Covid vaccine distribution has begun in much of the developed world. Politicians, commentators and citizens criticize the slow start to immunizations. But like the Tour de France: What counts is not who wears the yellow jersey during the first stage, but who crosses the finish line first at the end. Three factors are crucial to that: vaccine supply, vaccine distribution and, most importantly, vaccination acceptance.
Did the EU back the wrong horse with AstraZeneca?
The CEO of BioNTech has criticized the EU’s approach to focus on as many vaccines as possible rather than the most promising while ordering in summer 2020. Ex post, this statement may be correct, but in terms of Pfizer/BioNTech vaccines ordered per capita, the EU at 0.33 is actually just ahead of the U.S. and the U.K. at about 0.30. In any case, to achieve the herd immunity goal (about 0.75 vaccines per capita), other vaccine candidates are needed. Moderna’s vaccine has been licensed in the EU these days (per capita EU: 0.18 USA: 0.30). Approval is still pending for AstraZeneca’s vaccine, which has already been approved in India and the United Kingdom. The efficacy has been questioned due to inaccuracies in study design (per capita EU: 0.44 USA: 0.75). For the EU, however, the results of the phase 3 studies of the vaccines from Johnson&Johnson (per capita EU: 0.44 USA: 0.30) and CureVac (per capita EU: 0.25 USA: 0), which are expected for the end of January and the end of February, respectively, are likely to be decisive. Both vaccines have provided more robust results in Phase 1/2 trials than AstraZeneca and are storable in simple refrigerators.
The “Moderna Spritzer” – a questionable idea
In the U.S. the plan was to immunize up to 20% of the population each month from the time Pfizer’s and Moderna’s two mRNA vaccines were approved. This goal was ambitious from the outset, considering that during the 2009 swine flu pandemic, only about 10% of the population could be immunized each month. That with a single-dose vaccine that was much easier to store. Administering the two doses about a month apart turned out to be an administrative bottleneck. While initially the second shot of the vaccine was “reserved” when the first shot was administered to ensure that it would be available in a month’s time, the move is now to inject all available doses as soon as possible. More controversial is the idea of diluting Moderna’s vaccine to vaccinate even more people more quickly. Although the results of the Phase 2 trial of the vaccine suggest that it would be nearly as effective at a lower dose, at least in 18-55 year olds, there is disagreement in scientific circles about whether the measure makes sense. There are voices that would welcome this, while others speak of incalculable risks should SARS-CoV2 develop resistance to weak vaccines.
Vaccine fear and vaccine envy
Ultimately, any debate about availability and speed is futile if a recalcitrant minority of the population refuses vaccination. Since there will be no approved vaccines for children and adolescents under 16 years of age in the foreseeable future and this group represents about 15% of the population, 12% of strict vaccination opponents in the rest of the population are sufficient to make herd immunity impossible. Given this, the extent to which a vaccination campaign can succeed without some form of direct or indirect coercion is an open question. At the other end of the social spectrum envy debates are increasingly occurring when it comes to prioritization in access to vaccines. In all respects governments around the world will be challenged more than ever in the coming months to take the right actions to bring the pandemic to a swift end. While the logistical supply of vaccines may play a larger role in the beginning, it will take a whole-of-society effort to cross the finish line in the yellow jersey.
Prognoses are no reliable indicator for future performance.