The Road to Global COVID-19 Vaccination Will Be Rife With Risks and Setbacks
6 MINS READ
Jan 7, 2021 | 23:00 GMT
A pharmacist receives her first dose of the Pfizer COVID-19 vaccine in Miramar, Florida, on Dec. 14, 2020.
A pharmacist receives her first dose of the Pfizer COVID-19 vaccine in Miramar, Florida, on Dec. 14, 2020.
(Joe Raedle/Getty Images)
HIGHLIGHTS
The United States and Europe will overcome the slow and problematic rollout of COVID vaccination campaigns in the coming months, but concerns about new strains of the virus will likely push governments to adjust protocols in order to speed up distribution. Changing the timing of doses, skipping a dose or combining vaccines are all high-risk endeavors in that they would disrupt data collection and analysis of vaccine efficacy in ongoing studies. But such vaccine protocol changes may nonetheless be deemed necessary to increase vaccination rates as policymakers scramble to quickly secure herd immunity and bring an end to the pandemic. Vaccination rates, however, will still likely hit a roadblock once skeptics from broader swaths of the population begin to defer immunization in successive vaccination waves. ...
The United States and Europe will overcome the slow and problematic rollout of COVID vaccination campaigns in the coming months, but concerns about new strains of the virus will likely push governments to adjust protocols in order to speed up distribution. Changing the timing of doses, skipping a dose or combining vaccines are all high-risk endeavors in that they would disrupt data collection and analysis of vaccine efficacy in ongoing studies. But such vaccine protocol changes may nonetheless be deemed necessary to increase vaccination rates as policymakers scramble to quickly secure herd immunity and bring an end to the pandemic. Vaccination rates, however, will still likely hit a roadblock once skeptics from broader swaths of the population begin to defer immunization in successive vaccination waves.
A review of the global H1N1 vaccination campaign in 2009 suggests that logistical issues, along with communicating with and mobilizing healthcare workers, will be key in determining the pace of COVID-19 vaccination rollouts. Like the current COVID-19 campaign, the H1N1 vaccine campaign also began in the developed world as a result of an accelerated development effort spurred by the World Health Organization’s declaration of a pandemic. It took months for the H1N1 campaign to overcome initial delays in supply and confusion about who was eligible to first receive the vaccine. An after-action review of the H1N1 campaign in the United States stressed the need for future campaigns to “underpromise, overdeliver” vaccine doses, along with better communication across the board. But even with these lessons learned, dress rehearsals and dry runs can only prepare so much. Indeed, disjointed regional and federal guidelines, staff shortages, logistical difficulties and the phased administration process have already caused the Pfizer and Moderna COVID-19 vaccines to be doled out much slower in the United States and Europe than initially promised.
Reasons for delays in vaccine distribution have so far included accidental disposal of doses due to confusion about labeling; the need to ensure a second dose would be available before administering the first; the very limited pool of people in the first round of vaccinations, limited numbers of trained individuals to administer the vaccine due to the pandemic’s current stress on healthcare systems; and the need to stagger the administration of the vaccine to viable candidates to ensure potential side effects don’t take too many healthcare workers offline at once.
The United States initially promised 20 million doses by the end of the year, but ended up only vaccinating 2.79 million before the calendar year ended. As of Jan. 7, 5.31 million people have received the first dose of the COVID-19 vaccine in the United States, according to Our World in Data. The U.S. Center for Disease and Control (CDC) has also reported that more than 17 million doses of the vaccine have so far been distributed.
Israel has been cited as a standard for a successful vaccination campaign. Israel’s high per capita vaccination rate, however, is due to several unique factors, including the country’s relatively small population, centralized healthcare system and decision not to limit the initial viable candidates for the vaccine.
Ongoing uncertainty surrounding the new rapidly spreading variants of COVID-19 may tempt policymakers to find non-traditional ways to accelerate vaccination rollouts, even if it risks reducing vaccine effectiveness and eroding public trust. Typically, changing the protocol for delivery of a vaccine would be a non-starter. However, the recent emergence of two new variants of the SARS-CoV-2 virus in the United Kingdom and South Africa has increased calls to expedite vaccine rollouts in order to guard against the continued spread of the disease and, in turn, the potential for further mutations. To quickly immunize broader swaths of their populations, government officials may authorize lengthening the time between doses and/or allowing COVID-19 vaccines from different developers to be mixed. Governments could even forgo administering the second dose altogether. Such moves, however, would likely come back to bite.
The B.1.1.7 strain that has quickly become the dominant COVID-19 strain in much of the United Kingdom does not appear to subvert the current standard of treatment or the vaccine. There is more uncertainty surrounding the 501.V2 variant from South Africa, whose mutations appear to impact the effectiveness of some treatments, though the currently approved vaccines may still provide some protection.
The United Kingdom has already stated its intent to lengthen the amount of time between initial doses. Government officials have also stated that they may mix vaccines (i.e. giving someone a dose of the Moderna vaccine, even if their first dose was the Pfizer vaccine) if the correct second dose is not available.
Because the current vaccines have been authorized through emergency approvals, the full testing and trials are still ongoing. The impact of changing protocols mid-study cannot be known and, under typical conditions, would go under months (if not years) of additional study. But there is a high risk of diminishing the effectiveness of the vaccine by changing the dose concentration or timing.
As logistical issues are resolved, population resistance will persist as the primary factor limiting vaccination rates, lengthening the amount of time it takes to reach herd immunity. This could, in turn, provide the virus more time to disrupt the global economy, as well as potentially mutate to render current treatments and vaccines ineffective, forcing the process to start all over again. Numerous polls across the United States and Europe indicate that there is a high level of skepticism toward COVID-19 vaccinations. Experts believe that somewhere between 50-85% of the population needs to be vaccinated or immune to COVID-19 before the world will achieve herd immunity. Unforeseen consequences of changing protocols could further damage already low public trust in COVID-19 vaccines. Even when governments succeed in overcoming initial hurdles to distribution, vaccination rates will likely plateau over the next six months in the developed world, hindering efforts to end the pandemic. This could force governments to consider compulsory vaccination requirements, which would be a risky and difficult political move in many countries, including the United States.
A YouGov poll conducted in November indicated that only 41% percent of France’s citizens were unwilling to get the COVID-19 vaccination, Spain and Sweden also saw similarly low acceptance rates. Confidence in the United States has risen in recent weeks, but 40% of Americans are still either unwilling or hesitant to get the vaccine, according to Pew Research Center Polls.
Using basic epidemiological formulas, Dr. Zach Nayer with Stat News estimated it will take until May 2021 to achieve herd immunity in the United States, assuming that herd immunity can be achieved at 75%. But reaching herd immunity by May 2021 also assumes 64% of the U.S. population is vaccinated, and estimates that reducing U.S. vaccinations by just 3% to 61% of the population would extend the clock to July 2021. And if only 39% of Americans get vaccinated, herd immunity would take until Dec 2022.
