20210211 vaccines philippines
Health workers and employees of Philippine General Hospital register for COVID-19 vaccination, expected to arrive this month, in Manila, Philippines. Photo taken on February 9, 2021. About 80% of manufacturing capacity of leading vaccine makers in the West, estimated at 4.4 billion doses this 2021, had been pre-booked for 15% of global population. Image Credit: Reuters

Highlights

  • Vaccinating at least 70% of the earth’s 7.8 billion inhabitants — and that too, with a double dose — presents an unprecedented public health challenge.
  • At this level (70%), experts say the desired “herd immunity” may be achieved. But some experts now say the best-case scenario is to immunise up to 90% of the population.
  • With a double-dose protocol (two vaccines from the same manufacturer administered a few weeks apart), that means at least 5.85 billion people need to be inoculated, equivalent to 11.6 billion vaccines.
  • These do not include vaccines that may be needed against new variants now making the rounds in several countries.

Dubai: The demand for COVID-19 vaccines far outstrips supply today. The world currently faces an enormous challenge as the largest, most complicated public health drive in history gets underway. The imbalance, it’s been hoped, would be transient.

Consider the numbers: Epidemiologists initially stated that 70-75% of the world’s current population of 7.8 billion should be inoculated — or some 5.85 billion people (at 75% threshold). With a double dosage (for most vaccines), that brings the number of doses the world needs today to 11.7 billion.

Here’s the good news, sort of: The combined East+West vaccine production capacity stands at 12.18 billion doses, based on our current estimates. If all goes well, this could result in an excess of 480 million doses (still at 75% immunisation rate). These numbers are anchored on claimed monthly vaccine manufacturing run rates, multiplied by remaining months to get the total 2021 ballpark figure. Here’s the lowdown on vaccinating the world against the deadly pendemic:

Q: What are the challenges?

There are many. The minimum percentage of vaccinations to reach "herd immunity” must be hit. Estimates vary greatly, from between 60% to 70%, and 80% to 90% — the latter figure is the level now sought by Dr. Anthony Fauci, America’s top infectious disease expert. In which case, the numbers need to be adjusted.

First: production and distribution. The current global vaccine production capacity is nowhere close to the demand. And sheer production numbers are daunting, at least in the short term. There’s "vaccine nationalism" too, which means poor countries would be left behind, though studies warn that a delay in global COVID-19 immunisation could affect all nations. However, there's a silver lining with reports of production run rates getting ramped up everywhere — the US, Europe, Russia, China, India and Brazil — for the vaccines already approved in different jurisdictions.

Vaccine production global data
Image Credit: Jay Hilotin / Gulf News / Airfinity / Reuters / NPR / The Diplomat / Boston Consulting Group

Second, the people who will be vaccinated: In some countries, children younger than 18 comprise up to 30% of the population, yet they’re currently excluded from vaccinations as they had not been included in trials (also excluded from trials are nursing and pregnant women, those with allergies, people with immunodeficiency disease, and women planning to get pregnant in the near future). Fresh trials of approved vaccines on children have started, with results due later this year.

Third, vaccine hesitancy: In certain countries, up to 40% say they have no plans of getting vaccinated against COVID-19. It means even if the shots are made available for free through bulk government purchases or Covax, many may still opt out, potentially exposing them and those around them.

WHAT IS VACCINE HESITANCY?
• Also known as anti-vaccination or anti-vax, vaccine hesitancy is a reluctance (or refusal) to be vaccinated against contagious diseases — despite the availability of vaccination services. Healthcare workers encounter patients who have reservations about getting vaccinations for themselves or their children.

• It's the scourge of modern, instant communication. Disinformation, fear-mongering and misconceptions hyper-shared on social media, and becoming viral. Coupled with confirmation bias (seeking only the information one believes in), and algorithmic promotion, it’s the noisiest bunch that’s often heard loud and clear.

• There’s a fringe community of people trashing vaccines as a whole, citing non-existent “evidence” – and driving up vaccine hesitancy.

Q: How many days would it take to get the world vaccinated?

Vaccine
Here’s the good news, sort of: The combined East+West vaccine production capacity stands at 12.18 billion doses, based on our current estimates.

