Managing our expectations

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Irawan Ronodipuro INDEPENDENT OBSERVER

IO – The worldwide race for developing a Covid-19 vaccine is now entering the final lap. Or at least we hope. After months of lockdowns, new surges after reopenings and grim economic news without a clear picture of where the bottom lies, the only ray of hope has been news that there are vaccines now entering phase three trials. That’s a big deal, and if any of the vaccines pass this critical phase, showing it is effective and has no serious side effects on human volunteers, then there will be good reason to celebrate. 

Still, our hopes for a vaccine needs to be tempered. 

First, clinical trials can go wrong. It is very possible that upon vaccinating tens of thousands of people in trials that some volunteers will fall seriously ill. Then it›s back to square one and all that implies for public health and prospects for the global economy. 

But even if relatively safe vaccines are developed, the question is how to guage their effectiveness before they are distributed for widespread use. Health experts say that ideally the rates of disease will be 70 percent lower in vaccinated people than unvaccinated people in clinical trials. The Worid Health Organization, or WHO, recommends a rate of 50 percent effectiveness averaged across all age groups. 

Some politicians might be tempted to make any vaccine available regardless of how effective it might be in preventing the disease. But this is not a case where even a little is better than nothing. In fact, it would be a huge mistake. Imagine a scenario of large swathes of the population taking a vaccine that is less than 50 percent effective. This means we would have people who are only slightly protected behaving as if they were invulnerable. The result: a spike in transmissions and a costly failure. Hence it would be safer and much less expensive if the world waits until vaccines are found that meet WHO standards. 

In the best case scenario, where safe and effective vaccines become available, we should be aware that it more than likely will not prevent infection entirely. In other words, it will reduce the severity of the disease and reduce the death rate, but like the flu vaccine it will require a new shot every year. 

Assuming safe and effective vaccines are found, the next global challenge will be ensuring a quick and equitable distribution of the medicines. Without that, even with vaccines in hand, the pandemic will not end and still pose an existential risk. 

So far the outlook is not good. While wealthy countries have already struck deals to buy more than two billion doses of vaccines from pharmaceutical companies, international efforts to secure vaccines for lower- and middle-income countries are way behind in their funding efforts. 

The rush for pre-orders–coming mostly from the U.S.A., European Union countries, the United Kingdom and Japan–is exactly what happened during the 2009 H1N1 influenza outbreak, leaving some of the most needy countries without vaccines when they first came available. 

Richard Hatchett, who heads the Oslo-based Coalition for Epedemic Preparedness Innovations, or CEPI, has said that “if Covid-19 vaccines are misallocated in the way they were in 2009, the pandemic will last longer, more people will die and the disruption will be greater than it needs to be.” 

Hatchett’s CEPI, which has partnered with the WHO and Gavi, a Geneva-based funder of vaccines for low-income countries, is trying to raise funds to secure two billion vaccine doses under a joint fund known as the COVAX Facility, out of which half would be supplied to nearly 100 low- and medium income countries. So far, COVAX has managed to secure a deal to buy 300 million doses, but they are still far short of the $18 billion they need from donors to meet their goal of acquiring 2 billion doses. 

Further compounding the challenge of containing the pandemic are supply side constraints. A CEPI survey of vaccine manufacturers estimates that given their production capacities somewhere between 2-4 billion doses will be available by the end of 2021. 

What does all of this mean? With no certainty on vaccines yet, governments can’t afford to be bullish on the timing of safe and effective medicines being ready to be made before the end of this year. Neither can governments afford to relax once some vaccines pass their phase three trials–it may take much more time than most people assume for enough vaccine doses to reach enough people to contain the pandemic. No matter which way one looks at the situation, the road to getting back to normal is still going to be long and arduous one.