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Opinion

2021: year of the shot in the arm

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For the next two years, the world’s most competitive commodity will not be a metal, a currency, or even time; It will arrive in delicate glass jars, each containing no more than 10 to 20 drops. Often shipping it will require not only a fragile warning, but also dry ice packs, and perhaps even security. Upon arrival at its destination, it will be administered as an injection in the arm, and each injection will carry not only a vaccine, but also an eventual exit from a pandemic that has devastated the world.

As of December 31, there are three approved coronavirus vaccines in the world after scientific due process. Manufactured by Pfizer-BioNTech, Moderna and Oxford-AstraZeneca, each drug has largely undergone rigorous scrutiny for safety and efficacy. At the time of writing, a handful of countries have started managing them to their citizens, setting the pace for what is likely to dominate in 2021, a year that will be measured not by how much of the past we leave behind, but by how much of that we can. return.

Experiences in the US, UK, and various European countries during 2020 have shown that the factory-to-syringe process can pose several challenges, and that even the most ingenious nations can struggle with a process that can be as labyrinthine as it needs to be precise. This process involves identifying the people who need to be inoculated against the virus most urgently, ensuring that each dose is kept at the proper temperature, and requiring close monitoring to monitor for adverse reactions, and then, three to four weeks later, bringing back to vaccine recipients for a booster.

The urgency is accelerated by the threat of a new variant of the virus that threatens to further accelerate the pandemic.

2021: year of the shot in the arm

THE FIRST MILE CHALLENGE

By 2021, vaccine manufacturers and their production partners have projected that they will be able to produce 20 billion doses cumulatively, according to UNICEF’s Covid-19 Vaccine Market Panel. However, the number is unlikely to remain at this level. Some have done subtractions recently. AstraZeneca and its partners, for example, have lowered their end-of-December projections from $ 400 million to just over $ 100 million. At the same time, analysts expect a big increase in production later in 2021.

“In the first six months, there will definitely be a situation where there will be a global shortage; nobody can avoid that. We will see that this will decrease in August-September because there will be other vaccine manufacturers that will also be able to supply … In time, everyone will get it; of course, some countries will have to wait a bit longer, ”Adar Poonawalla, executive director of the Serum Institute of India, said Tuesday. SII is manufacturing the Oxford-AstraZeneca vaccine and has contracts for several others that are later in the process.

According to scientific analysis company Airfinity, the three approved candidates together have a declared production capacity of around 4.8 billion doses by the end of 2021. The other candidates for which a large number of doses are expected this year are being developed by Novavax, Johnson & Johnson / Janssen and Sanofi / GSK. Together, they have plans to produce about 4.1 billion doses, but they have yet to complete the large-scale trials that have the approved vaccines.

2021: year of the shot in the arm

NOT JUST ABOUT DOSE

But the bottlenecks of the production line are even further downstream. Airfinity evaluations also point to a possible shortage of vials and syringes that could slow down packaging and delivery, even if inoculations are done in large volumes. Today, approximately nine billion syringes and vials are produced annually worldwide, the company’s latest assessments showed.

In 2021, syringe production is expected to rise to just over 12 billion and vials to around 15.5 billion, but these numbers are still below expected vaccine production. Most vaccine manufacturers are now switching to larger vials that can hold 5 to 10 doses to overcome some of the shortage.

These problems are still outweighed by the strict temperature demands of some of these vaccines, in particular the mRNA injections developed by Moderna and Prizer-BioNTech that must be kept frozen. The latter requires temperatures of -70 degrees C, cooler than most typical cold storage infrastructure capabilities. Public health officials estimate that up to 15% of stocks can ultimately be lost through waste.

2021: year of the shot in the arm

THE QUESTION OF THE BILLION PEOPLE

However, shipping vials to destinations is likely to pale in comparison to the challenge of profiling and managing millions of recipients, some of whom may need a dose before others. The challenge is particularly acute in countries with large populations and geographic areas like India.

According to the Indian government’s tentative priority list, around 300 million people have been placed first in line for vaccines. Comprising healthcare workers, front-line essential service workers such as police and firefighters, and people over 50 (as well as younger people with comorbid conditions), these are the groups considered to be most at risk infection or serious illness. The government expects these groups to receive a vaccine by July, which means that if the rollout begins in January, India will need to vaccinate approximately more than 1.5 million people every day.

