The COVID-19 pandemic has set off a global pharmaceutical arms race, with more than 170 research teams vying to be the first to create a vaccine.
Seven of those trials are reported to be in the final phase of testing.
In the US, public health officials are confidently predicting that they are on track to deliver millions of doses by January next year.
But, for many countries, the discovery of a safe and effective vaccine is likely to be just the beginning of the matter.
Ramping up production to required levels, global competition for supplies and convincing sufficient numbers of people to take it are all challenges that could delay the impact of any scientific breakthrough.
Cayman’s Chief Medical Officer Dr. John Lee warns that the discovery of a vaccine will not provide an immediate and total solution to the problems posed by COVID-19.
Social distancing, hand washing and restrictions on movement are likely to be on the scene for some time.
The effectiveness of a vaccine, he said, was dependent on both its efficacy and a large percentage of the global population being willing and able to take it.
“Until successfully widespread global vaccination is possible, we will not be able to go back to a ‘pre-COVID-19’ freedom, so a new normal will be with us for some time,” he said.
“However, the light at the end of the tunnel will be getting a lot brighter when vaccines enter the scene, and I think we’ll all feel a huge sense of relief.”
Scramble for access
Across the world, governments are sponsoring research and advance-ordering doses of vaccines that have yet to be approved for public use.
At least 5.7 billion doses of various vaccines, still in clinical trials, have been pre-ordered around the world, according to media reports.
For the Cayman Islands, access will largely depend on its relationship with the UK, though there is potential that additional doses could be procured through the Pan-American Health Organization.
Cayman’s global reach and capacity have been demonstrated previously in the pandemic, with the islands pulling off an improbable deal to procure 200,000 COVID test kits at the outset of the crisis.
In an emailed response to questions from the Cayman Compass, Matthew Forbes, head of the Governor’s Office in Cayman, said, “The UK Department of Health has agreed that the Overseas Territories will be guaranteed a proportionate allocation of any vaccine produced in the UK or procured by the UK from elsewhere.
“At the same time, Public Health England are talking to PAHO to ensure the Caribbean Overseas Territories have access to any vaccine PAHO rolls out.”
The UK has reportedly pre-ordered a stockpile of 340 million vaccine doses from various research groups.
There remains uncertainty, however, not only over the likelihood of those vaccines to prove safe and effective, but also over the ability of drug manufacturers to mass-produce them on the required scale.
Who gets priority access to the first vaccines off the production line could depend, to an extent, on the state of the pharmaceutical production capacity within its borders.
The US has invested heavily, through a project known as Operation Warp Speed, in both research and development of vaccines.
According to a report in the Massachusetts Institute of Technology Review, many European countries, by conrast, have sold off or shuttered manufacturing centres and let national expertise disappear.
“An ample supply of a COVID vaccine could become a coin of geopolitical power, as oil and nuclear weapons are now. Governments will be counting on it to allow them to reopen economies and assure political stability,” according to the magazine.
“Alliances are already shifting, with leverage going to countries that can create vaccines, test them, manufacture bulk ingredients, and perform the ‘fill and finish’ bottling. The rest of the world apprehensively watches, fearful of being left defenseless against the deadly pandemic.”
Global vaccination needed
The non-profit Gavi Vaccine Alliance, which is based in Geneva and buys vaccines for poor countries, is raising $2 billion to make its own pre-purchase agreements for COVID-19 immunisations so that everyone will get supplies at the same time, the article stated.
“We saw a danger that vaccines would get snapped up by wealthy countries, and there would be no vaccines for the rest of the world,” Gavi CEO Seth Berkley told the magazine.
“I understand national governments trying to protect their citizens … but the issue is that you are not safe unless everyone is safe,” he said.
“If epidemics are raging in the rest of the world, you can’t go back to normal, you can’t travel, you can’t do tourism. You are not going to get the reprieve from the economic crisis.”
In that context, Lee suggested, Cayman could be dealing with the impacts of the virus on its economy and way of life for some time after a vaccine is discovered.
“You need to vaccinate large percentages of the population in order to get rid of a disease so it can’t jump from one susceptible person to the next and therefore continue to survive. That’s a global problem, not just a Cayman one,” he said.
“If you don’t manage to vaccinate large numbers of the world population, then COVID-19… can still infect people wherever they might be.”
Another key variable is the ultimate effectiveness of the vaccine. No immunisation is 100% effective.
The seasonal flu vaccine, for example, is around 65% effective. The smallpox vaccine is 95% effective.
Combine a partially effective vaccine with limitations on access and you quickly see that it may not be a total solution for COVID-19.
Lee said there were a number of variables to consider.
“Think of the case of a vaccine which is 70% effective and you only manage to vaccinate 50% of your population. How many people does that mean are still susceptible?
“And who do you choose to vaccinate? The answer to the latter is relatively easy, as I believe you should vaccinate those who are most vulnerable first, as well as those who are most likely to be in contact with those vulnerable,” he said.