The five sins that should not be repeated with the covid-19 vaccine

Since the covid-19 pandemic began it’s impossible not to look back and remember how mankind coped with other great epidemics. For example, that of influenza A in 2008. The expansion of cases around the world, the race for the vaccine, the possible treatments … “Many countries are now worrying about, and doing well, their own citizens. But the The solution is not going to be a national vaccine because the best science comes from all over the world, not from Sweden, France, Spain or the United States alone, “says Seth Berkley, epidemiologist and director of Gavi, the international alliance that immunizes half the children on the planet.

Berkley participated this week in a virtual dialogue with Joe Cerrell, global policy director of the Bill and Melinda Gates Foundation – the second largest donor to the World Health Organization – and Gayle Smith, president of One Campaign, a global organization dedicated to end curable diseases in the most vulnerable parts of the world. These three personalities from the global health world debated what went wrong in the past and what sins to avoid when finding, if any, a vaccine against covid-19.

Born, grow up and reach everyone

In 2009 there was a true global race to acquire the vaccine against influenza A. Spain announced that it would pay 266 million euros to two of the largest pharmaceutical companies to acquire 36 million doses. “Ten years later, we still do not have a global public goods management system. When that vaccine was discovered, a struggle broke out between countries to buy it and unfortunately only the richest countries were able to secure supplies. That is not fair,” says Smith by One Campaign.

In order for countries with lower incomes to play on this global board, specialists suggest different forms of financing that do not involve a huge outlay at once. “It is normal that when an epidemic occurs, you do not instantly have the money to face it. There are financial instruments that ensure good prices for the countries and purchase security for the industry,” says Berkley. The epidemiologist explained that it is a model similar to that of paying a mortgage: “You have the money in advance but you pay it in 20 years.”

Gavi proposes as an idea a project that they started years ago whereby donor countries and foundations commit to finance certain immunization campaigns for a specific period of years. This ensures that governments with less income will be able to continue to supply themselves and that it is profitable for the industry to manufacture doses on a larger scale.

Beyond the borders

The global scientific machinery has been put to work in these months in a way never seen before. Clinical trials of treatments and vaccines number in the hundreds. “We need global leadership to identify and prioritize vaccine candidates. That is not easy. The way it is done traditionally is by applying transparent criteria. This same leadership will be required for the second challenge, which is to ensure equal access, “Berkley details.

“At this time there are not many incentives to guarantee this transparency”, adds Smith. “This may be reasonable in the case of some pharmaceutical research, but in a pandemic, with this level of emergency, a greater exchange of information and sufficient clarity is necessary to know in advance the situation and avoid the kind of fuss that occurred with the influenza A “, adds the expert.

As an example of this global coordination, Berkley recalls that one of the Ebola vaccines was designed at the Canadian Institute of Public Health, passed through an American biotech company, and ended up being manufactured in Germany. “This is how science works,” he says.

If you take a world map and forget for a moment that there are borders, science and epidemiology will tell you how to deploy a vaccine in the smartest way to end the pandemic

An unprecedented deployment

Experts point out that the truly successful vaccine will not be the most effective one, but also the one that can be produced on a large scale. “The important thing is to start thinking about manufacturing costs now. It won’t do any good if we only get to produce a few million doses, ”says Cerrell of the Gates Foundation. Cerrell asks that vaccine companies make a commitment to expand their manufacturing capacity, whichever is the winner in this race.

The European Union wants show off this unit and this Monday inaugurates a world marathon of donations by which countries and organizations around the globe are invited to commit to help reach the goal of 7.5 billion in funding for the fight against the coronavirus. They call it Coronavirus Global Response.

The Gavi alliance supplies around 600 million doses of vaccines per year, many of them in contexts of precariousness, conflict and difficult access. “We must take advantage of the experience we have after having brought the Ebola vaccine in very difficult situations, to places like the Democratic Republic of the Congo. We must now work with the countries to make sure that we can replicate it”, defends Berkley.

The toilets, the first

“If you take a world map and forget for a moment that there are borders, science and epidemiology will tell you how to deploy a vaccine in the smartest way to end the pandemic,” says Smith. “Who would not want to make sure that the people who are essential in the fight against the virus are the first to receive it?”

The health community is, without a doubt, the most affected by this covid-19 crisis. 20% of the cases registered in Spain affect these professionals; in Italy that percentage is 10%; In the United States, the infected reach 3%, and in China it stands at 3.8%. “Health workers are at the top of the list of people who should be immunized, they are the ones most at risk of getting sick, but also the ones who can transmit the disease the most, something that encourages outbreaks to get out of control. Secondly, There would be the rest of the risk groups and finally the general population. But it is necessary to have these conversations before we have the vaccine, “emphasizes Cerrell.

Perhaps, these decisions should not depend only on good will. “As far as I know, there is no legal framework for equitable access. So one of the challenges is how do we establish moral and ethical guidelines and then create a guide on the agreements and investments that must be made,” insists Berkley.

Delay in other immunizations

Since the pandemic was declared, Gavi has already counted delays in 35 vaccination campaigns, which have disastrous results. Unicef ​​has warned that 37 million children may be excluded from immunization for preventable diseases such as measles. Niger declared a polio outbreak a week ago. The confinement and closing of borders causes shortages, the lack of health personnel and that families do not take their children to vaccination centers. “The challenge is to ensure that routine immunization continues during this pandemic, I have no words to explain how important this is,” says Berkley.

“One of the things that was least talked about in the 2014 Ebola outbreak was the increase in measles. I think international organizations like Gavi are going to play a very important role in ensuring that there is streamlining and effectiveness of the time to acquire treatments and vaccines “, defends Cerrel.

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