Vaccinating the world fairly

Critical to the success of any COVID-19 vaccine programme is going to be forward planning: thinking ahead to a time when we have a safe and effective vaccine that we now need to take to the world population. We need to be making decisions about who and where we’re going to vaccinate, and making sure that the capacity and infrastructure is ready on the ground so there are no delays in the roll-out. Adam Murphy spoke with Orin Levine, director of the global delivery programs at the Bill and Melinda Gates Foundation, which has already committed more that 300 million dollars to the fight to find a COVID vaccine, and then Chris Smith spoke briefly to University of Cambridge vaccine expert Gordon Dougan, about the challenges that lie ahead...

Orin - I have two things that keep me up at night. One is that we don't discover a vaccine in spite of all the effort that we do. And then the second, which is really the part that I'm focused on, is when we get it, how do we get it out there to everybody who needs it as quickly as possible? And success at that is going to require quite a lot of cooperation. It's already requiring the vaccine manufacturers to collaborate and cooperate in ways that we haven't seen before. And that's starting to happen. When that successful collaboration produces a vaccine, then we have to figure out how are we going to allocate the doses that we have, and how are we going to make sure that we've got everything lined up so that the day that the vaccine arrives in a country, is rolling out and getting into people and starts the process of protecting people as quickly as possible. That's going to require a lot. It's going to require communities to have a dialogue about when the vaccine arrives, what's the sequence by which they want to roll those vaccines out. I think there's probably widespread agreement that our healthcare workers are essentially heroes of our time that they go in every day to treat people and take personal risk and to be able to sustain our health in spite of risks that they may be taking to themselves and their own family. And they're probably going to be at the front of the line, but after we vaccinate healthcare workers, where do we go next? Are we going to try to interrupt transmission in hot zones? Are we going to try to put our economies back to work by getting the workforce vaccinated? Are we going to allocate to our most vulnerable people? Because they will suffer the most when an infection comes? These are all the kinds of questions that need to be answered by countries and communities as we get a vaccine and start to roll it out.

Adam - And so that's like the medicine of the vaccine, but how are we globally doing in terms of the infrastructure we need to do that. Like getting places where people can go, and even things like syringes for people, do we have enough of those kinds of things?

Orin - So these are great points, and these are exactly the kinds of things that people are starting to ask questions about and prepare for is, Holy cow, if our dream comes true and it all arrives, are we going to have everything that we need? There are a couple of really, really strong foundations of success that we have to build off of. First of all, the global immunisation program is a strength of global public health. We have experience in setting up campaign-style immunisation. It takes different forms in the UK and the US and places like that, every fall/winter, we essentially prepare for the flu epidemic that's coming and campaign to get people vaccinated against seasonal influenza. In a lot of the parts of the developing world where outbreaks of measles and yellow fever and meningitis still occur, we have a lot of capacity in trying to establish with communities points where people go and get vaccinated on mass, to be able to prevent that. In order to do that, though, we've got to have supplies, the kinds of things that you asked about like syringes, and there's a strong, robust supply system for syringes, but we need to tell them in advance, we're going to need more than we were using next year. The most important part though, is going to be making sure that health workers feel comfortable, feel safe, feel protected, going to deliver services. And that communities trust that the healthcare workers that they're being served by are going to be safe and protect them, and that the vaccine that they're getting has been rigorously evaluated and is the right vaccine for them. And so we're not only working the supplies of syringes and healthcare workers. We've also got to work, to prepare communities, to be ready to receive the vaccine. And that is a big, big piece of work for us and needs to start urgently.

Adam - Even everything going smoothly, vaccinating an entire planet of people is still like a Herculean task. So what kind of timeline do you think we could be looking at to get people vaccinated?

Orin - Well, it's hard to know exactly when we'll get the first vaccine, because there's so much science that's going on right now. And there's so much uncertainty each day that we do a little bit more science, we learn a little bit more. My suspicion is that the best case scenario is early 2021, that we're looking for a vaccine being licensed and available. But one of the things we've learned is it's really important to start planning immediately. And so we're going to start planning for success today, begin that dialogue around what will it take when a vaccine arrives to make sure that it's equitably distributed, safely delivered, and delivered at scale to everybody who needs it.

Adam - And then just lastly, if there was anything you wanted people listening to take away from this kind of work and the work you're doing with the Gates foundation here, what would it be? What would you want them to know?

Orin - I guess I'd want them to know probably two things. One is in my experience, I've never seen such a collaborative, coordinated, global effort to try and help humanity out of a jam. The intentions of a huge universe, a huge enterprise of people right now dedicated to trying to discover and make a vaccine safe, efficacious, and available is really a heroic undertaking. And trust them, they're about it for the right reasons and really going above and beyond to try and help the world right now.

Chris - Hear hear, couldn't put it better myself, Orin Levine there. And one of those experts who is trying to develop a vaccine and help the world, he's with us at the moment, that's Cambridge based, vaccinologist Gordon Dougan. Gordon in the program this week, we've highlighted a number the constraints and the hurdles that we need to overcome to try to achieve an effective Covid vaccine. But what in your view do we absolutely need to make sure we prioritise to make sure this happens and make sure we don't drop the ball?

Gordon - I think that the biggest challenge, and Orin hinted at it, is that we need to be able to measure the protection, the ability of the vaccine to protect. It's a bit of a race against time. As we drop down the level of virus in the community, the chances of getting a measure of protection are diminished. So that's one of the biggest hurdles and challenges that we have to face. Can we prove the vaccine is protective?