Just about a week ago, on 9th November, some groundbreaking news was made. Two pharmaceutical companies, Pfizer from the US and BioNTech from Germany, announced that they have jointly developed a COVID-19 vaccine that, having passed Phase 3 trials, has an effectiveness of an astonishing 90%. News of this quickly garnered major attention not only in the media, but also in the scientific community and the markets. It in fact generated a frenzy in the stock market, which increased shares for companies across the industry spectrum. Companies that have been hit hard by lockdowns like travel stocks and movie theatres soared, with Carnival and Cinemark jumping more than 35%.
Many observers herald this as the beginning of the end of COVID-19. It even seems to come at a very good timing, just days after the world’s largest economy, the United States, elected Joe Biden as its next President, denying Donald Trump a second term. Biden plans to set up a task force to tackle the pandemic, and the development of a new and potentially effective vaccine would do a lot to assist that. The celebratory mood was not uncalled for. Usually, vaccines take between 10 and 20 years to develop. The scientists at Pfizer and BioNTech took less than a year. It is also revolutionary in the sense that it employs a novel technology - mRNA (messenger RNA). Instead of using a piece of the virus, or a dead virus, or an attenuated virus, this vaccine puts in the genetic code into the body, which is considered a lot safer. When the body detects the presence of the virus, it mounts an immune response with antibodies and T-cells. If approved, this vaccine would be the first to employ this technology. And it would bring great optimism too, for it also suggests that other vaccines in development, such as those from Moderna and AstroZeneca, also have a good chance of success.
But at such an early stage, many things remain too soon to tell, and there obviously a number of challenges that have to be overcome. Assuming that the Pfizer-BioNTech vaccine is successful and more vaccines will too, these could be defining issues in 2021. First of all, about the details and workings of the vaccine itself. We are not exactly very sure if the vaccine’s efficacy is actually 90%. The trials are not fully over, and there is a chance that statistic is inaccurate. And even if the vaccine is 90% effective, we do not know how long the immunity it provides will last. It could be anywhere between a few months to a few years. This is important to know since vaccination programmes need to be informed of when the immunity expires. And very crucially for the fight against the pandemic, we also need to know if this vaccine stops transmission. Does it only stop people from falling sick, or does it also stop people from spreading the virus. It is not as direct as it seems, because as we already know, the coronavirus pathogen can be spread by asymptomatic carriers.
Next would be the logistical challenge. Mass production and subsequent storage will not be as simple as one might think. This is because the vaccine has to be stored at a temperature of -70°C. This is tough even for the most advanced hospitals in the rich world, and even more so for countries with hotter climates, which are often developing countries with inadequate infrastructure. The distribution of the vaccine will also force many tough questions to be answered. What should be the cost or price of the vaccine? Which countries should it first go to? Which demographic groups should be given priority access? A good case that for the greater good of the world as a whole, the vaccine should be provided for free, funded via government spending. This is the most reasonable way to go forward, but we must forget that even during times of crisis, the pharmaceutical companies still have profit as their primary motive, so the dynamics of pricing is likely going to be more complicated than that. What must not happen is to allow them to monopolise the vaccine market for it would grant them far too much power over a good so crucial to the livelihoods of so many people. Between different countries, governments around the world have already made deals to buy millions of doses of vaccines from various developers once they passed regulatory requirements. This is not unexpected, since a government’s duty is to its citizens and they all wish to obtain the vaccine for them as soon as possible. But it becomes clear it is only the more wealthy and powerful countries that have the purchasing power. Less significant and poorer countries are likely to lose out, even if they require it more. But putting it objectively, the vaccine will most likely go to Europe, the US and India first, since these are huge regions that are struggling hard to contain the virus. Most of the developing world would need the vaccine, but are unlikely to obtain it as quickly. East Asia and Oceania will be put on lower priority since the containment of the virus has been more successful there. And within a country, which groups should get it first? Clearly the ones most vulnerable to COVID-19. Healthcare workers, the elderly, workers in elderly care homes and other essential workers who move around a lot. The young who are less likely to die from the virus will likely wait a while longer.
It will also be a Herculean task to vaccinate all the world’s 7.5 billion people. Even if it gets approval now, Pfizer has said it will only be able to make enough vaccines to inoculate 25 million people in 2020, but up to 1.3 billion doses are possible, in theory, next year - enough for another 650 million people. These figures fall short of the world’s population by a long shot. Even with more producers, under the most optimistic scenarios, demand for the vaccine may well exceed supply throughout 2021. This is definitely a challenge of expanding production capacity and harnessing economies of scale, because the world is not safe until everyone is free and protected from the virus. And then there is the segment of people where demand is lacking. There is still significant public hesitancy about taking a vaccine, whether for grounded scientific or safety reasons, or due to plain anti-vaccine misinformation. 1 in 4 people say they won’t take a COVID-19 vaccine, and more than half of them are concerned with side effects, 29% doubt its effectiveness, and 19% say the virus is not enough of a risk to warrant mass inoculation. Hence efforts need to be made to convince them, both through persuasion and evidence, so they are willingly vaccinated.
Last but not the least, we should also be concerned and skeptical about the pharmaceutical companies themselves. Let us not forget that these are profit-driven companies whose main aim is not to be magnanimous saviours of the world, but to increase their revenues. While the pandemic is a crisis for almost everyone in the world, these companies see it as an opportunity to be the big winners. Pfizer itself is not exactly a company known for honesty and ethics. In 2009, it set a record for the largest healthcare fraud and the largest criminal fine in US history, amounting to US$2.3 billion. Therefore pharmaceutical companies despite the crucial role they play in ending the pandemic should be scrutinised and should not be put on a pedestal.
2021 will be an interesting year to watch. Hopes are that it will not be as devastating and destructive as 2020, and recovery from the pandemic begins. It will be a long road to recovery, and even painful bearing many costs. These aforementioned challenges will play a huge role in the main questions of 2021, but we could see a lot more. For vaccines are not only the medical protection against a pathogen, but also tools of power, symbols of prestige, and sources of profit.
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