Not days, but seven (7) years, according to a Bloomberg calculator, citing current rate of inoculations. One obvious flaw of this estimate: it does not account for the expected surge in production. The combined capacities of vaccine makers both in the East and the West actually point to a more optimistic picture. Besides, countries like the UAE have shown that it’s possible to hit 49.56% doses for every 100 people in a rather short span of time (as of February 12, 2021).

Q: So is 7 years just a 'guess-timate'?

It's a worst-case scenario. Given the 171.26 million cumulative COVID-19 vaccinations worldwide as of February 13, 2021 (based on Our World In Data numbers), this is equivalent to 3.89 million doses administered each day in the last 44 days since January 1, 2021. At this rate, it would take about 4 years to cover the whole world, instead of 7 years.

VACCINE INDIA TEA-1610967046025
A health worker administers a COVID-19 vaccine to a person at a hospital in New Delhi. Combined production from the “East” (China, Russia and India) could fill in the gap, with up to 7.78 billion claimed capacity between the three major producers. This could bring the theoretical East+West vaccine production globally to 12.18 billion doses this 2021. Image Credit:

Q: How soon will most of the planet get vaccinated for COVID-19?

The answer is a bit more complicated than throwing up straightforward numbers. In the intense competition for COVID-19 shots, the world faces quite a high bar in bringing those vials to peoples’ arms within the shortest time possible. Our best guess: 18 to 24 months.

Q: In a best-case scenario, how many vaccines can be produced this 2021?

Based on Gulf News calculations, using the Boston Consulting figures as base, the most optimistic scenario is a cumulative vaccine production this 2021 that's higher than the 70%, or even 75%, vaccination threshold. Between now and then, there's a lot of work to be done. Cooperation, instead of competition, is important.

Stock Covid Vaccine UAE
Countries like the UAE have shown it’s possible to hit 49.56% vaccination rate for every 100 people in a rather short span of time (as of February 12, 2021).

Combined production from the “East” — China, Russia and India — could greatly boost the drive, with up to 7.78 billion claimed capacity between the three major producers. This could bring the theoretical East+West vaccine production to 12.18 billion doses this 2021.

The numbers are just part of the equation. A key challenge: vaccinating people who are younger than 18 years (most approved shots are not tested yet for them). 

What if immunisation level is raised to 90% of the population?

These are all moving targets, like an accordion, with key variables to consider, including new virants of SARS-CoV-2. If the vaccination level is adjusted to 90% (14.04 billion doses), as Dr Fauci has suggested, it would mean a 2.4 billion shortfall in vaccine production this year.

It’s something data scientists performing multiple regression analyses must continuously crunch, and policymakers must take heed. But it's also possible production and inoculations may be scaled up, and new shots are devised against the really bad variants, as vaccine makers work together and science remains open.

171.26M

Cumulative COVID-19 vaccinations worldwide as of February 13, 2021.

Q. What about distribution?

Now, there's another good news: the tempo of vaccine manufacturing has gone up, and so is distribution. As of Saturday, February 13, 2021, more than 171 million doses had been administered across the globe — a 198,648% change from December 13, 2020, according to Our World in Data, which tracks COVID-19 shots. As governments drive up demand and vaccine makers boost capacity — there are signs the run rate will increase.

Why vaccination matters
• A large number of the world's population needs to be immune to the virus.

• The safest way to achieve this is with a vaccine (instead of waiting for them to be infected), say experts. Vaccines are a technology that humanity has often relied on in the past to bring down the death toll of infectious diseases.

• In less than 12 months since COVID-19 pandemic first broke out, researchers rose to the challenge and developed vaccines that protect from SARS-CoV-2 Now the challenge is to make these vaccines available to people around the world. It is of utmost importance that people in all countries — not just in rich countries — receive the required protection.

Do they really work? Here's a brief history of vaccines

Q: When will the entire world get vaccinated?

First, not everyone may be vaccinated — or need to be. Our best-case scenario is two years, based on available production figures (as of February 13, 2021) and estimated production by end-2021. This could change, depending on a number of factors.

