Weighing the odds: Pfizer and Moderna creates “a Lamborghini when what most countries really need is a Toyota”
With the entrance of the novel coronavirus (SARS-CoV-2) in late 2019 and its subsequent spread around the globe, concerted efforts have been made to mobilize and initiate the development of a vaccine for COVID-19. Invariably throngs of individuals and institutions in academia, biotechnology, government, and pharmaceuticals embarked on one of the most consequential scientific endeavors in living memory. Innovators, indeed, dashed to develop inoculations against the novel coronavirus. Vaccine developers equally went straight down to work, cooking up a storm in their laboratories in high anticipation of coming up with a winning panacea to the coronavirus.
Sitting on the edge of their seat like expectant ‘fathers-to-be’ in the waiting room, government officials frantically paced, belting out timelines for potential emergency use of vaccine candidates between the fourth quarter of 2020 and the first quarter of 2021. Just like the apprehension which characterizes childbirth, governments, especially in countries where they have experienced breakthroughs in their vaccine production are beaming with smiles of victory.
As it stands, it is quite easy for nations to be a tad apprehensive about mass distribution and vaccination of citizens despite 90% effectiveness of vaccines assured. Nonetheless, Britain has taken the lead in the relay match, followed closely by Russia and Bahrain in vaccinating citizens against the COVID-19 virus.
THE PRICE OF A LIFE
The pandemic has auctioned lives to the highest bidder; economy. A study, published in the journal Environmental and Resource Economics revealed that, the price the UK government was prepared to pay to save lives during the COVID-19 pandemic was far lower than in many other developed nations. In a cross-country comparison across nine nations - Belgium, the US, Germany, Korea, Italy, Denmark, China, New Zealand and the UK - researchers used epidemiological modelling to calculate how many lives were lost through delaying lockdown, estimating that a UK lockdown date just three days earlier would have saved 20,000 lives.
It further linked those policy decisions to the financial cost lockdown had on GDP, resulting in a 'price of life' estimate- the amount of money governments were willing to pay to protect their citizens' lives, reflected in the economic activity sacrificed. The price of life in the UK was among the lowest at around $100,000, and lower still once under-reporting of COVID-19 deaths is accounted for. In contrast countries that were quicker to go into lockdown, such as Germany, New Zealand and South Korea, put a price on life in excess of $1million.
"Price of life estimates are of critical importance given that government intervention has the ability to save life, yet trades off against other goods," said lead author Ben Balmford, from the University of Exeter Business School. “Comparing across countries those who pursued an early lockdown strategy reveal themselves to be willing to pay a high price to save their citizen's lives, only rejecting prices above $1m. However, some countries, those which imposed lockdown relatively late-on in their respective pandemics, were clearly only willing to pay far less."
The breakthrough vaccine development with the introduction of Moderna and Pfizer Covid-19 vaccines demonstrated efficacy in more than 90 percent of phase 3 trial participants. Regrettably, the disparity which is likely to be generated by the distribution and inoculation of people globally is that only a very small fraction of the global population will be able to reap the rewards of this achievement.
Forbes asserts that, to remain stable, the Pfizer vaccine must be stored in specialized freezers kept at an ultra-low temperature of negative 94 degrees Fahrenheit. Such storage units are manufactured at a select few “freezer farms” and priced at $10,000 to $15,000 apiece. While the Moderna vaccine doesn’t demand as deep a freeze—the requisite negative 4 degrees Fahrenheit is comparable to a standard home freezer—both must be administered in two doses a month apart, a logistical hurdle not uncommon but certainly not ideal in a quest for worldwide inoculation.
“Even hospitals in the United States and Europe, where governments have already bought up hundreds of millions of doses of the mRNA vaccines, will be hard-pressed to secure the equipment necessary for their safe storage and transport— especially those in small towns and rural areas where many residents, due to adverse socioeconomic and health conditions, are disproportionately vulnerable to Covid-19.
“The same is true of remote regions in Africa, Latin America, and Asia. Airlangga Hartarto, head of the Covid-19 task force in Indonesia, told Reuters that in his country, the Pfizer vaccine has already been ruled out as a viable option— so unlikely is it to survive distribution between 270 million people across 17,000-plus islands.”
