Countries which are free of Covid-19 would be able to enhance bilateral trade and travel. Borders will only be selectively opened. However, pre-Covid-19 normality will still be quite far away
By Mrinal Roy
The fantastic news announced this month that vaccines developed by three research laboratories namely the pharmaceutical giant Pfizer and its German partner BioNTech, the biotechnology firm Moderna and the University of Oxford have been found to be highly effective in clinical trials have lifted hopes across the world. In the race to find an effective vaccine, there were legitimate apprehensions as to the level of protection provided by Covid-19 vaccines being developed in research laboratories across the world, bearing in mind the scale, dire fallout and death toll of the pandemic in the world.
“When a person is injected with mRNA in a vaccine, their cells use the information in that mRNA to create a coronavirus protein which triggers the patient’s immune system to produce protective antibodies and immune cells. If the Pfizer and Moderna vaccines obtain approval from the US Food and Drug Administration, they will be the first-ever authorized vaccines that use mRNA. It will open the way for the development of a whole range of vaccines against a broad spectrum of viruses…”
On 16 November, Moderna reported that its coronavirus vaccine was found to be 95 percent effective. On 19 November, Pfizer reported that final trial results showed that its vaccine was also 95% effective. On November 23, University of Oxford researchers announced that interim data showed that its vaccine provided 70% protection, but the protection rate may be as high as 90% if the first dose was half the typical dose, with the second booster dose given a month later.
Both the Moderna and Pfizer vaccines also require two doses. Pfizer’s booster shot is given three weeks after the first one whereas Moderna’s second dose is administered four weeks later. Russia has also indicated that a double jab of its Covid-19 vaccine Sputnik V is 95% effective against the virus. There are in addition a wide range of vaccines being developed across the world which are in Phase III clinical trials which means that the vaccine is being given to thousands of people and tested for efficacy and safety.
It must be highlighted that research scientists have used a wide range of innovative pathways to develop a Covid-19 vaccine. This in itself is a gold mine in terms of scientific innovativeness for research scientists. For example, both Pfizer and Moderna vaccines use messenger RNA, or mRNA. When a person is injected with mRNA in a vaccine, their cells use the information in that mRNA to create a coronavirus protein which triggers the patient’s immune system to produce protective antibodies and immune cells.
“Those who continue to irresponsibly clamour for our borders to be opened must remember that Covid-19 positive passengers are detected on almost every incoming flight and are corralled for treatment. One asymptomatic Covid-19 carrier caused the first case of coronavirus infection in the country after months of being Covid-19 free.
If the Pfizer and Moderna vaccines obtain approval from the US Food and Drug Administration, they will be the first-ever authorized vaccines that use mRNA. It will open the way for the development of a whole range of vaccines against a broad spectrum of viruses. However, a major constraint in the distribution of these two vaccines is the storage requirements. The Pfizer vaccine has to be stored in temperatures of minus 70 degrees Celsius, which is colder than winter in Antarctica whereas the Moderna vaccine has to be kept in temperatures of minus 20 Celsius which is more like being stored in a regular freezer. This could hamper the distribution of the vaccine in developing countries not having the required ultra cold temperatures to store the vaccine.
In contrast the Oxford vaccine is claimed to be far cheaper, easier to store and distribute across the world as it requires standard refrigerator storage facilities rather than the ultra-low temperatures required for the Pfizer and Moderna vaccines.
Peer review and safety checks
The world is already scrambling to obtain their share of these vaccines to fight the pandemic in their countries. Governments must however bear in mind that several hurdles need to be crossed before the vaccines are approved for use. All three vaccine companies have to seek regulatory clearance before offering their vaccines to millions of people. The vaccines have to meet required safety standards and be peer reviewed. This is doubly necessary as the research for an effective vaccine has been fast tracked.
In the US, the Food and Drug Administration (FDA) regulators will assess the effectiveness, safety and the conditions and norms of manufacturing of each vaccine to ensure safety. An FDA advisory committee will vote on whether to recommend that the agency approves each vaccine. In the UK, it is the Medicines and Healthcare products Regulatory Agency (MHRA) which is the regulator responsible for assessing the quality, safety and effectiveness of vaccines before they are approved for use in the country.
Creating a vaccine and obtaining approval for its use is only the first step. Its production has to be organized in safe and approved manufacturing conditions to meet demand. As two doses of the vaccines will be needed to be effective, the vaccine producing companies will have to produce some 15 billion doses to meet the total requirements of the world population. It is a race against time to save lives in a context of a resurgence of Covid-19 infection.
