Three promising vaccines: What next?

In the past few weeks, we have heard uplifting news about three promising candidate vaccines against SARS-COV-2. These candidate vaccines have been optimistically announced as effective against the novel coronavirus. The first vaccine candidate to be announced was by BioNTech-Pfizer followed by America’s Moderna. This enthuthiasm was not only seen in scientists and leaders around the world, the stock markets of these pharmaceutical companies also increased dramatically including stocks of blue-chip companies.

A few days later, a third candidate vaccine developed by AstraZeneca-Oxford University was said to protect 70 percent of volunteers against the virus. This protection could increase to ninety percent if the dosages were tweaked at the first and second doses. Vaccines only need to give fifty percent protection for approval. To give ninety percent protection, the first dose must be given at half dose while the second dose will be given at a full dose. The Moderna vaccine gave almost a 95 percent protection while the BioNTech-Pfizer vaccine gave a 95 percent protection. Surprisingly, in early November when BioNTech-Pfizer announced the percentage of volunteers protected by its vaccine, it gave it as 90 percent. Following Moderna’s announcement some days later, it now said its vaccine gave a protection of 95 percent.

The precursors of these three candidate vaccines are seeking for emergency approval from different regulatory bodies that would examine their data and check for adverse effects. Volunteers who took any of the three candidate vaccines did not require hospitalizations even after they developed COVID-19 symptoms. Most importantly, there were no deaths. Not to waste time and to ensure their citizens get adequate supply, several high-income nations have already secured their supply for the three candidate vaccines. The United Kingdom ordered 100 million doses from AstraZeneca-Oxford University, 5 million doses from Moderna and 40 million doses from BioNTech-Pfizer. The European Union has already ordered for 300 million doses from BioNTech-Pfizer. The World Health Organization (WHO) in partnership with other organisations formed a COVAX facility to ensure an equitable distribution of vaccines. One hundred and eighty-nine countries are involved in COVAX. Russia and the USA are not members. Also, Moderna and BioNTech-Pfizer did not join COVAX. AstraZeneca has joined COVAX and has committed to not make profit from the vaccines at least till the pandemic is under control.

It takes a behemoth amount of money to produce and distribute vaccines. So far, 2 billion dollars have been raised by COVAX. One of the objectives of COVAX is to make sure that when vaccines become available, low-income nations are not left bereft. The way it stands, low income countries may not get the vaccines at the same time as the high-income nations. Already, we see the rich nations buying up millions of doses for their populations as was done in previous pandemics. Canada has already pre-ordered vaccine doses that is five times its population. As it is, wealthy nations are reserving billions of vaccine doses. The COVAX facility has also secured hundreds of millions of the AztraZeneca-Oxford University vaccine for low-income nations.

These three candidate vaccines are not the only ones that have reached the third phase of clinical trials. The Russian vaccine named Sputnik V and the Chinese Sinovec Biotech vaccine have also shown some potential and are being given on an emergency basis to essential workers in their respective countries. The Russian vaccine gave 92 percent protection among 16,000 volunteers. Data has not been released on the late stage trial of the Chinese Sinovec Biotech vaccine. AstraZeneca-Oxford University recruited 23,000 volunteers while BioNTech-Pfizer trial involved 41,000 volunteers and the Moderna trial included 30,000 people. All these trials are all still ongoing.

What next? The global race for vaccine is nearing the finishing line. There’s light at the end of the tunnel. Can the vaccines be distributed fairly especially to low income countries? If the vaccines have been produced, how do we maintain the cold chain from manufacturer to consumer? Are people generally willing to take the vaccines? If you’ve already had COVID-19, do you still need to get vaccinated? How do you deal with vaccine misinformation and conspiracy theories? If they do get the vaccines, how long will immunity last?

Preliminary results have shown that the volunteers who got the vaccines, presented with less severe symptoms but only time will tell if they can spread the virus. If you’ve already had COVID-19, you should still get vaccinated because we don’t really know how long your antibodies from a previous infection will last, so getting vaccinated strengthens your antibody build-up. And only time will tell how long the immunity from the vaccine will last. With a global population of 7.8 billion people, can pharmaceutical companies make enough doses considering they still have to manufacture the standard vaccines for all the other hitherto immunizable diseases? The three promising candidate vaccines are given in two doses. How many cargo planes will be needed to transport the vaccines to the countries needed? Eight thousand Boeing747s will be needed to transport the vaccines around the world.

