Viral variants and vaccine nationalism pose two-pronged threat to Covid victory
Even before the appearance of a number of worrisome variants threw a spanner into the works of the world's coronavirus vaccine rollout, the free-for-all in which wealthy countries snapped up enough doses to inoculate their populations several times over, while some developing nations have yet to administer a single shot, had been dubbed a "catastrophic moral failure".
Faced with variants believed to be deadlier, more contagious, and more resistant to first-generation vaccines, it's clear that nationalistic vaccine deployment is not just an ethical disaster, but a global health risk as well. Any country's lack of sufficient vaccines increases the risk of dangerous new variants surfacing, jeopardizing the entire global enterprise. It will take concerted political will to increase the pace of global vaccination – along with second-generation vaccines that solve the logistical problems hamstringing distribution, storage, and deployment – to definitively end the COVID-19 pandemic.
Me-first approach leaves public health last
Sadly, knee-jerk nationalism has characterized many wealthier countries' approaches to vaccine distribution. Out of over 90 million people vaccinated by the end of January 2021, a mere 25 were in sub-Saharan Africa—a region home to around one billion people. Even leaving aside the moral implications of 14% of the global population cornering 53% of the supply of vaccines, this inequitable distribution could have a devastating effect on global efforts to control the coronavirus. Places, where the virus continues to spread unchecked, will serve as reservoirs for dangerous new variants, as has already occurred— most notably in South Africa and Brazil. While most available vaccines are still able to neutralize existing variants, experts have warned that unless the virus's spread is quickly curtailed around the world, the disease will eventually evolve into forms against which first-generation vaccines are no longer effective.
Compounding this public health fallout, experts estimate that failure to equip low- and middle-income countries (LMICs) with the vaccines they need could entail cumulative costs of up to $9.2 trillion, with almost half of that financial burden falling on the very same countries which are now stockpiling vaccines. Initiatives like the Covax scheme will be instrumental in avoiding this nightmare scenario, but the project requires significant investment to secure vaccines and to build the infrastructure necessary to distribute them effectively.
Second-generation vaccines crucial to overcoming logistical challenges
Indeed, infrastructural challenges pose a particular obstacle to vanquishing Covid worldwide. Even if Covax is able to get hold of the two billion doses it has targeted by the end of the year, putting them in the right hands is a tricky challenge in countries without adequate cold chains and other facilities. The Pfizer and Moderna vaccines, for example, are highly effective and have formed the backbone of the US's successful vaccine rollout—but are transported under conditions that would be impossible for many regions around the world.
The AstraZeneca jab appeared to be a viable solution to these dilemmas. Given its affordability, accessibility, and relatively modest refrigeration requirements, the Oxford-developed vaccine made up the vast majority of deliveries in the Covax scheme's first wave. Growing fears that the vaccine may be linked to rare blood clots, however, may have struck a death blow to AstraZeneca's chances of underpinning the developing world's vaccination drive.
Much of Europe temporarily paused AstraZeneca's rollout, shaking confidence in that particular jab even beyond European shores. The fact that risks appear particularly acute in young people—the UK recently recommended under-30s be offered an alternative jab, while a number of EU countries are restricting AstraZeneca to above-60s—is a particular problem. In Africa, where 70% of people are under 30, many are now distrustful of a shot that Europeans themselves rejected. "Why should I allow it to be used on me? Are we not human beings like those in Europe?" one Ugandan asked journalists. This kind of public apprehension could be deadly in the global campaign to contain the virus, especially since less than one-third of LMICs have strategies in place for combatting misinformation about vaccine efficacy and associated risks.
Fortunately, several forward-thinking companies are already working on the second generation of Covid vaccines – shelf-stable products which could be used to decrease vaccine inequality around the globe and provide booster shots for already-vaccinated populations. Massachusetts-based firm Akston Biosciences, for example, has developed AKS-452, a recombinant subunit candidate which is easy to transport, shelf-stable for weeks at up to 37°C, and inexpensive to produce.
Following encouraging results in preclinical animal trials, more than 1500 people have already registered for human trials of AKS-452 at the University Medical Center Groningen (UMCG) in the Netherlands, amidst high hopes that the vaccine candidate could prove pivotal both in narrowing gaps in the global vaccine rollout and in providing booster doses to maintain immunity. As well as dispensing with onerous refrigeration procedures during storage and distribution, this potential game-changer can also be manufactured at scale; a single facility could reportedly generate up to a billion doses of the vaccine per annum.
Collaboration is key
It's hoped that AKS-452 and some 250 other vaccine candidates currently in development (with 82 in the clinical trial stage) could form a formidable second wave of vaccines to help circumnavigate the logistical potholes that have plagued the world's vaccine rollout thus far. Promising options including single-shot jabs, combined Covid-influenza vaccines and no-needle options could represent the scientific breakthroughs needed to thwart the coronavirus, even as new mutations appear. As noted above, however, effective treatments are only half the battle.
Viable vaccines which are affordable to manufacture and easy to distribute must be accompanied by the political will to ensure the entire planet is protected from the disease as swiftly as possible. The sooner policymakers view other countries not as rivals for the finite supply of vaccines but as partners in the fight against the virus, the sooner we can prioritize the containment of the disease in areas it is most rampant, reduce its ability to mutate and turn the page on the pandemic.
(Disclaimer: Devdiscourse's journalists were not involved in the production of this article. The opinions expressed are the personal views of the author. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)