In less than a year of sequencing the SARS-CoV-2 genome, multiple pharmaceutical companies have successfully developed vaccine candidates. The World Health Organization has tracked a total of 235 vaccine projects – and counting (WHO, 2021a). Vaccines are one of the many ways to help mitigate the impacts of the on-going COVID-19 pandemic, by decreasing the incidence of new cases and helping to curb the waves of infections that overwhelm the healthy functioning of societies.
The success of a technology is determined not only by the efficacy of the science underpinning the vaccine but also by social determinants influencing the delivery of the vaccine itself. This pandemic is testing our societal structures more than ever before and non-medical factors present a multitude of challenges to effectively implementing COVID-19 vaccines globally. Vaccine hesitancy, manufacturing and logistics, and the pharmaceutical marketplace unveil but a few of the difficulties in vaccine delivery that need to be overcome in order to curtail the on-going pandemic.
Vaccine hesitancy is the reluctance or refusal to have yourself or those you are liable for, such as your children, vaccinated (WHO, 2019). Vaccine hesitancy has been an ongoing challenge even prior to the emergence of SARS-CoV-2, with the World Health Organization identifying vaccine hesitancy as one of the top ten global health threats of 2019 (WHO, 2019). The success of immunization is dependent in part by reaching herd immunity. Herd immunity differs from disease-to-disease but it is when the vast majority of the population uptakes a given vaccine (Mallory et al., 2018; Smith, 2017). Herd immunity is important as it reduces the transmission of disease and minimises the risk of disease spreading in vulnerable populations, such as those who are yet to be vaccinated or those who are immunocompromised and so cannot be vaccinated (Mallory et al., 2018).
When taking a closer look at vaccine hesitancy in the United Kingdom, there is recent evidence from the Oxford Coronavirus Explanations, Attitudes, and Narratives Survey (OCEANS) to suggest that continued hesitancy may impede the threshold of herd immunity from being achieved with the COVID-19 vaccines. Despite a substantial majority of 72% being found in favour of vaccinating against COVID-19, 16% were very unsure and 12% were outright opposed to it. A key feature of hesitancy found in this survey was the concern of the speed in which the vaccines have been developed and whether this has comprised safety. In light of this, it is imperative for public institutions, health professionals and science communicators to responsibly and accurately report on vaccine development. Otherwise the growing erosion of trust in science, experts and public institutions amongst the general public will continue to threaten the health of populations.
Manufacturing and Logistics
Developing an effective vaccine candidate is a great feat in and of itself, but only part of the challenge. Ensuring that there are the manufacturing facilities to meet the high demand as well as the infrastructure in place to distribute the vaccines is vital. Out of the vaccines that have been approved by the USA and EU, Pfizer-BioNtech (2021) boldly intends to manufacture a total of 2 billion doses by the end of 2021 whereas Moderna (2021) has promised 2.6 billion doses. Acquiring the facilities that can produce the sheer amount of doses as quickly as possible is a huge challenge, let alone maintaining these manufacturing facilities and accurately predicting productivity.
Moderna, Pfizer-BioNtech, and AstraZeneca-Oxford have all experienced disruptions in their manufacturing plants that have led to delays and restrictions in rolling out their vaccines across Europe (Deutsche Welle, 2021; Pharmaceutical Technology, 2021). This presents a logistical nightmare for healthcare administrators, as this lack of reliability implicates the design and implementation of effective vaccination schemes; schemes that are of a scale that as of yet have never been attempted. There are a lot of unknowns that healthcare administrators have to account for especially when coordinating with multiple actors; preparing for the ‘perhaps’ presents monumental challenges to healthcare delivery systems the world over.
The Pharmaceutical Marketplace
The pandemic is a global health problem and necessitates equitability distribution of preventative measures and treatments around the world – lest we succumb to the perpetual rise of mutated variants. Not only is having a pay-wall for vaccines morally reprehensible but when large numbers of people are left unvaccinated disease can spread amongst them and evolve (Smith, 2017). The continued evolution of the SARS-CoV-2 virus may lead to mutations that differ so vastly from the initial structure that the currently available vaccines may be rendered ineffective. Although current vaccine candidates are thought to still be effective against the present mutations that have arisen, this does not guarantee protection further down the road when virus evolution is left unbridled (WHO, 2021b). It is pivotal for the paywalls put in place of pharmaceutical giants to be fervently counteracted.
Both Pfizer-BioNTech and Moderna have for-profit business models. The cost of their vaccines is determined by price negotiations that countries or economically tied regions, like the European Union, enter into. These negotiations reflect a pharmaceutical marketplace that places capital and profits over the health and livelihoods of the global population and increases the time taken to deliver vaccines. In addition, the vaccines from both Moderna and Pfizer-BioNTech involve storage at -70 degrees Celsius due to the mRNA component. This is not only a physically difficult requirement but also an expensive one, leaving this vaccine further out of reach to poorer countries. Alternatively, AstraZeneca-Oxford coalition has promised their vaccines at a non-for-profit rate as, too, the Johnson and Johnson candidate which is currently in the pipeline.
The Wrap Up
Addressing COVID-19 necessitates the global mobilization of health ministries, regulatory agencies, health professionals, the pharmaceutical industry, and the general public alike to help overcome the many challenges present by the virus. The COVID-19 vaccine candidates, and the ones to come, are a great achievement whose full impact is determined by the extent to which actors successfully address these social determinants. However, it is important to note that vaccines are only one, preventative approach to curbing the ongoing pandemic. As vaccines slowly roll-out worldwide, social distancing, quarantining, wearing a mask, tracking and contact tracing and hygiene practices are still necessary for the imminent future, as well as the pharmaceutical and medical industries in discovering treatment to COVID-19 (WHO, 2021). The 21st century will be, in part, determined by how we learn to collectively coincide with this new virus and structural impediments to realizing health must not go unchallenged.
BioNTech. 2021. Update on vaccine production at BioNTech’s manufacturing site in Marburg | BioNTech. [online] Available at: <https://investors.biontech.de/news-releases/news-release-details/update-vaccine-production-biontechs-manufacturing-site-marburg> [Accessed 25 February 2021].
Deutsche Welle. 2021. Pfizer, BioNTech cut back vaccine deliveries to EU at ‘short notice’ | DW | 15.01.2021. [online] Available at: <https://www.dw.com/en/pfizer-biontech-cut-back-vaccine-deliveries-to-eu-at-short-notice/a-56237275> [Accessed 25 February 2021].
Freeman, D., 2021. COVID-19 vaccine hesitancy in the UK | University of Oxford. [online] Available at: https://www.ox.ac.uk/news/science-blog/covid-19-vaccine-hesitancy-uk [Accessed 25 February 2021].
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Smith, T., 2021. The Unforgiving Math That Stops Epidemics. [online] Scientific American. Available at: <https://www.scientificamerican.com/article/the-unforgiving-math-that-stops-epidemics/> [Accessed 25 February 2021].
World Health Organization. 2019. Ten health issues WHO will tackle this year. [online] Available at: https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019 [Accessed 25 February 2021].
2021a. Draft landscape and tracker of COVID-19 candidate vaccines. [online] Available at: <https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines> [Accessed 25 February 2021].
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