“In order to effectively reach the target population for Covid-19 vaccination, India will need to use its existing national immunization network, including infrastructure (production, storage, transportation, delivery facilities), as well as human resources (vaccinators , supervisors, etc.). However, given the scale of the vaccination effort required for Covid-19, the effort will need to build on existing networks. This needs to be planned, budgeted for, and efforts made to implement it before a vaccine is available, ”said Anant Bhan, researcher in global health, health policy and bioethics.

When, who, and where are some of the most crucial questions in vaccination arithmetic, and countries are likely to follow different strategies, depending on what they plan to focus more on with their inoculation program. For example, Israel, a small country with a relatively small population, has prioritized people over 60, healthcare workers, caregivers and people at high risk. It also currently has the fastest vaccination campaign in the world, having covered about 8% of its population. The country’s goal is herd immunity.

By comparison, the UK is prioritizing its older population. The country is in the grip of the worst wave of infections yet and hospitals in many regions have exceeded their capacity to respond. Its officials declared Wednesday that they will focus on vaccinating as many people as possible to reduce the burden on their health care system, even if it means booster shots are delayed.

2021: year of the shot in the arm

NATURE OF THE RACE

Among the top 10 countries with the highest number of vaccine doses administered by the end of 2020, eight are advanced economies. In early December, international advocacy groups such as Amnesty International, Frontline AIDS, Global Justice Now and Oxfam, which are part of an alliance calling for a popular vaccine, said that wealthy nations that make up about 14% of the world’s population have purchased 53% of the most promising vaccines so far.

Citing data from eight leading vaccine candidates in phase 3 trials that have reached substantial agreements with countries around the world, the groups estimated that nine out of 10 people are likely not to get vaccinated in 2021.

“When you enter a pandemic, the normal market mechanism will take scarce resources and only make them available to the richest countries and the richest people in those countries,” said Bill Gates, co-chair of Bill & Melinda Gates. Foundation, in an interview with HT in December.

Gates and his organization are helping multilateral agreements, such as Gavi, the Vaccine Alliance, build Covax, a WHO-led initiative to pool resources to help bring vaccines to lower-middle-income countries.

Concerns about inequalities caused by the perpetual pandemic in the race to secure a vaccine have led some experts to advocate for more creative solutions. Nobel laureate economist Richard Thaler wrote in the New York Times Dec. 9 on letting celebrities and wealthy people skip the line on vaccines when bidding for places at auction. The offers, he suggested, could be used to “redistribute money from the rich to the poor.”

Such ideas found support among some bioethics scholars: “My idea is that instead of dollars, [wealthy] people should push to send vaccine units to the global South, “said Peter Singer, professor of bioethics at Princeton, in a discussion organized by the NYT on December 24.

These conversations have taken place long before the pandemic, when experts began asking policymakers to heed principles of fairness. “Some rich countries are likely to end up with substantial amounts of vaccine. Over time, if all goes well, these countries will have to decide how much product to keep and how much, if any, they are willing to share, ”said Johns Hopkins bioethicist Ruth Faden, a member of the World Organization. Of the health. Covid-19 Vaccines Working Group said during a college interview on July 1.

While it remains to be seen if this will come true, there were some encouraging signs in December when Canada, which has gotten the most doses per capita, announced that it will consider giving away its overdoses.

GROWING THREAT

The discovery of a new variant in the UK, which has grown rapidly in some parts of the country and has accelerated the outbreak, is fast becoming a cause for concern. Scientists are quick to find out more about its biology and what it means for the pandemic, but early indications suggest that it is even more capable of infecting people and possibly even groups (children) that were largely protected until now.

While the variant doesn’t appear to be making current vaccine options outdated, it will likely make the race for doses more intense. “The appearance of this mutant definitely reinforces the importance of vaccinating as many people as quickly as possible with Covid vaccines, and being vigilant about wearing masks and social distancing,” wrote Shane Crotty, a professor at the Institute of La Jolla Immunology.

The start of 2021 and a large part of its first months could therefore revolve around these problems. At first, the conversation will be dominated by how well or badly countries can speed up vaccine delivery. Along with that, a debate is likely to ensue about who should be the first to get a fix and the complex moral calculus of such decisions.

But what may turn out to be the most watched aspect is how well and for how long vaccines will actually protect us, and whether this will be enough to get us ahead of an evolving pathogen.

(With Rhythma Kaul tickets)

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