The unspoken challenges of Covid-19 vaccine
Amid the fevered speculation about which Covid-19 vaccine will be successful and when it will hit the market, there has been much less focus on a critical aspect of the equation: ensuring the right people get the right vaccine at the right time.
Failure to do so will allow the virus to remain at large, with those most in need living in low- and middle-income countries likely to lose out.
Countries need to start preparing to distribute a vaccine to the right populations at an unprecedented pace.
Under the WHO ACT-Accelerator framework, countries will initially receive doses for three per cent then 20 per cent of the population, ultimately scaling up to full coverage.
Although more detailed guidance is forthcoming on who the 20 per cent should be, it will be up to individual governments to work out who and where health workers and key at risk populations are.
A lack of robust and comprehensive health information systems will make it difficult for many countries to work this out.
Planning for vaccine distribution and the identification of vulnerable populations needs to be transparent to ensure access is equitable, and that citizens understand who will receive vaccines, and who won’t.
Transparency is also key to ensure access, or lack of, is not used to detriment of marginalised populations, or to foster political patronage — something that we’ve seen happening already in Bangladesh.
Distributing vaccines needs careful preparation and has never been done before at pace presenting an unprecedented global challenge.
The COVAX Facility is designed to ensure there is equitable access to vaccines globally, but the demand is massive.
Complicating things further, most national vaccine distribution systems are designed to ensure that children receive their full immunisation schedule — not for large scale adult vaccination programs.
In addition, cold chain — refrigerated storage required to preserve the vaccine — requirements may also be different for Covid-19 vaccine.
UNICEF and others have begun to work on this, and plan to have 65,000 solar cold-chain fridges in place in lower-income countries by the end of 2021, but more work is needed if vaccines are to reach those in need in remote and difficult to reach locations.
In many such countries the private sector is a or the major provider of healthcare.
Working through who and where best partners for delivering the vaccine will vary from country to country and inevitably pose challenges.
Whilst most vaccines have little street value, initial limited supplies of a Covid-19 vaccine, compounded by a high demand from anxious populations — will make it a target for theft and diversion.
Many countries lack what the WHO considers to be well-functioning and integrated medicines regulatory systems, making it more likely that substandard and falsified vaccines will appear on the market.
The impact of these could be devastating, fueling skepticism and distrust, worsening the pandemic, and ultimately costing lives.
Add to this the real risk that vaccines will become a new weapon with which powerful states attempt to wield geopolitical influence.
Premature approval and deployment of any vaccine risks doing more harm than good, and not just to the recipient — a lack of transparency in the development and approval of vaccines gives room for sceptics to discredit vaccines.
There are many issues still to be resolved in what may shape up to be one of the biggest logistical challenges the world has ever seen. A lot rests on its success. — The writer is head of major projects at Transparency International Health Initiative