Vaccines
Image Credit: Gulf News
VACCINE APPROVALS & TRIALS
• Numerous vaccines are available in different continents from various manufacturers. Altogether, there ate at least 8 approved double-dose vaccines — Pfizer, Madonna, AstraZeneca, Sputnik V, Sinopharm, Sinovac, Cansino, Novavax, and one single-shot vaccine from J&J/Janssen.

• In January, Pfizer started vaccine trials for children; this was followed by Oxford this February. Pfizer recently announced that its trial in adolescents (ages 12-15) is fully enrolled and it could seek US authorization in the first half of this year.

• Meanwhile, Moderna’s vaccine has also been authorized down to age 18, and it is enrolling adolescents ages 12-17 in trials. Janssen is expected to seek emergency use authorization of its vaccine for adults in the next several weeks. Moderna could start trials in adolescents about four to six weeks later.

• AstraZeneca’s Phase 3 trial in US adults is ongoing, and it could start trials in adolescents also in the first half.

A single dose from J&J’s vaccine-making arm Janssen, could be a game changer. Another potential game changer: the intra-nasal Covid shot announced by Israel. Another source of optimism, the quicker development time of mRNA shots by Pfizer and Moderna against new strains.

A group purchase scheme under the Covax initiative for developing countries is also in place, part of the mix of individual, country-level deals, non-profit intervention, and other arrangements to boost production and distribution. Let’s not forget, the first doses are out, and had been used in 171.26 million shots.

Target: 3 billion mRNA vaccines this 2021
• Pfizer-BioNTech aims to make two billion doses this year 1— enough for a billion people to receive their two doses.

• Moderna plans to deliver as many as 1 billion doses.

• This is before counting what non-mRNA manufacturers in China, India, and Russia may be able to deliver. The three countries have a combined capacity of 7.78 billion vaccines this year.

Q: What is the production time for inactivated vaccines?

It takes time for conventional vaccines to develop, typically 48 days (for inactivated shots) from cell culture to the vial-in-a-box package. This is a natural limitation. Most inactivated vaccines against viral diseases are made from viruses grown in chicken eggs or mammalian cells. The process of collecting the viruses, adapting them to grow in the lab, and shipping them around the world can take several weeks, if not months.

Q: What is the production time for mRNA vaccines?

Production time for mRNA vaccines, on the other hand, is relatively much faster. It typically takes one week to generate an “experimental batch”, according to BioNTech. The RNA (which encodes an antigen of the infectious agent) is made from a DNA template in the lab. The DNA can be synthesised from an electronic sequence that can be sent across the world in an instant by computer.

Q: What’s the upside with mRNA vaccines? And the downside?

The new mRNA-based vaccines are theoretically faster to produce than conventional ones. It’s unclear at this point how long it takes to generate a batch of, say, 100 million mRNA vaccines. But while production may be faster, mRNA vaccines have one downside: they need super-cooling to keep their efficacy. For example, Moderna’s shot needs -20°C freezing, and Pfizer’s needs -70°C freezing. By comparison, the average Arctic winter temperature is -34°C.

3 billion AstraZeneca vaccines this 2021
• AstraZeneca hopes this year to produce as many as three billion doses of its vaccine, developed with Oxford University.

Q: What’s the advantage of conventional (attenuated and inactivated virus) vaccines?

The biggest advantage of conventional vaccines is, once they’re made, they only need regular refrigeration.

Q: If enough COVID-19 vaccines are made, then our problem is solved?

Possibly. But not yet. Bringing those shots to all corners of the world, including remote areas, is a key hurdle. It would mean the primacy of vaccines that can be stored in regular fridges — or that don’t require cold storage at all.

This would mean a more intense demand for the initially limited number of vials for the regular-fridge COVID-19 doses. But in the face of great odds, one can never underestimate human ingenuity. It's the same drive that led to the discovery of the first vacccine by Dr Edward Jenner in 1796, the now tried-and-tested platforms that helped humans fight polio, measles and other deadly infections — and the new mRNA shots that showed +90% efficacy against the new coronavirus.

covid 19 vaccines ver 3
Image Credit: Seyyed dela Llata/Gulf News

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