Putting the vulnerable first could end the pandemic faster

The role of serendipity in science came to the fore yet again when AstraZeneca and the University of Oxford revealed that a dosing error was at the heart of their COVID-19 vaccine candidate being tested as a half-dose followed by a full dose. This regime in fact showed better efficacy than two full doses.

The most oft-quoted example of serendipity is, of course, the discovery of penicillin, which has saved innumerable lives.
And maybe so will AstraZeneca’s vaccine but why did the initial press release not mention this sequence of events and merely present it as if it was a planned dosing regime?

Experts point out that this is the reason why clinical research and trials normally would take a much longer time, precisely so that such errors come to light.

But the breakneck speed of COVID-19 trials is understandable, with the virus showing signs of resurging in waves across all countries.

And clinical trials are just one hurdle in the long journey of a vaccine from lab to clinic.

The next hurdle will be putting a cold chain system in place. While India is lucky to have strong local vaccine manufacturers, a recent study on the requirements for an ideal cold chain for COVID-19 vaccination for low and middle-income countries (LMICs) has some lessons for India.

If high-income countries get vaccines first, it would avoid 33 per cent of preventable deaths, but equitable global distribution would stop 66 per cent of such deaths

The report uses Bangladesh as a case study, which like India, is considered a strong pharma and vaccine manufacturing hub. Its vaccination framework is supported by GAVI, the Vaccine Alliance and the World Health Organisation (WHO), but, like many countries, Bangladesh still lacks the capacity to deliver unprecedented, fast-track mass vaccination. Sound familiar?

And why is ensuring COVID-19 vaccination in LMICs so important? Because if high-income countries get vaccines first, it would avoid 33 per cent of preventable deaths, but equitable global distribution would stop 66 per cent of such deaths. Thus ending this COVID-19 pandemic depends on putting the most vulnerable first in line.

With this strong argument, the study authors also point out that such a cold chain design should also plan for medical waste disposal of PPEs, syringes, vials, etc. As well as ensuring that routine immunisations restart and continue without disruption.

And ensure that the medical refrigerators and cold chain components that are deployed are environmentally sustainable. This would be a tall task because cold chains are by nature energy intensive and rely on planet-warming refrigerants.
With promising trial results from BioNTech/Pfizer, Moderna, AstraZeneca/University of Oxford and the Gamaleya Centre-RFID vaccine, and more candidates due to release results in the next month will we finally be closer to wresting control from this virus?

It is important to realise that there are still many unknowns. It is possible that initial vaccine efficacies of over 90 per cent may fall as more data accumulates.

And it is still too early to take bets on how long immunity from these vaccines (effectiveness) will last. Are we talking months? Or years?

India will have access to the latter two vaccine candidates, with Serum Institute of India (SII) making AstraZeneca’s shot and Dr Reddy’s Laboratories, and most recently Hetero Pharma, collaborating with RFID.

Health officials have assured that India will be AtmaNirbhar for its COVID-19 vaccination campaign, with around 30 vaccine candidates in various stages of development, with front-runners like Bharat BiotechICMR and Zydus Cadila, besides SII, leading the way.

As we mark Express Pharma’s 26th Anniversary, it is a relief to finally end this year on a note of hope. But as annus horibilis 2020 winds down, while we wait our turn to be vaccinated, be sure that masking, hand washing and physical distancing will last into 2021.

Viveka Roychowdhury
Editor, Express Pharma

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