• Having licensed vaccines will not be sufficient to stop the pandemic, a new opinion piece states.
• The scale of production, affordability, global allocation, and local community deployment of vaccines will be the key to efficient control.
• Vaccine hesitancy can also hamper efforts, and governments need to actively raise public confidence, especially in disadvantaged groups.
• A traffic light system devised by the authors allows the comparison of the leading 26 vaccines according to characteristics such as price, manufacturing capacity, efficacy, and storage requirements.

At the beginning of February 2021, 289 experimental vaccines were in development. So far, 20 candidates have reached the critical phase 3 of clinical trials, and five have received authorization for use by one of the stringent regulatory authorities on the World Health Organisation’s (WHO) list.

A recent health policy opinion piece, published in The Lancet on 12 February, reviews four interconnected challenges to the success of vaccination schemes: production, affordability, allocation, and deployment of the vaccines.

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Public health policy, vaccination, and infectious disease experts from the United Kingdom, United States, Thailand, and Singapore co-wrote the paper, making a series of recommendations.

“Several manufacturers have successfully developed COVID-19 vaccines in under 12 months, an extraordinary achievement. But the stark reality is that the world now needs more doses of COVID-19 vaccines than any other vaccine in history in order to immunize enough people to achieve global vaccine immunity. Unless vaccines are distributed more equitably, it could be years before the coronavirus is brought under control at a global level.”

– Lead author, Dr. Olivier Wouters, from the London School of Economics and Political Science, U.K.

Scaling up production

The authors of the paper highlight that 10 vaccine developers have predicted that they will be able to produce 1 billion or more doses this year, and a further nine developers have estimated capacities of up to 700 million a year.

But not all of them have completed the development and approval process, and no single company would be able to supply enough for the entire adult world population.

The authors also point out that the concentrated state of vaccine manufacturing capacity worldwide, highlighted in a report by the Coalition for Epidemic Preparedness Innovations (CEPI), and the relationships between developers and manufacturers, limit the production of COVID-19 vaccines.

Supply chains, including those for glass vials, syringes, and stabilizing agents, also limit production.

The WHO have indicated that if states, manufacturers, and other organizations agreed to share knowledge, intellectual property, and data relating to COVID-19 technologies, it would help scale up production.

Affordable vaccines

The price of available vaccines is vital because countries are hoping to vaccinate nearly their entire populations. Vaccinations may become recurring expenses, depending on how long they protect people and the level of protection they offer against future variants.

The prices of authorized vaccines and leading candidates range between $5 and $62. These differences are due to various factors, such as the cost of the technology involved, the amount of public funding, the companies’ production networks, profit-making strategies, and demands by funders and governments.

Governments will incur further expenses due to the distribution costs and administration of vaccination programs.

According to the Lancet, 85% of the world’s population live in low- or middle-income countries that might lack the appropriate resources.

This highlights the need for targeted mechanisms to ensure that vaccines are affordable both now and in the long-term in every country and for every section of the population.

Global allocation

Universal access to vaccines is not guaranteed because of the scarcity of supply and because high-income governments, representing 16% of the world’s population, have pre-ordered at least 4.2 billion doses and secured at least 70% of the doses available in 2021.

If billions of people do not receive the vaccination in 2021, it may prolong the pandemic, and new mutations might occur.

The WHO have created the COVID-19 Vaccine Global Access (COVAX) Facility, which aims to secure low prices and allows high-income countries to subsidize vaccines for low and middle-income countries.

COVAX also regulates distribution and aims to ensure that 20% of each participating country’s population receives the vaccination before further international allocation of supplies based on needs.

For COVAX to achieve its goals, more high-income countries would need to sign up for the scheme, and it would require further funding.

Community deployment

The fourth challenge is the efficient deployment of vaccine supplies. Some countries and local authorities lack the infrastructure to identify and contact eligible people, provide transport when necessary, and administer the vaccine.

Strict requirements on the storage temperature and short shelf-lives of some of the leading vaccine candidates also pose a logistical challenge.

Further research and vaccine development might help remove some of these barriers. COVAX might also be able to assist by allocating the appropriate vaccine to each participating country.

Governments and vaccine developers also need to address vaccine hesitancy. There are vaccine skeptics in all socio-economic, religious, and ethnic groups, both in low-income and high-income countries. The authors of the Lancet paper conducted a survey in 32 countries on the potential acceptance of the vaccine.

The survey found that 66% of U.S. respondents would get vaccinated, with the highest acceptance levels in Vietnam (98%), India (91%), and China (91%), while the lowest were in Serbia (38%), Croatia (41%), France (44%), and Lebanon (44.

“To overcome challenges in vaccine hesitancy and ensure that vaccines are administered to as many people as possible, governments need to do much better at building public trust in the safety of vaccines and to combat misinformation and rumors around COVID-19,” says paper co-author Prof. Heidi Larson, from the London School of Hygiene & Tropical Medicine in the U.K.

“This will require increasing vaccination knowledge and awareness, promoting community engagement, and making vaccines available in convenient and accessible locations. Vaccine manufacturers should aim for maximum transparency and scrutiny of their clinical trial data, and post-marketing safety surveillance with compensation schemes for severe adverse events in resource-poor countries with poor consumer protection,” she adds.

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