A lot of the world might not have entry to a COVID-19 vaccine till 2022

Coronavirus survives on skin five times longer than flu: study

SARS-CoV-2 (shown here in an electron microscope picture). Credit: National Institute for Allergy and Infectious Diseases, NIH

Almost a quarter of the world's population may not have access to a COVID-19 vaccine until at least 2022, warns a study published today by the BMJ.

A second study estimates that 3.7 billion adults worldwide are ready to receive a COVID-19 vaccine. This underscores the importance of developing fair and equitable strategies to ensure that supply can meet demand, especially in low and middle income countries.

Taken together, these results suggest that the operational challenges of the global COVID-19 vaccination program will be at least as difficult as the scientific challenges associated with its development.

In the first study, researchers from the Johns Hopkins Bloomberg School of Public Health analyzed pre-orders for COVID-19 vaccines prior to their regulatory approval, which had been publicly announced by countries around the world.

As of November 15, 2020, several countries had reserved a total of 7.48 billion doses or 3.76 billion courses from 13 manufacturers of 48 COVID-19 vaccine candidates in clinical trials.

Just over half (51%) of those doses will go to high-income countries, which make up 14% of the world's population, the authors say. Low and middle income countries may have the rest, even though these countries make up more than 85% of the world's population.

If all of these vaccine candidates were successfully scaled, total projected production capacity would be 5.96 billion courses by the end of 2021, with prices ranging from $ 6.00 (£ 4.50; EUR 4.90) per course to $ 74 per course .

Up to 40% of the vaccination courses from these vaccine manufacturers could potentially remain for low and middle income countries. However, this will depend in part on how high-income countries share their procurements and whether the US and Russia join in globally coordinated efforts.

However, the authors point out that even if all of these vaccine manufacturers managed to reach their maximum production capacity, at least a fifth of the world's population would not have access to vaccines by 2022.

"This study provides an overview of how high-income countries have secured future supplies of COVID-19 vaccines, but access for the rest of the world is uncertain," they write. "Governments and manufacturers could provide much-needed assurances for fair allocation of COVID-19 vaccines through increased transparency and accountability in these agreements."

In the second study, researchers from China and the United States estimated the audiences who would need vaccines to guide the development of fair and equitable allocation strategies around the world.

They note that target population sizes for COVID-19 vaccination vary depending on geographic region, vaccination goals (e.g., maintaining essential core services, reducing severe COVID-19, and stopping virus transmission), and the impact of vaccine reluctance in reducing demand vary greatly.

They point to evidence suggesting that around 68% of the world's population (3.7 billion adults) are ready to receive a COVID-19 vaccine and say their results "provide an evidence base for prioritization and allocation globally represent regional and national vaccines ".

"Differences in target population sizes within and across regions underscore the weak balance between vaccine demand and supply, particularly in low- and middle-income countries that are unable to meet domestic demand for COVID-19 vaccines," Close.

Both studies are observational and the authors acknowledge the implications of uncertainty and incomplete information for their analyzes.

However, these results illustrate the vast extent and complexity of manufacturing, purchasing, distributing and administering COVID-19 vaccines in a manner that meets global needs and does so among nations and populations.

In a linked editorial, Jason Schwartz of the Yale School of Public Health points out that many countries have already committed to equitable global access to COVID-19 vaccines by purchasing through the COVAX Facility – an initiative that is part of it investing in vaccines for poorer countries.

But he says vigilance is needed "to ensure that such aspirations are realized in the months and years to come".

He argues that the successful and equitable implementation of COVID-19 vaccination programs "requires unprecedented global coordination and sustained use of financial, logistical and technical resources from high-income countries".

In particular, he says US participation in vaccination efforts "will be invaluable in ensuring that all populations around the world have access to the COVID-19 vaccines that will ultimately help end this devastating global health crisis."

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