The COVID 19 vaccine: logistical and ethical considerations

During the past few days, the world has been following the latest developments surrounding a potential vaccine for COVID-19. The news itself is cause for some relief because it means that the end of this pandemic is closer (sort of). In the following months, much of the conversations and analysis will be centered on the vaccine’s distribution, and therefore, on the economic, political, and ethical implications of said process. But first, let’s dive into the science, logistics, and challenging work behind a possible cure. 

According to the head scientist of the World Health Organization, ChAdOx1, being developed by The University of Oxford and Astra Zeneca with U.K. funding is the most advanced COVID-19 vaccine candidate. Phase one and two of the clinical trial took place simultaneously in April in southern England, after checking the safety and immune responses for more than a thousand healthy volunteers between the ages of 18-55. The vaccine is now in the third and final development phase, which involves testing volunteers in Brazil. The next step will be to get the approval of the U.K.’s Medicines and Healthcare products Regulatory Agency (MHRA). The expectation is to conduct the ChAdOx1 clinical study in the U.S. and South Africa, to recruit up to 50,000 volunteers. 

Another candidate is Moderna Inc., a company based in Cambridge, Massachusetts, who is also in a late-stage trial testing the effectiveness of its vaccine. Moderna is positioned to test the response to the vaccine in 30,000 adults who haven’t contracted COVID. It is on track to deliver about 500 million doses a year, and possibly up to 1 billion doses a year, beginning in 2021 (Reuters, 2020). Alongside companies and universities in the U.K. and the U.S., they are also publishing similar results in China. But what does this mean in terms of availability? The BBC reported that the U.K. ordered 100 million doses of the vaccine - bear in mind that the country has 66 million people – however, even if a vaccine is proven effective before the end of the year, it will not be widely available. Healthcare and frontline workers will be prioritized alongside high-risk people due to their age or medical conditions.

“The majority of candidate vaccines fail. If against all the odds, some of this rushed project does work out, then we need to be extra careful about monitoring what happens to those people who get it”

U.K.’s Prime Minister stated: ‘I’m hopeful, I’ve got my fingers crossed, but to say I’m 100% confident we’ll get a vaccine this year, or indeed next year, is, alas, just an exaggeration […] We are not there yet’. As one can see, progress has been made, but the road ahead, or the end of, is not necessarily close. Nonetheless, it is essential to think about that imminent future. For example, once the vaccine is here, how will it be distributed? (Gallagher, 2020)

Bioethicist Ruth Faden, from John Hopkins University, is a member of the World Health Organization’s COVID-19 Vaccine Working Group, comprised of a team of experts from different countries tasked with making recommendations on fair and equitable global access to a vaccine. Faden explains that significant efforts are underway to figure out how private industrial developers can make vaccines available at an affordable price to all countries, particularly low and middle-income countries. She believes that there will be an initial scarce supply of the vaccine and that governments will be scrambling to procure it, and the predictable winners will be the countries that have the resources to purchase the vaccine. 

There is a term called vaccine nationalism, where countries understand their obligations to be primarily, if not exclusively, to their residents. There is an expectation that rich countries with functional production capacity will first meet their own health needs. The question is whether they should ignore the needs of people living in other countries with severe economic constraints? Faden states that, from an ethics perspective, a balance must be struck (Pearce, 2020).

In this regard, it is vital to highlight the role of COVAX, or ACT Accelerator, a global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines. COVAX is co-led by Gavi - an international organization created to improve access to new and underused vaccines for people living in the world’s poorest countries -, the Coalition for Epidemic Preparedness Innovations, and the WHO. Besides accelerating and manufacturing, COVAX aims to guarantee fair and equitable vaccine access for every state. 

According to the WHO, 75 countries have expressed interest in safeguarding their populations and those of other nations by joining COVAX. They would finance the vaccines from their public budgets and partner with up to 90 lower-income countries that could be supported through voluntary donations to Gavi’s COVAX Advance Market Commitment (AMC). The goal of COVAX is to deliver two billion doses of safe, effective vaccines that have made it through regulatory approval and/or WHO prequalification by the end of 2021

These vaccines will be distributed equally to all participating countries, proportional to their populations, initially prioritizing healthcare workers then expanding to cover 20% of participating countries’ people, the most vulnerable 20% according to their description.

Further doses will then be made available based on country need, vulnerability, and COVID-19 threat. It is important to note that the expected success will depend on securing enough funding from governments and commitments from vaccine manufacturers to participate at a scale large enough to deliver a global solution. The formal expressions of interest submitted are non-binding (WHO, 2020). COVAX’s goals are indeed remarkable, given the circumstances, but 20% coverage leaves us wondering what will happen to the remaining 80%. 

As previously stated, new questions will arise in the coming months about capacity, because even in a rich and powerful country like the U.S. that is home to over 300 million people, the logistical task of distributing the vaccine, and everything that it implies, will be - by no means - easy.  

What do you think, what could be the most effective method of distribution? What political, economic, or ethical challenges in the next stage of the pandemic could arise? And most importantly, what are your thoughts and questions about all the logistical efforts necessary to tackle a health issue of this magnitude? Please let me know in the comment section. 

For more information, visit: 

Damasio, K. (2020). Oxford vaccine final phase of COVID-19 trials. Here’s what happens now. Available on: https://www.nationalgeographic.com/science/2020/07/oxford-vaccine-enters-final-phase-of-covid-19-trials-in-brazil-cvd/

Gallagher, J. (2020). Coronavirus: Oxford vaccine triggers immune responses. Available on: https://www.bbc.com/news/uk-53469839 

Pearce, K. (2020). Distributing a COVID-19 vaccine raises complex ethical issues. Available on: https://hub.jhu.edu/2020/07/01/covid-vaccine-ethics-faden/

Reuters (2020). Moderna’s COVID-19 vaccine candidate moves into late-stage trial. Available on: https://www.aljazeera.com/ajimpact/moderna-covid-19-vaccine-candidate-moves-late-stage-trial-200727143207589.html

WHO (2020). More than 150 countries engaged in COVID-19 vaccine global access facility. Available on: https://www.who.int/news-room/detail/15-07-2020-more-than-150-countries-engaged-in-covid-19-vaccine-global-access-facility