“If pandemics are microbial wars,
then vaccines are our preferred weapons of mass salvation.”
Tedros, dir. gen. of WHO

The coronavirus has caused the greatest health crisis of the past hundred years. Already 2.4 million people have died and someone dies from COVID-19 every six seconds. Vaccines are the best and only salvation. Without them, the pandemic might well cost up to 30 million lives.[1]

Fortunately, the vaccines are very promising. After most of the over-60s in Israel were vaccinated, the number of hospitalized people in that vulnerable age group has dropped by 40 percent in three weeks. And that number is continuing to drop.

Yet it is still too early to cry victory. It is not at all certain that with vaccines we will be able to beat COVID-19. There is a growing realization that we are not going to eradicate the virus soon or even completely. There are at least three reasons for this: the failure of the market approach, the limitations of the vaccines themselves and the resistance to vaccination.

Market failure

In the West, vaccine production is dominated by a handful of pharmaceutical giants. They monopolize both production and distribution, thus largely determining the pace and extent of global vaccination. In their pursuit of profit, they refuse to scale up their production drastically and sell it to whoever offers the most. They also have every interest in keeping that production completely in their own hands and not sharing their know-how with other potential producers. In short, artificial scarcity is to their benefit.

The result is that delivery in the rich countries is far too slow. But much worse is that there are far too few vaccines for the countries of the South. Rich countries, which account for 16 percent of the world's population, have bought up as much as 60 percent of all vaccines. At the moment, 85 percent of countries have yet to administer the first vaccine. Predictions about this are not easy, but chances are that many people in the poor countries will have to wait until 2023 or 2024.[2]

The latter is not only a problem for the countries of the South. Because the virus knows no borders and we live in a highly connected world, the pandemic will not be overcome anywhere until it has been everywhere. Or in the words of Tedros, the Director General of the World Health Organization (WHO): “To the virus, we are all one herd. To beat it, we must act as one community”.

It is clear to the head of the WHO that this market approach has completely failed and that we are losing the race against time: “Market-driven mechanisms alone are insufficient to achieve the goal of stopping the pandemic by achieving herd immunity with vaccines. Limited supplies and overwhelming demand create winners and losers. Neither is morally or medically acceptable during a pandemic.”

To overcome the artificial scarcity, increase vaccine production and broaden distribution, Tedros proposes to share vaccine manufacturing technology, intellectual property and know-how through the COVID-19 Technology Access Pool, to temporarily lift the patents and to allow and expand cooperation between producers.

According to Tedros, the omnipotence of the pharmaceutical giants must be broken: “The international community cannot allow a handful of actors to dictate the terms or the timeframe for ending the pandemic.” However, the European Commission continues to swear by the course it has followed to date, with Big Pharma calling the shots. It is unfortunately followed in this by conservatives, social democrats and liberals. The masks often fall off at times of crisis, and it is no different now.

Vaccines are not a panacea

The vaccines are great for preventing the severe symptoms of COVID-19 that lead to hospitalization or death. But it is not yet known whether and to what extent they also stop the contagion itself. They will probably reduce the infectivity, but will not really stop it. For example, the AstraZeneca vaccine might reduce transmission by nearly two-thirds. It will take months however, before a definite answer is available to this important question.

That question has become even more important with the new variants. Because they turn out to be up to 50 percent more contagious. In addition, they may even be more deadly. For example, the British variant could possibly cause 30 percent more fatalities. In any case, a small increase in lethality could have a catastrophic effect.

Moreover, the question is whether and to what extent current vaccines protect against the new variants. Recent research shows that the new mutations can lead to vaccine resistance. At least four vaccines[3] have been found to provide less protection against the South African variant, which has already surfaced in 30 countries. In Novavax and Janssen, this is about a 60 percent reduction. For the Brazilian variant, there are increasing indications that some vaccines are less effective in fighting the virus.

Equally worrying is that the new variants may also put people at risk of reinfection.[4]

All of this could indicate that a one-off round of vaccinations will not be enough and that in the future, just like with the flu vaccines, we will have to administer a new vaccine at regular intervals - when dangerous new variants emerge. In the light of the clumsiness and slowness of the current campaign, this is not a very uplifting thought. For the pharmaceutical giants, on the other hand, this sounds like music to their ears: each round of vaccination is good for several tens of billions of dollars. Ka-Ching! Ka-Ching!

Dangerous vaccination hesitancy

A third reason why we risk never being able to eradicate the virus completely is the danger that a significant part of the population will choose not to be vaccinated. Willingness to get vaccinated varies greatly from country to country and it also varies over time. Between August of last year and January this year, the rate of people willing to get vaccinated dropped by 10 to 20 percentage points in many countries, despite the promising results of the vaccines.

Vaccination hesitancy has many causes. A vaccine introduces a substance into your body that you do not always fully understand the working mechanisms of. That scares people. A lot of vaccine doubts also stem from mistrust of the establishment. The corona approach in most Western countries was and is disastrous: despite months of (semi-) lockdowns, the number of deaths per 1,000 inhabitants is tens of times higher than in most Asian countries, which moreover were able to return to a normal life very quickly. This pitiful approach in the West has only increased distrust in governments, which has always been very great anyway. The shameless attitude of the pharmaceutical giants has added to this even more.

Vaccination hesitancy and conspiracy theories spread more easily when people lose faith in the establishment. The doubts are also strongly fueled by the (extreme) right and lavishly spread via social media. Financial motives often play a role in spreading disinformation.^[5] So, you’d better be on your guard.

Be that as it may, with the new variants, a herd immunity of about 80 percent is needed to get the virus down. Only a handful of countries currently reach the 80 percent willingness to get vaccinated mark.[6] Most countries are well below that. And that number could drop even further in the coming months as young people feel less threatened and may therefore be less likely to take the vaccine once it is their turn.

If we stay below the 80 percent threshold, it will possibly cost many lives, among the doubters as well as among other citizens. The challenge of overcoming vaccination hesitancy will be at least as big as that of delivering vaccines around the world on time. And eradicating vaccination hesitancy is not easy.

As The Economist puts it: “fear and uncertainty are easier to foster than trust and confidence, and inaction easier to encourage than action.” And to restore confidence in governments, never mind pharmaceutical giants, a serious turnaround will be required.

A very tough stress test

The combination of market failure, the limitations of existing vaccines, the emergence of new variants, the vaccine doubts and the fact that young people under 18 have not been vaccinated yet means that we may never achieve herd immunity. This group immunity is nevertheless necessary to permanently eradicate the virus.

If we keep muddling on like this, it looks like COVID-19 is going to circulate for years on end and reemerge regularly, with or without dangerous variants. In contrast to many Asian countries, we have not been able to suppress the virus. That inability will cause hundreds of thousands or even millions of unnecessary victims.

The corona crisis is an unrelenting stress test for our social model. The corona approach teaches us a lot about the way our society is organized, what the priorities are, how efficient governance is, etc. It works as a magnifying glass for the bottlenecks we are facing. This stress test invites us to rethink our social model thoroughly. What are we waiting for, or do we prefer continuing to plod on?

(Translation: Dirk Nimmegeers )

Source: https://www.dewereldmorgen.be/artikel/2021/02/15/covid-19-zullen-vaccintwijfel-en-marktfalen-ons-de-das-om-doen/

Footnotes