
Human Nature and Political Discourse
The JAMA Networks’ research is an indication of a much larger issue: human nature. The current political climate has given momentum to a once-fringe anti-vaxxer movement. Compounded by the geopolitical discourse, vaccinating enough people is not going to be easy.
In 2019, the UK-based Wellcome Trust and Gallup Poll surveyed more than 140,000 people in more than 140 countries about their views of science and major health challenges. The first of its kind report made a shocking discovery: people living in high-income countries have the lowest confidence in vaccines. Worldwide, more than 188 million parents say their children are unvaccinated, the survey found.
Driven by the internet, the anti-vaxxer movement has today found a home in the mainstream. Similar to how the anti-mask movement gained popularity, anti-vaxxers have found allies in right-wing politicians and celebrities, who see vaccines as an issue of freedom, as opposed to a basic medical necessity. A report by the Centre for Countering Digital Hate found that anti-vaxxers have increased their following by 7-8 million since 2019.
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That has deadly consequences. Without adequate belief in the science of vaccination, it is very likely we could see a long drawn out battle similar to the one currently occurring on mask-wearing and social distancing norms. Any delays in vaccinating enough people could prolong the need to enforce stay-at-home orders and travel restrictions.
In the UK, the GCHQ and Ministry of Defence are already engaged in a digital battle to root out false claims published by hostile states. However, it’s not an easy process. While taking down misinformation on platforms like Facebook, Twitter and YouTube is relatively straightforward, the challenge lies with controlling encrypted services like iMessage, Telegram and WhatsApp.
With the chaos and confusion around COVID-19, anti-vaxxers have found the perfect opportunity to spread misinformation. Our nature to cave in to fear has allowed the movement to thrive, creating an environment of deep mistrust against the very people who are giving their lives to protect us.
The Economics of COVID-19 Vaccination
Even if, by some miracle we manage to put politics and fear aside, vaccinating enough people won’t just happen. Vaccine development is a very expensive process. In an article for Lancet Global Health, researchers estimated that “the cost of developing a single epidemic infectious disease vaccine from preclinical trials through to the end of phase 2a (dosage requirements) is US$31–68 million.” That high cost is bound to reflect on the pricing.
As of now, Pfizer has set the initial price as $19.50 per dose and Moderna at $25 per dose. That’s an average of $44 per person since both vaccines require two shots. In the US, those costs are in line with the annual flu shot, which costs around $40. For those insured, this won’t be of concern since the COVID-19 vaccine will be covered. That also covers employer health plans and Medicare and Medicaid services.
The challenge will be affordability for those without insurance. President-elect Joe Biden promised free vaccination if elected on the campaign trail. That is however, going to require massive bipartisan support to get off the ground, given the huge costs involved. A 2019 survey published by the US Census Bureau found that “26.1 million Americans did not have health insurance at any point during the year.”
Right now, it is unclear who will fund the doses for these people. It could lead to a long drawn out political war in the US Congress, especially as the Republicans seem intent on killing Obamacare and other public health programs.
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Around the world, there is an ongoing battle to secure as many doses as possible. Just like the war for masks, the winners here are clearly the countries with more money in their pockets. ‘Vaccinationalism’ has quickly taken over global supply chains, with countries like the US, UK and the EU signing advanced purchase orders. If companies are pushed to fulfil these orders first, it could leave very few for those in the developing world.
A global assessment by Duke Global Health Institute found that “most people in low-income countries will be waiting until 2024 for COVID-19 vaccinations if high-income countries keep engaging in what some are calling vaccinationalism.” According to the analysis, countries have already confirmed purchases for 3.8 billion doses and a further 5 billion doses were under negotiation/reserved as of late October.
Securing enough doses aside, poorer countries also face a disadvantage when it comes to distribution. Pfizer’s vaccine requires storage at temperatures ranging from minus 60 to minus 80 degrees Celsius. Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security told the World Economic Forum: “This will be a challenge in all settings because hospitals even in big cities do not have storage facilities for a vaccine at that ultra-low temperature.” While developed nations may be able to afford temporary systems to overcome this, it is very unlikely poorer nations can.
On that note, there is some good news. Astrazenca’s AZD1222 vaccine cane be stored and transported at normal refrigerated conditions (36-46 degrees Fahrenheit) for at least six months and administered within existing health-care settings. That should help with the supply chain in poorer nations.
Right now, none of the vaccines has been approved for use. They are all still going through the process of being tested. Only if they do clear all the regulatory hurdles will we start seeing a global vaccination drive. There’s no telling when we will reach this stage, especially given the expedited nature of vaccine development.
A Tricky Path Ahead
If we do reach that stage, there are other issues to be ironed out. How will we ensure the wealthy do not skip the queue to get vaccinated first? How will we keep track of who has been vaccinated? Does the vaccine work on all strain types? These are questions we still do not have answers to.
Finally, there is the question of who foots the bill? The $44 cost of dosage may not seem like much for America to afford, but it translates to around 16,746 Nigeria Nira. With an estimated population of 200 million, that’s an amount well above the 3.67% of the GDP the government spends on healthcare. If the nation hopes to vaccinate even half its population, it is going to require a massive loan or handout. That’s a trend across the developing world.
At the recent G20 summit, leaders pledged to ensure a fair distribution of COVID-19 vaccines, drugs and tests around the world. But as the drive towards vaccinationalism shows, that is merely lip service. When it comes to it, the rich will be the first in line, leaving behind the rest of us.
There has never been a greater need for a globally coordinated response. To ensure equitable access at affordable costs and that the anti-vaxxers don’t harm the effort, there is a tricky path ahead. It is almost impossible to eradicate COVID-19, but even elimination is going to be a tough challenge. The first polio vaccine was invented in 1953. Only by the 1990’s did it become eliminated in the Americas.
Of course, with digital tracing and national IDs, eliminating COVID is not going to take as long. That doesn’t mean we should start celebrating just yet. Hopefully though, by the end of 2021, we might have more reasons to.