The first two candidate vaccines announced in November; BioNTech-Pfizer and Moderna are using a messenger RNA vaccine type. There are other types of vaccine types which I discussed in my Guardian article on “Bringing COVID-19 Vaccine to the World; a Race of Prowess.”

The messenger RNA type of vaccine being used by Moderna and BioNTech-Pfizer have never been used on humans before. The AstraZeneca-Oxford vaccine is using a more traditional vaccine type; a weakened version of a common cold virus from a chimpanzee. The BioNTech-Pfizer vaccines need special, cold storage facilities of minus 80 degrees Celsius. This means it cannot be given in hospitals, clinics or in primary health care centers because of the logistics of maintaining the cold chain. Germany has purchased several special freezers at 20 thousand Euros each and is preparing a stadium as the location where the people will get vaccinated. Obviously, vaccines that require special freezers cannot be used in African countries especially where electric power supply is anaemic. We also need to think in terms of manpower.

How many nurses, doctors, hospital aides, technicians and security personnel would we need to maintain such a cold chain and to even immunize at a central point assuming we use the BioNTech-Pfizer vaccines? The Moderna vaccine can be stored at minus 20 degrees Celsius for up to six months. After thawing, it can be kept in a standard fridge (2-8 degrees Celsius) for up to a month. The Moderna vaccine is more accessible than the BioNTech-Pfizer vaccines in terms of maintaining the cold chain but AstraZeneca-Oxford University vaccine beats both Moderna and BioNTech-Pfizer vaccines in terms of cold chain and cost. AstraZeneca-Oxford vaccine can be stored at normal fridge temperatures of 2 to 8 degrees Celsius. A dose of the Moderna vaccine is 25 Euros and a dose of the BioNTech-Pfizer vaccine is 23 Euros and a dose of the AstraZeneca-Oxford University vaccine is 3 Euros. AstraZeneca-Oxford vaccine is the choice vaccine for developing countries in terms of cost, cold chain and vaccine type.

The underlying reasons behind the reluctance to take vaccine is fear, vaccine misinformation, conspiracy theories and mistrust of governments. I already discussed conspiracy theories in another article titled, “Of Conspiracy Theories and COVID-19.” Studies have shown that where there’s mistrust of government mingled with fear, conspiracy theories abound. An old conspiracy theory around Bill Gates has resurfaced again; that vaccination is a gimmick intended to inject implants into people so that they can be monitored. It is pointless to argue against such beliefs because foundationally, they have ideologies birthed in fear and mistrust of the government. It would take multiple levels of health education and vaccine campaigning as well as building trust in the government before such people can be dissuaded from their beliefs. Unless the government is transparent, the people cannot trust it. The error of their belief infringes on other people because their non-vaccination can cause a flare up in the disease amongst non-vaccinated people. Another conspiracy theory is that in some European countries, Blacks are being targeted by their general practitioners to get vaccinated. The general population is actually being encouraged to get vaccinated and not just Blacks. However, it is not surprising if Blacks feel this way because though they make up a minor percentage of the population, they have suffered a disproportionately higher fatality during this pandemic.

What can we do? We must understand that even taking water at times can be a risk depending on what’s going on in our bodies; Post surgery, you’re advised not to take even water. However, before deciding to take any vaccine, it is not enough to imbibe information from only the manufacturer. That is letting the manufacturer be the judge and the jury at the same time. Data from the clinical trials are still in the hands of the vaccine manufacturers and are yet to be approved by different regulatory bodies.

Normally, it takes months to get approval from these bodies because they want to wait for at least six months post vaccination to check for adverse reactions. These are not normal times and they can’t wait for six months. Further, the data should be released and made available for consumers to read and digest. Fortunately, as I wrote in another article titled, “Low COVID-19 Numbers: Contextual Questions, Facts,” we have relatively low COVID-19 numbers so we can use the time to ramp up vaccine campaign and continue with social distancing, mask wearing and frequent hand washing. On the Monopoly Board game, there’s a square that warns players, “Do Not Pass Go! Do Not Collect $200!” At this point, Nigeria should not pass the “go” until she has read the full, transparent data on any of the vaccines that would be brought into the country.

Obilade, a medical doctor and an Associate Professor of Public Health, wrote from Abuja.