COVID-19 vaccines must go to rich and poor countries, warns advocate

The world will not return to normal until a vaccine against the coronavirus is distributed widely and not just to developed nations, one of the leading vaccine experts said in a wide-ranging interview Wednesday.

Seth Berkley, who heads the vaccine alliance Gavi, said he was encouraged by the pace of scientific progress toward a vaccine, but that he is concerned that wealthy nations may snap up all the available supply, leaving poorer and developing nations to struggle through the pandemic without the proper aid.

Berkley said there is a “humanitarian side” to ensuring all nations have access to a vaccine, but he also characterized it as being in every nation’s self-interest to do so given the spread of the virus around the world from Wuhan, China.

“So I think we need to keep in mind that we’re only safe if everybody is safe,” he said. 

“The idea that a few counties would vaccinate themselves and get the high vaccine coverage and then they would feel safe I don’t think is really right. If the pandemic is raging out of control in other countries, you still won’t go back to normal travel, tourism, commerce. The virus has the potential to mutate if it’s continuing to spread heavily,” he said. “So from a public health point of view, what you want to try to do is tamp down the virus globally, and that means having a vaccine available globally.”

Berkley pointed to the 2009 outbreak of H1N1, or swine flu, a disease public health experts feared had the potential to cause significant death around the globe. That year, just a handful of nations bought up the vast majority of the vaccine stock. If H1N1 had turned into a truly deadly pandemic, developing nations would have suffered steep losses.

“That’s really what we’re trying to avoid here, is to make sure we don’t end up in a situation where 10, 15, 20, 30 countries have vaccine and the other 170 countries in the world have none,” Berkley said. “That would not be a good public health situation, as well as an ethical situation.”

Gavi, a public-private partnership that brings together governments from both developed and developing nations, international groups like the World Health Organization, the World Bank and UNICEF, and private entities like the Bill and Melinda Gates Foundation, works to distribute vaccines across the globe. 

It has launched a special alliance called Covax, meant to coordinate and speed development of a coronavirus vaccine by committing to purchase doses from manufacturers. The initiative has drawn interest from 78 higher-income nations and 90 developing and middle-income nations and has raised $600 million so far.

Berkley said initial distribution of a vaccine would be targeted at those most at risk of contracting the virus, front-line health care workers.

In many countries, that would mean vaccinating about 3 percent of the population. As more doses are manufactured, higher-risk populations — seniors, nursing home workers, those who work in meat-packing plants — would all be vaccinated.

The Covax program aims to distribute about 2 billion doses of an eventual vaccine by the end of 2021. Half of the doses would got to low-income nations and half to developed nations. 

“The idea is when you get to about 20 percent of the population, you’ve got enough coverage to dampen down dramatically the pandemic. Now you may want to continue to vaccinate afterwards, but what you’ve basically done is kind of stop that global risk, and we think that is the best way to deal with a global pandemic,” Berkley said.

Berkley and other public health experts have called for an international approach to vaccine development. If too many countries pour too many resources into vaccine candidates that fail, it may hinder the world’s ability to produce a vaccine that eventually succeeds. 

“If every country could do 10 to 15 vaccines, it does increase the probability of success, but then you would very quickly use up all the capacity that’s there. And that’s why a coordinated approach is a more efficient way to work,” he said. “We’d like to have a way for people to have almost an insurance policy, to share risk, to have a large number of approaches that are in the portfolio to maximize the probability of success, to manufacture those at risk, and then to pivot as science moves along to the more promising products.”

While typical vaccine development takes 10 to 15 years, more than 200 vaccine candidates are already in some phase of development, Berkley said, a remarkable pace for a virus that was unknown to science just eight months ago.

“Of course, at the end of the day, we don’t know yet whether any of them are going to work or what percentage of them or which technology is best. We love the idea that initially a thousand flowers are blooming, but we’re going to obviously have to narrow them down over time and work to accelerate the ones that show promise,” Berkley said.

About 25 vaccine candidates are in some form of clinical trials, and five are in phase three trials, the final phase before they would begin the process of regulatory approval. Those phase three trials, happening in China and the United States, will take months, depending on how quickly people enroll and how quickly the data come back.

There are still significant questions to be answered about the virus itself, and how it might respond to a vaccine. Some of the most consequential involve the most basic assumptions scientists have made — that targeting the spike protein, the part of the virus that it uses to bind to human cells and that gives it its crown-like shape, is going to prove effective.

“The current hypothesis is that neutralizing antibodies to those spike proteins will give you protection. We don’t know that definitively, so that’s an important question that’s going to be critical,” Berkley said.

It is not clear, too, whether a vaccine would provide long-term immunity. Someone infected with a different species of coronavirus, which might cause nothing more serious than the common cold, can be vulnerable to reinfection by that same pathogen 10 or 12 months later.

“One of the questions is going to be is there long-term immunity possible from coronavirus vaccines? If the answer is no, that doesn’t make it impossible. What it would mean is that you would need to regularly have booster shots for it,” Berkley said. “The seasonal coronaviruses, which are common cold viruses that people get often in winter, they do not give long-term immunologic protection.”

Only about 10 percent of vaccine candidates that make it to clinical trials actually succeed. But with so many resources being poured into the fight to develop a vaccine, it is possible — if still unlikely — that a successful candidate might emerge before November’s elections.

“It’s certainly possible that we may have a signal by November, but it is certainly not guaranteed,” Berkley said. 

Public health officials are conscious of, and troubled by, the extent to which politics has crept into a health response they believe should be free of partisan influence. Politicization, Berkley said, is helping spread misinformation and undermining confidence even before a vaccine is approved.

“It is absolutely critical that this be driven purely by science, and that’s important because one, if we’re going to have credibility it’s going to be critical,” he said. “We have to remember that vaccines are going to go into large numbers of healthy people, and we need to make sure that we understand these vaccines well.”