Pfizer and Moderna, according to Forbes “have created a Lamborghini when what most countries really need is a Toyota—a vaccine that can be manufactured, stored, and administered simply and cheaply, preferably via existing distribution channels”. Luckily, such alternatives exist. “One is the adenovirus vaccine being developed by companies like AstraZeneca and Johnson & Johnson, which uses a nonlethal cold-causing viral vector as its means of inoculation, rather than synthetic proteins as mRNA vaccines do. Adenovirus vaccines are, however, hampered by one deep and fundamental flaw. Recipients would risk developing immunity not just to Covid-19, but the vector itself, meaning after initial rounds of rollout, another candidate might have to be developed from scratch. The AstraZeneca vaccine and others of its ilk can be thought of as Mercedes—not as high-maintenance as a Lamborghini, but certainly not as practical as a Toyota”.
“With such metaphoric comparisons, “chances are high that vaccination against Covid-19 won’t be a one-and-done affair, but an annual or even biannual reoccurrence like the seasonal flu shot. Alternatives to mRNA vaccines that are more logistically feasible and cost-effective for all won’t be available quite as immediately, but have a far greater chance of reaching more people in need when they do hit the shelves. Two to three months is my best guess, at which point we’ll have a better idea of which populations the Pfizer and Moderna vaccines cannot penetrate. In a pandemic, no country is an island— a lesson China is learning on a weekly basis as new infections arrive in one form or another from overseas. A vaccine all but exclusive to urban, high-income countries won’t cut it. The more pragmatic solution is a vaccine viable and affordable to all”.
ENSURING EQUAL DISTRIBUTION OF VACCINES
With more than 1.5 million lives lost to COVID-19, world leaders in General Assembly demand urgent action to guarantee equitable distribution of life-saving vaccines. Emmanuel Macron, President of France, proposed a donation mechanism to ensure that a portion of the first vaccines doses are used to vaccinate priority groups in developing countries. Those doses, whether they come from Europe, China, the Russian Federation or the United States, or whether they result from donations from States or pharmaceutical companies would be allocated effectively and fairly, based on WHO recommendations. He stressed, however, that vaccines will not be enough. Unless primary health systems are strengthened in the most vulnerable countries, and unless health workers everywhere are trained, the overall health response will remain suboptimal. Echoing the French President’s sentiments, Justin Trudeau, Prime Minister of Canada, called on Member States to unite in pursuing global efforts ensuring full, equitable access to a potential vaccine. “The pandemic has taught us difficult lessons about inequality both at home and between countries,” he said, noting that advanced economies have spent 20 per cent of their GDP to support their citizens during the pandemic, while developing economies can only afford to spend 8 per cent.
Developing countries have been tipped to lose out on the race in winning an equal bid in the distribution of vaccines, as whoever can pay the most at the earliest stage of production gets to the front of the queue. For those who cannot secure their tranche of the vaccines, they are found smartly capitalizing on their resources to gain the inoculation batches. Some middle-income countries with manufacturing capacity have also been able to negotiate large purchase agreements as part of manufacturing deals. While other countries with the infrastructure to host clinical trials such as Brazil and Mexico have been able to use that as leverage in procuring future vaccines. Oxfam International asserts that, one of the leading vaccine candidates, developed by Moderna, has received $2.48 billion in committed taxpayer’s money. Despite this, the company has said it intends to make a profit from its vaccine and has sold the options for all of its supply to rich nations at prices that range from $12-16 per dose in the US to around $35 per dose for other countries putting protection out of reach for many people living in poverty. While it may be making real efforts to scale up supply, according to reports, the company only has the capacity in place to produce enough for 475 million people, or 6 percent of the world’s population.
Oxfam and other organizations across the world have called for a People’s Vaccine; one available to everyone, free of charge and distributed fairly based on need. This will only be possible if pharmaceutical corporations allow vaccines to be produced as widely as possible by freely sharing their knowledge free of patents, instead of protecting their monopolies and selling to the highest bidder. With bated breath, one can only hope of a total success of vaccination program rolled out without complexities and complications being an albatross, thereby complicating an already fragile and precarious situation; a cure for all and not just some privileged lot.