Nearly a quarter of the world’s population may not have access to a COVID-19 vaccine until at least 2022, according to a study published today in The BMJ, which warns that vaccines will be as difficult to administer as to develop.
Another study in the same journal estimates that 3.7 billion adults worldwide are willing to receive a COVID-19 vaccine, underlining the importance of designing just and equitable strategies to ensure that supply can meet demand, especially in low- and middle-income countries.
These findings together suggest that the operational challenges of the global COVID-19 vaccination program will be at least as difficult as the scientific challenges associated with their development.
In the first study, researchers from the Johns Hopkins Bloomberg School of Public Health in the United States analyzed pre-orders for COVID-19 vaccines prior to their regulatory approval which was publicly announced by countries around the world.
“This study provides an overview of how high-income countries have secured future supplies of COVID-19 vaccines, but that access for the rest of the world is uncertain,” the researchers said.
“Governments and manufacturers could provide much-needed guarantees for a fair distribution of COVID-19 vaccines through greater transparency and accountability about these agreements,” they said.
The researchers noted that by November 15, 2020, several countries had reserved a total of 7.48 billion doses, or 3.76 billion courses from 13 manufacturers, out of 48 COVID-19 vaccine candidates in clinical trials.
They said more than half (51%) of these doses will go to high-income countries, which represent 14% of the world’s population, while low- and middle-income countries will potentially have the rest, despite these comprising more than 85%. the world population.
If all of these vaccine candidates were successfully scaled, the total projected production capacity would be 5.96 billion courses by the end of 2021, with prices ranging from $ 6 per course to $ 74 per course.
Up to 40 percent of these manufacturers’ vaccination cycles could potentially remain for low- and middle-income countries, the researchers said.
However, that will depend, in part, on how high-income countries share what they buy and whether the United States and Russia participate in coordinated efforts globally, they said.
The researchers noted that even if all of these vaccine manufacturers managed to reach their maximum production capacity, at least one-fifth of the world’s population would not have access to vaccines until 2022.
In the second study, researchers in China and the United States estimated the target populations for which vaccines would be needed, to help guide the development of fair and equitable allocation strategies around the world.
They found that target population sizes for COVID-19 vaccination varied widely based on geographic region, vaccine goals, such as maintaining essential basic services, reducing severe COVID-19, and stopping transmission of the vaccine. virus, and the impact of vaccine hesitation in reducing demand.
The researchers point to evidence suggesting that approximately 68% of the world’s population (3.7 billion adults) is willing to receive a COVID-19 vaccine and say their findings “provide a basis of evidence for assignment and priority. of vaccines at global, regional and national levels. “
“Variations in the size of target populations within and between regions underscore the tenuous balance between vaccine supply and demand, especially in low- and middle-income countries without sufficient capacity to meet domestic COVID-19 vaccine demand. “, they said.
Both studies are observational, and the researchers recognize the implications of uncertainty and incomplete information for their analyzes.
The findings illustrate the remarkable scale and complexity of manufacturing, purchasing, distributing and administering COVID-19 vaccines in a way that meets global needs and does so fairly between nations and populations, the researchers said.
Jason Schwartz of the Yale School of Public Health noted in a related editorial that many countries have already shown a commitment to equal global access to COVID-19 vaccines by purchasing through the COVAX tool, an initiative that invests part of the payment in vaccines for children. poorer countries.
However, he said vigilance is needed “to ensure that these aspirations are realized in the months and years to come”.
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