A shot at redemption
What price a vaccine which would protect us against COVID-19?
The answer is about $9bn, which is the amount committed to the 160-odd projects taking place around the world – very little when compared to the huge human cost and the estimated hit to the global economy by the end of 2021 of around $9tr. For every week we can bring forward successful vaccines and mass vaccination, we save lives and billions in lost economic output globally.
Despite the recent pause announced in the Oxford/AstraZeneca trial in the UK, we may not have much longer to wait, as the mass human trials on the first candidates – the one from Oxford’s Jenner Institute, and two at Moderna and Pfizer in the US – should roll out in the next couple of months. This has been achieved far quicker than the usual timelines associated with drug development due to innovative thinking by very smart people using new techniques to develop antibodies within the body.
Chief amongst the means used to speed up the process is that the usual linear stages of drug development have instead been conducted in parallel, including production. You would, of course, usually make the product once it has been approved for use following successful trials. However, backed by investment from the UK and overseas’ governments, many of these vaccines have been in production for months now so that when (or if) they are found to be successful we will have tens of millions of doses ready to go.
The announcement of successful trials will spark a huge sense of joy and relief around the world, not least by politicians, bureaucrats and advisors, who have often botched their responses to this virus. They will have a shot at redemption – ‘we couldn’t get paper masks, but we do have amazing science which will save the world’.
However, it will also cause problems for governments. Firstly, the two things scientific regulators look for are safety and efficacy – will they bend to political pressure to approve something which is not quite right? The US Food and Drug Administration has already come under pressure to give the incumbent president a popularity boost ahead of November’s election. This has clearly been the case in Russia, which has already approved mass vaccination with their untested product. And in the rush to get a product to market, will it really provide durable protection if we don’t have long term data?
Then there is the question of which countries will get it first. In getting access to innovative drugs, we usually see the application of the ‘Golden Rule’, whose single statute is ‘whoever has the gold, rules’. This means that the US, Europe and other rich countries get access to the best drugs at speed, and low income countries don’t. Will we see the rise of ‘vaccine nationalism’ with a country which is successful in discovering a vaccine keeping it for themselves and denying countries they don’t like – or who can’t or won’t pay for it - access? The news here is good, however, with, for example, the Oxford vaccine already licenced to many countries, including an Indian maker who will supply 1bn doses to low and middle -income countries.
Within countries, the logistics of tens of millions of people getting a shot are complex, not least as vaccines are sensitive and need to be stored and transported carefully and it is likely that the initial vaccines will need at least two doses to make them effective.
The main controversy will then be that the government will need to decide which citizens should get it first. Front line health care workers will probably be at the top, but then who? Based on the data, the elderly are more vulnerable to infection, as are people on lower incomes, people in cities and the BAME community. Or is it more important to give it to the economically active so they can get back to work? Can it be purchased privately for those wishing to skip the queue?
Whilst the majority will jump at the chance, there are a hard-core of ‘anti-vaxxers’ and anti-authoritarians who will resist any attempts to give them a jab. However, there are surely many more who will want to see how things develop. Given governments cannot obligate people to receive a medical procedure, they will need to ‘nudge’ them – maybe seeing political leaders being publicly vaccinated themselves would help, possibly with a soundbite along the lines of ‘never has so much been owed by so many to so few’ if their country has discovered the vaccine first. Maybe this will have the knock-on effect of increasing the number of people who get vaccinated against flu thereby reducing the thousands of annual victims in the UK and the strain it places on the NHS.
Finally, how much should the innovators be paid for the product? Whilst the vast majority of health systems around the world are run by national governments, drug discovery is mostly carried out by private companies with citizens benefitting from the huge competition needed to come up with innovative treatments and cures. There are some good signs here too as makers have pledged that the vaccines will be delivered at close to cost, at least in the first year. Given that governments have funded the R&D, companies will not be allowed to hike prices or they will see their patents cancelled.
2020’s coronavirus crisis feels like a war situation and the power of governments has been brought to bear on our lives in ways not seen since the 1940s. The issues discussed around a vaccine are no different, with difficult choices to be made. The UK government has invested in six different vaccines and good news is surely just around the corner. However, in other ways this news is just the beginning.
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