The COVID-19 Vaccine Distribution Dilemma

Just as vaccines helped us get rid of several serious diseases in the past, the expectations of a new COVID-19 vaccine are high. Whether your hopes lie with the controversially approved Russian vaccine Gam-COVID-Vac or another candidate vaccine in the development, we can soon expect a vaccine having successfully undergone all phases of clinical trials. However, the discovery of an effective vaccine is not the end of the COVID-19 pandemics.

First, the vaccine needs to be manufactured in large quantities – this will take months, if not more, and still not cover the global demand. Then, there is the issue of financing. During a pandemic, no one is safe until everyone is safe¹, but not all countries would be able to afford the significant price tag of the potential vaccine. Experience from the 2009 influenza A (H1N1) pandemic showed that developed countries bought virtually all vaccine supplies by placing large advanced orders – something that poorer countries simply cannot afford to do². With the current COVID-19 pandemic, some countries are trying to do the same³. To this end, a global vaccine alliance initiative COVAX has been formed to “accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world⁴”. Global collaboration and communication are essential in times like these, but seeing the level of miscoordination during the beginning of the pandemic in the spring, the job will be more than difficult.

Logistical issues aside, the real dilemma is who should get the vaccine first? Which countries should get it first? Should the number of vaccines be divided among the countries based on their population, or based on the proportion of population impacted by COVID-19? Various countries have different testing strategies and some perhaps even positive cases and deaths-reporting policies⁵. Will they tweak their numbers to get more vaccines? Could this impact the study of the virus? 

Once a country gets a certain number of vaccines, it needs a strategy for their distribution. Should they start with the medical personnel, front-line workers, or all essential workers? What about at-risk people with serious medical issues? Furthermore, vaccines are very sensitive to storage conditions – the WHO has previously reported over 50 % vaccine wastage around the world⁶, so an effective distribution plan is crucial to not diminish the already low number of vaccines available.

Lastly, a critical point of this whole process is the attitude of the public – once a vaccine is available, would they want it? Will it be voluntary, or compulsory in hopes of achieving herd immunity against the disease? People might have reservations about this fast-track vaccine development and some are against vaccines in general. Fortunately, a recent survey has shown that almost three-quarters of adults would get a vaccine for COVID-19 if it was available⁷. Nonetheless, a crucial step in COVID-19 vaccine distribution is communication with the general population.

Not to repeat the miscoordination and chaos of global response to COVID-19 this spring, we need answers to these questions before we have the vaccine. The vaccine against COVID-19 is on its way. A well-thought-out plan needs to be too.

References

1. https://www.gavi.org/vaccineswork/why-no-one-safe-until-everyone-safe-during-pandemic
2. Fidler DP (2010) Negotiating Equitable Access to Influenza Vaccines: Global Health Diplomacy and the Controversies Surrounding Avian Influenza H5N1 and Pandemic Influenza H1N1. PLOS Medicine 7(5): e1000247. https://doi.org/10.1371/journal.pmed.1000247
3. Bollyky TJ, Gostin LO, Hamburg MA. The Equitable Distribution of COVID-19 Therapeutics and Vaccines. JAMA. 2020;323(24):2462–2463. doi:10.1001/jama.2020.6641
4. https://www.gavi.org/covid19/covax-facility
5. https://www.cebm.net/covid-19/death-certificate-data-covid-19-as-the-underlying-cause-of-death/, https://www.bbc.com/news/52311014
6. https://apps.who.int/iris/bitstream/handle/10665/68463/WHO_VB_03.18.Rev.1_eng.pdf?sequence=1&isAllowed=y
7. https://www.weforum.org/agenda/2020/09/covid-19-coronavirus-vaccine-opinion-survey/