In order to measure the time frame of vaccine production, it should be noted that Pfizer has indicated that based on current projections they expect to globally produce up to 50 million vaccine doses in 2020 and up to 1.3 billion doses in 2021. As regards, the University of Oxford vaccine, a minimum of 100 million doses will be available by January 2021 and hundreds of million doses could be ready by the end of February according to the Serum Institute, the manufacturer of the vaccine in India.
The production of 15 billion doses of vaccine and the vaccination of some 7.5 million people in the world could therefore spill into 2022. Hopefully other vaccines will be approved soon which will help boost production and distribution capacities of vaccines in the world. The need for two doses of vaccine per person also means that the number of doses required by each country as well as its costs is doubled. There is also the key question of whether the vaccine gives lifelong immunity.
Long drawn battle
The constraints regarding production and the stringent storage conditions add to the challenges facing the world in its long drawn battle to conjure the pandemic. A rigorous vaccination programme will hopefully free cities, regions and countries from the throes of Covid-19 in stages. Countries which are free of Covid-19 would be able to enhance bilateral trade and travel. Borders will only be selectively opened. However, pre-Covid-19 normality will still be quite far away.
Those who continue to irresponsibly clamour for our borders to be opened must remember that Covid-19 positive passengers are detected on almost every incoming flight and are corralled for treatment. One asymptomatic Covid-19 carrier caused the first case of coronavirus infection in the country after months of being Covid-19 free. It necessitated a vast contact tracing exercise which identified more than 800 persons which had to be tested for coronavirus.
Too many people are yet to realize that the Covid-19 pandemic is an unprecedented crisis which can only be overcome if we do what it takes to first contain and circumscribe the virus rather than persistently try to arbitrate between the economy and the lives of people. People cannot be expendable. The recent resurgence of Covid-19 infection in Europe, in the US, South America and many other countries across the world and the imposition of new lockdowns, curfews, confinement and social distancing rules have caused the world to wake up to the glaring reality that social distancing, strict hygiene rules and the wearing of masks are our best protection against the virus and the most efficient battle plan to contain its spread.
In a context where Mauritius and the world are buckling under the colossal socio-economic costs of the pandemic, the driving leitmotivs must be solidarity and burden sharing. Is it reasonable in such a grim economic context where whole sectors such as the tourism sector and large swathes of economic activity have stopped operating owing to the pandemic to clamour for demands which the country can certainly not afford at this juncture? Can’t such demands be postponed till after the Covid-19 crisis? Is it not also high time for government and politicians to stop leveraging dwindling public funds to gain political mileage in these trying times?
Judicious choice and planning
Vaccinologists have warned that a small proportion of people, representing less than 2% of recipients of the Pfizer and Moderna vaccines developed severe fevers of 39°C to 40°C or suffered other transient side effects such as sore arms and fatigue. These are “unpleasant but not dangerous’. Front-line public health workers should therefore alert people that they may experience a fever that can feel severe but is temporary. Honest sharing of information on the vaccine will help overcome apprehensions regarding vaccination. People must realize that Covid-19 kills at least one in 200 of those it infects. An effective vaccine is basically a robust protection against the virus and a gateway to a normal life.
Each approved vaccine is promoted by its marketing narrative and hype. The choice of a vaccine or vaccines must therefore be a careful exercise based on objective criteria and advice and the findings of due diligence exercises carried out by internationally renowned vaccine regulators and international bodies like COVAX (led by WHO, GAVI and CEPI) which facilitate the equitable access and distribution of approved vaccines to protect people in all countries in particular the people most at risk. It is however important to ensure that unlike the controversies and allegations tainting previous tenders, the procurement of the required quantity of vaccines for the country is carried out in a transparent, accountable and competitive manner so as to judiciously manage dwindling public funds.
It is equally important in anticipation of the availability of vaccines for each country to establish a vaccination plan which gives priority to frontline workers, the elderly and the ailing and covers the rest of the population in a well planned and orderly manner to the satisfaction of one and all.
It is still a long way to go before the world population of some 7.594 billion people is vaccinated by vaccines having a high protection rate. In the meantime, social distancing, strict hygiene rules and the wearing of masks remain our most effective vaccine to protect us. We are still far from being out of the woods. Vaccines are however a big step forward towards seeing a glimmer of light at the end of the tunnel after the trauma and trials of the past year.
* Published in print edition on 27 November 2020