Vaccines: Points to ponder | Sunday Observer

Vaccines: Points to ponder

3 January, 2021

The New Year has begun in the shadow of the Covid-19 pandemic. The world still has a long way to go before Covid-19 can be totally eradicated, if that is possible at all. But there is hope on the horizon in the form of vaccines and even some advanced, though expensive, treatments for those already infected by the virus.

Sri Lanka too has not been spared by the virus. Granted, our infection and death rate is nowhere near those of many developed states, yet the damage caused to the economy and daily life has been immense. The sooner we can see an end to this scourge, the better.

It is in this context that a debate has arisen on procuring a suitable vaccine or vaccines for Sri Lanka. Five vaccines are currently in use worldwide. The vaccines are from Pfizer/BioNTech (US/Germany), Moderna (US), Oxford University/AstraZeneca (UK/Sweden), Gamaleya Institute (Sputnik V, Russia) and Sinopharm/Sinovac (China).

The World Health Organization (WHO) has just granted the COVID-19 mRNA vaccine manufactured by Pfizer/BioNTech its “Emergency Validation”. This is the first vaccine out of the five to be granted the WHO seal of approval. The WHO’s Emergency Use Listing (EUL) opens the door for countries to expedite their own regulatory approval processes to import and administer the vaccine. It also enables UN to procure the vaccine for distribution to countries in need.

“This is a very positive step towards ensuring global access to Covid-19 vaccines. But I want to emphasise the need for an even greater global effort to achieve enough vaccine supply to meet the needs of priority populations everywhere,” says Dr Mariângela Simão, WHO Assistant-Director General for Access to Medicines and Health Products. The good news is that WHO and its partners are working to evaluate the other vaccines that have reached safety and efficacy standards.

Several Opposition parliamentarians have alleged that the Government has no plans to bring down a vaccine. This is simply not true as the Government has already appointed a high-powered committee to look into vaccine procurement. Sri Lanka has already signed on to the UN/WHO COVAX facility which grants free vaccines to around 20 percent of a given country’s population, which, in Sri Lanka’s case is slightly over four million. These vaccines should first be given to those on the frontlines of the battle against Covid-19 – health staffers, Security Forces and Police, other essential workers, followed by those aged over 70 and those who suffer from Non-Communicable Diseases.

Some rational decision-making is, however, called for in procuring a vaccine for the rest of the population and there is no need to rush into a hasty decision. No vaccine has yet been validated for use in children, which leaves our four million schoolchildren out of the equation, at least for the moment. Besides, this is the group that has the highest immunity to the virus judging by current trends. They might have to wait some more time until the vaccines are deemed safe enough to be injected into their arms.

That still leaves 14 million Sri Lankans for whom the Government has to procure a vaccine. The cost is one crucial factor that it has to look at. Another is the cold chain infrastructure needed for vaccine storage and transport. The new mRNA vaccines are undoubtedly expensive especially for emerging economies like ours. At US$ 20 a dose (two doses are needed per person), the Pfizer vaccine will cost around US$ 600 million for 14-15 million people, which is a sum we can ill afford. Moreover, most of our rural hospitals lack the -70 Celsius freezers needed for storing this vaccine. Thus mRNA vaccines (Moderna’s too is an mRNA vaccine) may not be suitable for Sri Lanka from a financial and infrastructure perspective.

On the other hand, the Oxford vaccine, granted approval in the UK this week, costs only US$ 3 per dose. It can also be stored in a normal refrigerator which every rural hospital and dispensary has. This particular vaccine will cost only around US$ 100 million for 14 million people, even allowing for extra stocks to account for spoils. This is a far more affordable sum. In any case, wholesale purchases attract a discount from the manufacturers. The vaccines from Russia and China too are likely to be similarly priced. We might even be able to wait until a single dose vaccine comes along – from Johnson and Johnson and from several other manufacturers, although pricing remains unknown. It would be logistically less challenging too.

Thus the committee has to consider all these pros and cons before giving the go-ahead for a vaccine. Sri Lanka has often been cited as an immunisation success story which has already eliminated several diseases through inoculation and good health practices made possible by its free healthcare system. Thus unlike in other countries, the authorities will not encounter any vaccine hesitancy here.

But inoculating 22 million Sri Lankans (if the school-going population too is included) is not an easy task. It is a massive logistical undertaking. Even some advanced economies that targeted 20 million vaccinations (almost nearing our entire population) in two weeks, have barely managed one million jabs. Once a vaccine rollout is approved, countrywide sites should be set up and the entire process should be computerised for easy record keeping. Citizens may also be given an electronic certificate on their smartphones to prove that they have been vaccinated. Let us hope that with the arrival of vaccines on our shores this year, 2022 could be started off on a much better footing.