Eleven vaccines are already in clinical use in the countries where they obtained approval, often with emergency or limited authorization. More than 80 additional candidates are in clinical trial and hundreds of candidates are in the pre-clinical phase.
The announced cumulative supply target by the end of 2021 is up to 14 billion doses. This is three to four times the pre-COVID-19 annual global demand for all vaccines.
However, demand is difficult to forecast. For example, if booster shots are needed after an assessment of the vaccines in use, it would add strain on supply. Or if the committed procurements cannot be completed due to reasons such as a change in the situation, ranging from pandemic to financial, the investment in production is at risk.
Governments that provide vaccines to other societies, either free or through sales, face the need to give priority to full-scale domestic vaccination first. Citizens of the providing country may question why their country is lagging behind in domestic vaccination in comparison with others.
However, such sentiment, while understandable, is not necessarily sound as vaccination is but one of the many instruments toward the goal of reaching herd immunity. An "our own country first" approach risks wasting a valuable product, in addition to facing accusations of hoarding.
For societies that must secure vaccine supply from outside, effective development requires input in infrastructure. A fitting analogy is the use of a new aircraft. There must be airports, pilots and passenger confidence in flying for it to deliver its designed service. With about 70 countries having limited or no meaningful adult vaccination program in place before COVID-19, reaching the goal of having everyone protected is daunting indeed.
Therefore we need to approach the topic of fairness in distribution of vaccine supply with equal attention to effectiveness and speed in vaccination. As such, collective effort needs to be made for fast vaccination, wherever feasible.
We need to reemphasize some points here.
First, there should be no nationalism in vaccine selection. Geopolitical competition among governments is real, so is commercial rivalry among vaccine developing corporations. Vaccines should be chosen solely on the basis of their safety and efficacy, not their country association.
Second, the World Health Organization (WHO) should make public its assessment of vaccines approved by national regulatory authorities. Doing so can help enlarge the pool of supply, relieving pressure on the vaccines approved and to be approved. Multilateral health agencies like WHO should be enabled to enhance regulatory harmonization in the entire process of vaccine manufacturing, transportation and deployment.
The customs procedures for licensed vaccine manufacturers should be simplified to allow maximum utilization of capacities.
The global vaccine input supply chain should be kept fully functional. Scaling up COVID-19 vaccine manufacturing has been accompanied by competition among cutting-edge science and technologies. But government and corporate policies must ensure free flow of goods and workforce, as the real competition all parties face is the one against time, not each other.
For many low-income countries, cost of vaccination is as pivotal as availability of supply. Mechanisms like the COVAX Facility, the global alliance helping equitable distribution of vaccines globally, and the offer of vaccine assistance by various governmental and non-governmental agencies are steps taken in the right direction. Any measure conducive to at-cost vaccine sales should receive full support.
All said and done, uncertainty is the only certainty about the pandemic and the ensuing demand on the global vaccine industry. Therefore quality exchange and evidence-based assessment of the evolving challenge is essential to overcome it. The provision of COVID-19 vaccines as a global public good requires inputs by all.
(Print Edition Title: Toward Vaccine Equity)
