COVID-19: ‘The world needs to make 349 vaccines per second’

Humans must learn to live with the coronavirus, as it becomes more or less "permanent", say experts. The most effective way to deal with the virus, like the still-active pathogens that once tyrannised the world (i.e. polio, measles, smallpox), is to create a vaccine that helps "train" the immune system to mount a response. At least 8 vaccine makers have had their COVID-19 jabs authorised in different jurisdictions.

But having vaccines is one thing. Producing enough is quite another. Tougher still: Distributing and then administering them.

Tougher still: Distributing and then administering them. That's apart from convincing at least 70% of people about their efficacy/safety. That could be a long journey — and that, too — with some nasty side trips, given the refrigeration challenges, fast mutations, geopolitics and vaccine hesitancy.

It’s a race against time. The big question, then, is: How far are we from vaccinating even 70% of the world, enough to achieve the much-ballyhooed “herd immunity”?

When do we reach herd immunity? 

Quick answer: nobody knows. We can only make some informed guesses. A Nature article published in March 2021 cite some experts who believe we may never get even to that herd immunity stage. Others disagree, saying it always seems impossible until it's done, citing massive efforts on all fronts, including vaccine patent waivers to speed up production. As the debate rages on...consider the numbers.

Given the enormity of the challenge, several years of painstaking work were compressed into months. In less than a year, COVID-19 made a warp-speed dash through human trials and approvals. Within a few months, vaccine makers have produced hundreds of millions of doses of COVID-19 jabs.

But then the world needs billions — and as fast as possible.

Vaccine production: What we know

How many vaccines can the world make this year? Many companies claim they could make enough shots to immunise most of the world’s population by end-2021. Those are expressions of best intentions. There had been snags and distribution delays.

Rasmus Bech Hansen, chief executive of Airfinity, a London-based analytics company that compiles pharma data, notes that the pharma does not reveal its production capacity. That’s a common practice with many industrial sectors. Yet there's hope. Nature cited Hansen as saying that vaccine growth is likely to be “exponential” in the coming months.

Some 413 million COVID-19 vaccine doses had already been produced by the beginning of March, Airfinity data show. The company projects that this will rise to 9.5 billion doses by the end of 2021. That's the lower limit of the 2021 production estimates.

Vaccine Production: Upper estimate for 2021

These numbers are moving targets.

The upper estimate is 12 billion doses by end-2021 based on vaccine makers’ publicly-announced forecasts, according to the Global Health Innovation Center’s report at Duke University in Durham, North Carolina, published in March 2021.

Claimed targets

Vaccine production targets, however, remain promises at best. The enormous need for vaccines is real and unprecedented. Now, both China and India — two major manufacturers — are keeping more doses for domestic use.

Amid surging cases in South America and South Asia, the current drive to immunise the world against COVID-19 is anything but successful. It will take more to cut this upward spiral. As the virus spreads unchecked, it gets more lottery tickets to “win” — more time means greater ability to mutate into more contagious variants that could evade the protections of existing vaccines.

Andrea Taylor, leader of a Duke University research team, said these numbers are more likely to be reached by the end of 2022, instead of 2021. “Supply chains could break down and countries could threaten to block vaccine exports,” she says.

Vaccine shortfall facts:

Scientists extolled WHO’s approval on Friday (May 7, 2021) of China’s Sinopharm vaccine as it allows the shot to be included in Covax, the global initiative to ensure vaccine distribution for less-developed nations. The WHO-backed Covax initiative had shipped just 54 million doses, as of Tuesday (May 4, 2021) — less than 25% of its earlier April target.

Vaccine production can require more than 200 individual components, often manufactured in different countries. These include glass vials, filters, resin, tubing and disposable bags.

“If any critical item falls short, then it can disrupt the entire process,” said Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations, an Oslo-based NGO, speaking at a March summit of manufacturers and policymakers.

At least one potential bottleneck can be avoided: the process of filling vials with the vaccine substance (known as fill-and-finish), said Martin Friede, head of vaccine development at WHO in Geneva.

Many companies that make injectable drugs can help out with filling vials. The WHO has drawn up a list of several hundred facilities worldwide that currently fill insulin, monoclonal antibodies or injectable antibiotics — which could potentially be repurposed for filling up COVID-19 vials, Friede said.

The world body has also launched a matchmaking service to link these producers to vaccine companies, he added.

Creating the vaccine is not enough

There are critical issues that currently stand in the way of fighting this virus to its logical end.

Production: Labs can produce only a limited number of vaccines per day — it won't be enough to vaccinate entire nations, not to mention the whole world. The entire process may take even years.

Delivery: Depending on a company and its laboratories' localisation, it may take some time to transport and distribute the vaccine.

Side effects: Vaccine can be discarded at any moment of the clinical trials/further observation if the researchers conclude that its side effects are intolerable.

Anti-vaccine movement: The number of people who will not want to vaccine themselves or their children. The fewer people will gain immunity, the longer we will be at risk of the disease.

Fortunately, we now have a clearer idea — however imperfect — of what it would take to hit 70% of the world’s population with a double dose of COVID-19 shots.