Affordability, availability, hesitancy hampering COVID-19 vaccination

The development of new COVID-19 vaccines will have little impact if the global population is not immunized against the virus on time to build strong immunity against the virus, warned a team of researchers in a study published in The Lancet.

The situation is alarming in developing countries as they struggle with various issues, including technological challenges, affordability and collaboration with pharmaceutical companies to manufacture and access COVID-19 vaccines.

At present, national and regional health regulators have approved more than 26 vaccines for emergency use. But rich countries have already purchased and placed advanced orders in large quantities, hampering global efforts for equitable distribution of approved vaccines.

"Several manufacturers have successfully developed COVID-19 vaccines in under 12 months, an extraordinary achievement. But the stark reality is that the world now needs more doses of COVID-19 vaccines than any other vaccine in history in order to immunize enough people to achieve global vaccine immunity," said Dr. Olivier Wouters, lead author of the study.

"Unless vaccines are distributed more equitably, it could be years before the coronavirus is brought under control at a global level. The questions now are when these vaccines will become available, and at what price," Wouters added.

Limited technological and scientific capabilities of developing countries coupled with challenges in knowledge transfer have further affected the mass production of new vaccines in developing countries.

A few pharmaceutical giants have come forward and collaborated with manufacturers in other regions to boost the production of COVID-19 vaccines. However, the terms of agreements are not clear on factors like whether the vaccine manufactured in that region could be supplied to other countries or not. 

"Based on known deals, governments in high-income countries representing 16 percent of the global population have secured at least 70 percent of doses available in 2021 from five leading vaccine candidates," said Mark Jit, co-author of the study.

In order to ensure equitable distribution of vaccines, the World Health Organization (WHO), Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI) constituted COVAX--the global initiative to ensure access to COVID-19 vaccines for all countries.  But vaccine nationalism, researchers pointed out, could leave the initiative with limited supplies of vaccines.

The initiative needs $6.8 billion to secure two billion doses by the end of 2021, including 1 billion vaccine doses for 92 Low and Middle Income Countries (LMICs). Pricing has also become a crucial issue among LMICs, with vaccines' costs ranging from $5 to $62. COVID-19 vaccines are among the highest ever charged for a vaccine, authors wrote in the study.

"The extensive involvement of public funders in COVID-19 vaccine development provides an opportunity to make these vaccines globally available and affordable," said Kenneth Shadlen, co-author of the study.

"Governments can insist that, as a condition of getting public funding, companies engage in sufficient licensing to enable widespread global production, and they must set affordable prices."

With people's trust in immunization witnessing a sharp decline in many countries, the government will have to tackle the issue before rolling out the COVID-19 vaccine. Over 90 percent of respondents in India and China answered that they would "definitely" or "probably" get the vaccine for novel coronavirus.

But over 40 percent of respondents in France, Lebanon and Serbia said they would "probably not" or "definitely not" get vaccinated for COVID-19.

"Vaccine manufacturers should aim for maximum transparency and scrutiny of their clinical trial data, and post-marketing safety surveillance with compensation schemes for severe adverse events in resource poor countries with poor consumer protection," said Heidi Larson, co-author of the study.

"These factors are vital to build confidence during vaccine roll-out."  

(Cover: Small bottles labeled with a "Vaccine COVID-19" sticker and a medical syringe are seen in this illustration taken taken April 10, 2020. /Reuters)

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