Covid-19 vaccine: Light faint at the end of the tunnel

"There are different options for Vietnam as well as other developing countries in accessing effective Covid-19 vaccines. The first one is joining the Covax facility, the second is having direct contact with manufacturers, and the third is producing domestic vaccines," Dr. Thu Anh Nguyen, Faculty of Medicine and Health, University of Sydney, Australia, said.

The Covax facility is a global mechanism in the development, manufacturing and procurement of Covid-19 vaccine candidates, facilitating and supporting member countries to access the vaccines when they become available. Covax aims to provide two billion doses by the end of 2021, which is to cover 20 percent of the population of member countries. Gavi, the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO) are coordinating the Covax program.

As of October 19, a total of 184 countries had joined the Covax, according to WHO. Vietnam is among 92 low-and middle-income countries that will be supported by Covax.

The potential advantage for Vietnam as a Covax member, according to Tram Anh Wartel, Associate Director General, Epidemiology, Public Health, Impact, and Clinical Development, International Vaccine Institute (IVI), South Korea, is that a country can buy vaccines at a lower price compared to direct purchases from manufacturers.

The reason is that CEPI asks vaccine manufacturers to commit to producing a certain amount of doses to distribute globally at a capped price.

Thu Anh, however, was not optimistic about Vietnam being able to access effective vaccines from Covax.

She said a lot of middle-income countries including Vietnam haven't placed any direct orders with manufacturers. They will rely on Covax, but there will not be a big share for everyone under this facility.

So far, the purchase of 7.2 billion doses of the Covid-19 vaccines has been confirmed. Of this, high income countries account for 52 percent and just 9.5 percent is held by the Covax facility, which is equivalent to 700,000 doses. This number is expected to increase in the future but is still far from two billion doses the Covax facility expects to procure and distribute.

Current estimates indicate that there will not be enough vaccine to cover the world population until 2023 or even 2024. So it will be very challenging for Covax to access the vaccines and supply member countries.

Some countries like Canada have ordered enough vaccines for their population five times over, meaning each person can get five doses. Such purchases are understandable because countries don't know which vaccine candidate is going to be effective when they place an order, Thu Anh said.

Currently, there are very few manufacturers, mostly in the U.S., Germany, Belgium and other developed countries, and nothing yet from developing countries. So it's not easy even for countries with money to queue up to get the vaccine. The U.S., which has the most promising vaccines to date, has not joined Covax.

Thu Anh said at this point, with the pool of vaccines in the world being limited, a pertinent question would be: how many doses the Covax facility can place confirmed orders before any vaccine candidate is even approved for the market.

"I would say there is a low chance of Vietnam getting the vaccines," she said.

Equitable?

Professor Stephen Evans, London School of Hygiene and Tropical Medicine, University of London, the U.K., said he was concerned that vaccine availability will not be equitably spread globally.

He also said that the possibility of effective vaccines that do not require more than the usual cold chain leaves some grounds for optimism. The cold chain keeps vaccines and medicines within a specific temperature range from the point of manufacture until they are administered.

Thu Anh said Vietnam can consider the second option of dealing directly with manufacturers. Some low and middle-income countries like Bangladesh, Ecuador, Indonesia, Israel, Malaysia, Nepal, Peru and Thailand have already entered into direct deals for purchasing around 1.75 billion doses of Covid-19 vaccines.

"If low-income countries like Nepal and Bangladesh can place an order, why doesn't Vietnam do it?" she asked, adding that the Vietnamese government should form a professional multidisciplinary team with members from the health, commerce and foreign affairs sectors to strike deals.

The direct deal will involve other costs like legal consultancy and procedures which would be complicated even if the vaccines are not expensive, she noted.

She recommended that Vietnam directly contacts the University of Oxford to buy AstraZeneca vaccine because the price is reasonable and transportation is feasible.

The vaccine developed by AstraZeneca costs $2-3 per dose and by Pfizer $39.

The Pfizer vaccine should be stored in a box for 10 days at below minus 80 degrees Celsius. Then, when it arrives in the country, it can be stored at 2 to 8 degrees Celsius for up to five days in an ultra-low freezer. The one developed by AstraZeneca can be stored at 2-8 degrees Celsius, which Vietnam can manage for nationwide distribution, Thu Anh said.

Vietnam has chances of accessing an effective vaccine with the direct deal, as the market in Vietnam is not small for manufacturers, given its 100 million population. The country also has the capacity for conducting a large-scale vaccination program, which is another positive, she said.

Self-reliance a must

Toan Ha, Assistant Professor, Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, said it is critical that Vietnam is able to produce its own vaccines to inoculate its population.

Vietnam has a strong track record in producing different types of vaccines for the local market and has successfully developed vaccines against A/H1N1, A/H5N1, A/H7N9, and seasonal influenza. The WHO has highly valued Vietnam’s capacity for quality vaccine production.

"I believe that Vietnam will be able to successfully develop clinically-tested Covid-19 vaccines in the near future. It is better to be self-reliant, being able to locally produce an affordable and safe vaccine to ensure that Vietnam has enough vaccines for the population, than relying on foreign manufacturers," Toan said.

On December 17, Vietnam began human trials of Nanocovax, the first Vietnamese Covid-19 vaccine, produced by Nanogen Pharmaceutical Biotechnology JSC in HCMC. The country currently has four Covid-19 vaccines under development, the others developing it being the Institute of Vaccines and Medical Biologicals (IVAC), the Vaccine and Biological Production Company No. 1 (Vabiotech) and the Center for Research and Production of Vaccines and Biologicals (Polyvac).

Thu Anh advised caution, saying it was too early to talk about the effectiveness of made-in-Vietnam vaccines.

One of the significant challenges for domestic producers will be the paucity of financial resources. In an interview with her team, three of four companies in Vietnam said they haven't received sufficient funding to invest in the development of a Covid-19 vaccine.

While some hope is ignited as local companies conduct phase one or two of clinical trials, phases three or four cannot be done in Vietnam because the country does not have transmission in the community. While the lack of community transmission is lucky, it also makes it difficult to assess whether domestic vaccines are effective or not, Thu Anh said.

Vietnam has planned to finish its trials for the first Covid-19 vaccine by February 2022, with the third and final phase seeing volunteers injected with the vaccine in either Bangladesh, India, or Indonesia.