First, life might not be fully back to normal until an effective vaccine is developed, produced in mass quantities and distributed throughout the world. Anything but a cautious reopening of the economy in the meantime is likely to cause a significant second wave outbreak and renewed physical distance. There is no substitute for herd immunity.
Second, despite recent scientific advances and heroic efforts to accelerate vaccines to the market, the 12 to 18 months that public health officials continue to refer to are aspirations rather than certainty. Private companies and government laboratories are in a hurry to put vaccine candidates into trials, but there is no guarantee that they will prove safe, effective and easily measured. The world has not made the long-term investment needed for a pandemic ready vaccine.
Emergency funding, hard work, and ingenuity can produce vaccines relatively quickly. But the amount of uncertainty in the outcome and the number of deaths that will increase even in the best case scenario shows the need for a far more ambitious intervention.
Making vaccines is difficult and expensive at the best of times. It usually takes years to bring a candidate to market. On top of scientific difficulties, vaccines must clean up very high safety bars: Unlike other treatments, this vaccine is given to healthy people in large numbers. Any significant side effects can have disastrous consequences, and lengthy and careful testing is needed to avoid danger. According to one estimate, getting one epidemic infectious disease vaccine from the preclinical stage to a large-scale testing fee was between $ 319 million and $ 469 million.
These costs and risks are increasing in a pandemic, because there is no time for the usual long and careful processes. Researchers are still trying to find out what animals will be used to test potential vaccines, for example, but preclinical testing, dose selection and human trials are ongoing at warp speed in dozens of laboratories. That increases the chance of errors that might not be caught until later. To have something available at a reasonable timeline, production capacity must be built before efficacy and safety are confirmed. Seeing on the other side of this very expensive process is a series of abject market failures. A long vaccine timeline means that epidemics often go out, leaving no demand for products. That is not possible in this case, but companies that jumped into the challenge of developing the SARS and Zika vaccines saw their commitment and funding dry up and their work languished. In testimony at the Congress in March, Peter Hotez, a Texas-based researcher, described that he could not find public or private funds to bring the promising SARS vaccine to the trial once the disease transmission stopped. He is not alone, and as a result, the world does not have valuable insights about vaccines for the similar corona virus.
Even if an effective vaccine appears on time, there is no guarantee of a refund, let alone making money. In many cases, infectious diseases occur in developing countries with limited ability to pay. Covid-19 is a rare exception that also damages rich countries. But that does not guarantee returns. The German Parliament has recently expanded the powers that allow the government to suspend patents in response to the crisis; Emergency law in Canada allows the same thing. If the country does not like vaccine prices or sufficient amounts are not available, they will only make it themselves.
It is very encouraging that even with this challenging background, there are already more than a dozen vaccine candidates in development. That variation must increase the chance of at least one success. However, some migrants have succeeded in developing and scaling up global vaccines, and no one has done so for new pathogens within 18 months.
The world needs far more sophisticated efforts to create incentives and make companies invest in the face of significant risks.
An important step in that direction would be to offer a top prize, or purchase order that is guaranteed to be better yet generous, for the Covid-19 vaccine that meets reasonable efficacy and safety standards. Guaranteed payments help reduce concerns about confiscation of intellectual property and commercial viability. Prizes have been suggested and offered in the past, but big problems require greater incentives.
The Center for Global Development recently published an attentive report noting that there must be an appreciation for better and slower choices that advance science. This will encourage continued investment and hedging against final stage failures. Any rewards must also include a value rating: the safer and better vaccine, the greater the prize. Ideally, this would be an international effort, increasing the size and sustainability of prizes while reducing the financial burden.
However, getting a decent vaccine is only the first step. Manufacturing and distribution will require other coordinated open source international efforts. Creating substantial production capacity for candidates who use different and sometimes new technologies – some of which are likely to fail – will be a very expensive endeavor. Choosing the wrong winner or waiting too long will have unacceptable consequences. This is the definition of a global scale project and public goods.
Leaving manufacturing to individual countries or companies is likely to cause shortages and uneven distribution. It’s too easy to imagine rich countries with severe vaccinations as poor countries with greater needs and weaker health systems waiting. Large, coordinated investment in adapting existing production capacity and creating new lines will solve some of the problems. The CDG report suggests making a gift on the condition that low-cost licensing be granted to low-income countries.
These steps must be done faster than slow – anything to get the vaccine to market faster. There will also be long-term benefits; Covid-19 vaccine’s collective support can serve as a basis for better long-term disease preparation. The world needs a financing system that plays a consistent role from discovery to manufacturing and allocation. In the current crisis, groups such as the World Health Organization and the Coalition for Innovation Epidemic Preparedness can manage these programs and make them run fast. In the long run, a new global body must be formed to dedicate attention and fund the needs needed in this matter. More established organizations and permanent reward systems must create demand that is stable enough to encourage companies to invest in infectious diseases as a business proposition, not as a charity.
Such a system will also create a better environment for what is called a vaccine platform, a technology that allows the manufacture of vaccines for many pathogens through the same basic formula. Newer approaches, such as the mRNA vaccine that is being developed by Moderna Therapeutics Inc., offer the potential for a faster response than might have happened in previous epidemics. But this effort is still untested, especially under conditions of rapid response. The possibility of years of ongoing support is needed to get a new platform to the point where they can quickly deliver a safe and effective vaccine.
The new vaccine development paradigm will not appear overnight. But the current crisis is an opportunity to start a much needed improvement.
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