The path to a covid-19 vaccine may be quick, but it will be bumpy

By Edward Carr: deputy editor, The Economist

FOR A WORLD that desperately needs to be vac­cinated against SARS-CoV-2, the virus that causes covid-19, 2021 will be a frustration sandwich—two thick slices of good news, wrapped around a layer of conflict, delay and disappointment. Policymakers should try to make that filling palatable. Many thousands of lives will depend on their efforts.

The first slice of good news is that the next six months will see lots more new vaccines to complement the successful candidate from Pfizer-BioNTech. That is a testament to the power of scientific collaboration. Vaccines used to take 10-20 years to create, but today there are more than 320 projects, including dozens in advanced clinical trials. What’s more, this work is yielding valuable advances in vaccine research, as teams attack the virus from different angles. Some vaccines take the old-fashioned route of using an attenuated virus. Others, like the Pfizer vaccine, are breaking new ground by, for example, priming the immune system using viral genes (see article). Such vaccines are easier to manufacture at scale.

The second slice of good news is that, all being well, by the end of 2021 enough vaccines should be available in sufficient quantities to mean that the spread of covid-19 can be slowed substantially. Vaccines may also protect infected people by making their symptoms less severe. Covid-19 will not suddenly disappear, but it will start to fade into the background.

In between those layers of good news, however, will be plenty of bad. The wave of winter cases in the northern hemisphere has been severe. And certifying, making, distributing and administering billions of doses of competing vaccines is sure to present problems.

Time saves lives, so regulators are rightly in a hurry to approve vaccines. But Russia and China have given the green light to medicines that are yet to pass through large phase-III trials. Their products may fail to work or cause complications. Vaccines that receive emergency authorisation in the West will need watching too, because they may work differently in different groups, or provide only transient benefits. Expect lots of sniping about regulators cutting corners and lots of theories—many conspiratorial—about why vaccines should be avoided.

Production of several vaccines has started. Pfizer says it will have 50m doses ready by the end of 2020. Even so, scaling up vaccine production will be a mammoth task. The Serum Institute, the world’s largest manufacturer, has warned that there will not be enough doses to inoculate the entire world until 2024 or beyond. Shortages of medical glass, and of the “cold chains” that are needed to keep some vaccines, including Pfizer’s, at -70ºC or even colder, could cause delays. So could a shortage of people trained to administer vaccines. Given that the pandemic cost the world about 8% of GDP in 2020, a reluctance to invest in such things for fear of wasting money would be wantonly short-sighted.

This may hurt
There could be fights among countries. China and Russia are already using vaccine supply as the inoculated arm of their soft power (see article). America and Britain may try to lock in supplies for their own citizens. Many lives are at stake. Modelling by Northeastern University in Boston suggests that if 50 rich countries receive the first 2bn doses of a vaccine that is 80% effective, it will prevent 33% of deaths from covid-19, whereas if the vaccine is distributed according to countries’ population, the share of those saved almost doubles. Such insights are the inspiration behind COVAX, an initiative to ensure equal access.

There may be fights within countries, too. If limited supplies are to save as many as possible, health workers must be vaccinated first, followed by the most vulnerable. In health care, as in other areas, they often find themselves at the back of the queue.

Paradoxically, once the supply is adequate, the problem will switch to rejection by anti-vaxxers and by sceptics worried about rushed certification. Polls have found that a quarter of adults globally would refuse a vaccine. The hope is that, if the vaccines are more than 90% effective, as Pfizer’s seems to be, governments will be able to persuade most people to turn up for a jab.

All this amounts to a daunting agenda for governments. They must communicate clearly about the scientific rationale for approvals and the criteria for distribution. They must invest in supply chains and training, knowing that some spending will be wasted. And they will need to explain to their citizens how the whole world gains if countries work together to distribute vaccines fairly.

Edward Carr: deputy editor, The Economist ■

Correction: Due to an editing error, the word "may" was omitted from the sentence about Chinese and Russian vaccines, wrongly implying that they do not work or cause complications. This was corrected on December 23rd 2020.

This article appeared in the Leaders section of the print edition of The World in 2021 under the headline “Needle and spread”