Since the beginning of the coronavirus pandemic, the entire world has been waiting for news of an effective vaccine. In November 2020, Pfizer and Moderna announced their vaccines had proved to be 94.5% and 95% effective, respectively. This fact was considered as promising by experts but there still remain several unanswered questions.
Will a COVID-19 vaccine end the pandemic?
“The recent announcement of effective COVID-19 vaccines is good news. The cycles of lockdowns and re-openings are unpopular, not sustainable in the long run and, from a purely economic standpoint, suicidal; vaccines are our best hope of returning to normal life. There is still a long way to go before these vaccines are available to most people, but it will not be necessary to vaccinate the entire population of the planet. A targeted approach to vaccination will be used. No, the vaccine will not, in a purely epidemiological sense, end the pandemic. It will just allow the world to contemplate a return to normality.”
“A clarification to start with; each vaccine can be made available on the market only after being approved through a marketing authorisation delivered by a regulator. Once it is approved, multiple issues remain: how will it be supplied, stocked and delivered? Will everyone accept being vaccinated? Two of the major vaccine candidates require two doses: how will we make sure that the most vulnerable receive both their first and second shots? The pandemic will remain as long as those questions remain. To date, the announcements made by pharmaceutical and biotech companies are little more than advertising. A very thorough process of assessing the data (which has not yet been published and/or peer-reviewed) that will be made available to regulatory agencies will have to take place. Such processes are extremely meticulous because they determine the safety and efficacy of the candidate vaccine, not only in clinical settings, but also in real-world conditions. The key question will be: is the vaccine safe and effective for everyone? What type of adverse events will there be and for whom? How long will the protection provided by the vaccine last for each subgroup of population? Lastly, future mutations of the virus will likely hamper the effectiveness of vaccines. Again, as long as those questions remain, the pandemic will be far from over. In any case, vaccine introduction will not replace public health measures as long as herd immunity is not reached.”
“In general, vaccines are a valuable tool to prevent or lessen the impact of an infection. A COVID-19 vaccine is no different and will not resolve all the issues. Wearing masks, social distancing, good hygiene, self-quarantine, awareness of risky behavior is and will be needed. One of the dangers of being vaccinated is that it can provide a false sense of security with all other aspects falling by the wayside.”
COVID-19 vaccines: how can it be ensured that developing countries have access?
“Ensuring equitable access to future COVID-19 vaccines is crucial because there will only be a global solution to the COVID-19 pandemic. The COVAX, one of three pillars of the Access to COVID-19 Tools (ACT) Accelerator, is a concerted effort by governments, global health organizations, manufacturers, scientists, the private sector, civil society and philanthropy to ensure that COVID-19 vaccines, once they are available, are equitably accessible to all countries, irrespective of their level of economic development.”
“This is a very important issue. The COVID-19 Vaccine Global Access Facility (COVAX), which is led by the WHO and other international entities, was created to prevent vaccine nationalism by wealthy countries. The objectives of the COVAX facility are to secure doses for all countries, and distribute those doses fairly, beginning with the highest-risk groups, and up to a fifth of a country’s population. The 92 lower-income countries who are members of COVAX will thus receive their doses free of charge. This is all supposed to happen in a spirit of international collaboration and social justice. The reality is that wealthy countries prioritize securing their own ‘lion’s share’ by monopolizing early doses of any promising vaccine. Even though these countries represent only 13% of the world’s population, they have already acquired 51% of the predicted production of the most promising COVID-19 vaccine candidates. A more promising approach is the proposal made by India and South Africa calling for a “TRIPS Waiver” of the WTO’s requirements. This proposal will be discussed in the coming days by all WTO members. If it is accepted – and let’s hope it is – manufacturers of promising vaccines will be compelled to share all their intellectual property, including technology (e.g., novel mRNA technology) and know how to other vaccine manufacturers in the developing world. These will then be able to produce and supply vaccine doses, possibly at a lower price, making the vaccine(s) much more affordable.”
“There is no assurance that COVID-19 vaccines will be available or accessible to all who need them (higher risk individuals should be vaccinated first). This is very true for developing countries, but also in developed countries. It would be hoped that developing countries would prioritise the health of their citizens rather than making huge deals with arms manufacturers (the same is true for developed countries and those in transition).”
When and how do you see the end of coronavirus pandemic?
“It depends on what we mean by the “end” of the pandemic. People want to move, meet, hug, work without worries, people want children to return to school with little to none of the current precautions. In short, people want to return to life before COVID-19. So, the end of the pandemic for most of the world is a sociological end, the time people stop worrying about the disease. With the new vaccines and the level or effectiveness reported, the sociological end of the pandemic can be contemplated in the short term. The infectious agent will still be around and will still circulate, people will still become infected, become sick and some will eventually still die from it, but the world will have moved on.”
“It’s difficult to give a definite answer to this question. It depends on so many factors, global health equity being the most important of those. Unfortunately, I think the pandemic might last longer in poor settings. For what it’s worth, I do not see an end to it before the spring of 2023. I find the ‘how’ in your question more interesting. What this pandemic highlights is how we humans, regardless of the level of technology and economic advancement we may achieve, are still vulnerable to unexpected crises. Most importantly, this crisis is partly man-made – alarming levels of deforestation have led to the unlikely contact between animal carriers and human hosts. So, make no mistake, the underlying crisis behind the COVID-19 pandemic is the climate crisis. A paper in Nature from last August highlighted that ‘global changes in the mode and the intensity of land use are creating expanding hazardous interfaces between people, livestock and wildlife reservoirs of zoonotic disease’. And, as long as we continue to pay lip service to climate change and refuse to change our industrial structures and ways of living, we face a great risk of future pandemics of this type – and possibly more lethal than COVID-19.”
“There is no crystal ball. A COVID-19 vaccine will help diminish the infection and fatality rates, as long as it meets regulatory standards in safety and efficacy, but compliance with other aspects of disease control in these difficult times will be required.”
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