Vaccine distribution starts countdown for the end of COVID-19 restrictions

COVID-19 vaccine
Vaccines currently pending approval from regulators are seen as the solution for the world to emerge from the COVID-19 pandemic, but even if they are as effective as it is hoped for, the process to regain our freedom of movement is set to be arduous.

 

The vaccine solution

The UK has become the first country in the world to approve the Pfizer/BioNTech coronavirus vaccine, paving the way for mass vaccination. The Pfizer/BioNTech vaccine which initial data found to be 95 per cent effective against COVID-19, as well as the Moderna vaccine (94 per cent efficacy) are currently awaiting approval from many medicines regulators. The AstraZeneca/Oxford jab could also receive approval in January 2021 despite some controversy around its efficacy.

It is likely that many national vaccination programmes with the aforementioned vaccines will be able to start at the end of 2020 or early 2021. First in line are high-income countries, as well as a few middle-income countries, which together have purchased nearly 3.8 billion doses, with options for another five billion, according to an analysis released by the Duke Global Health Innovation Center. 

The national vaccination programmes are likely to follow a hierarchy for distribution, starting with those most at risk. The UK, for example, has produced the provisional prioritisation ranking below: 

1.    older adults’ resident in a care home and care home workers
2.    all those 80 years of age and over and health and social care    workers
3.    all those 75 years of age and over
4.    all those 70 years of age and over
5.    all those 65 years of age and over
6.    high-risk adults under 65 years of age
7.    moderate-risk adults under 65 years of age
8.    all those 60 years of age and over
9.    all those 55 years of age and over
10.    all those 50 years of age and over
11.    rest of the population (priority to be determined)

This all suggests that those most at risk living in rich countries will receive the aforementioned vaccines first while the least at risk in developing countries will come last. Taking into account that each person will likely require two doses of any vaccine, it is estimated that it will take three to four years to manufacture enough vaccines to cover the world’s population.

However, the big unknown is the role China may play in the supply of a COVID-19 vaccines. Sinovac Biotech’s experimental COVID-19 vaccine CoronaVac triggered a quick immune response, according to preliminary trial results, although the level of antibodies produced was lower than in people who had recovered from the disease. CoronaVac and four other experimental vaccines developed in China are currently undergoing late-stage trials to determine their effectiveness in preventing COVID-19. Nevertheless, Brazil’s Sao Paulo state has already begun importing the first of 46 million doses of China’s Sinovac vaccine. Meanwhile, Turkey has signed a contract to buy 50 million doses of COVID-19 vaccine from China’s Sinovac Biotech. Chinese leaders have reportedly promised a growing list of developing countries priority access to its successful vaccines.

Russia has also developed a coronavirus vaccine named Sputnik V which it claims has more than 95% efficacy against COVID-19, according to preliminary data. Russia is reportedly seeking approval for Sputnik V use in 40 countries. Meanwhile, president Vladimir Putin has said that Russia should begin general vaccination of its population with the drug.  

So far it is not clear if and when COVID-19 vaccines will be available for private purchase. A Pfizer/BioNTech spokesman has suggested that there are no short term plans to offer its COVID-19 vaccine for purchase to the private health sector in the UK as the focus lies on fulfilling government contracts.  

 

Potential issues

While the immunisation of the population is carried out, those still waiting to get the jab will likely need to keep protecting themselves and others with well-known means such as mask wearing and social distancing. There is also a chance that those who have been vaccinated may still transmit the virus to others. Most vaccines do not completely prevent infection but do prevent the infection from spreading within the body and from causing disease, according to the Johns Hopkins University. Many vaccines can also prevent transmission but there is no proof yet that this is the case for COVID-19 vaccines.

Despite the general enthusiasm about the effectiveness of COVID-19 vaccines, members of anti-vaccine movements are trying to persuade the public not to participate in vaccination programmes. Refusing vaccines has a long history which goes back to the early 1800s when the smallpox vaccine started to be distributed in large numbers. At that time, arguments against inoculation included sanitary, religious, and political objections.

Today, arguments used by so-called anti-vaxxers include conspiracy theories and misinformation campaigns that quickly spread online without fact checks. The UK government has become more proactive about countering disinformation regarding vaccination and social media platforms, including Google, Twitter and Facebook, have agreed to introduce measures to limit its spread. 

A recent World Economic Forum-Ipsos survey on vaccine confidence published in November 2020 shows that on average, across 15 countries, 73% of adults strongly or somewhat agree with the statement “if a vaccine for COVID-19 were available, I would get it”. This represents a reduction of 4 percentage points from August.  

Although taking the vaccine is unlikely to become mandatory in democratic societies, those without the protection may nevertheless face restrictions. Qantas chief executive Alan Joyce, for example, has suggested that travellers may in future need to prove that they have been vaccinated against COVID-19 in order to board flights. Also, anyone refusing to take the vaccine without a medical reason may have their travel insurance invalidated. Furthermore, Tom Tugendhat, a Conservative member of the UK parliament, suggested that anti-vaxxers who reject a safe coronavirus jab may not be allowed back into their physical workplace by their employers. 

While vaccinating the world’s population is a huge undertaking in itself, the exercise may need to be repeated as immunity provided by the jab could be short lived. Determining the duration of immunity for a given COVID-19 vaccine is likely to only be resolved once community-wide vaccination programmes progress. Before any vaccine can be applied for a specific purpose in the population it needs to successfully pass three test phases. In phase III trials it is tested on a large group of thousands of people to confirm its effectiveness, further explore potential side effects, and assess additional characteristics. While a vaccine is already being distributed to the wider population in phase IV, its performance continues to be monitored, and only at this stage there can be confirmation for how long the immunisation from a given COVID-19 vaccine lasts. 

 

The clinical trial insurance market 

Insurers remain unfazed by the risks of clinical trials for the COVID-19 vaccine, even with other 40 experimental COVID-19 vaccines being tested on humans.

There has been slight pressure on moderate increases in the UK however in Australia currently the premiums within the clinical trial space still remain relatively stable and at times even competitive given more specialised insurers are coming into this space.

Another part of the reason why premiums are not rising as harshly as other risks such as property and directors and officers' liability insurance is due to the nature of risk. Participants agreeing to partake in a trial are often aware of the risks involved by signing an informed consent agreement. Whilst side effects always happen with clinical trials, these are typically mild and expected. At times, there are incidents of really bad loss. However such events are much less frequent than in other risk areas. As a result, there is little volatility both in terms of premium and cover offered by insurers. 

Nevertheless, the race around the globe to get a COVID-19 vaccine has raised worries about adherence to the usual protocols and safety standards and fear that some could ‘slip’ due to the hastiness.

However, those within the industry have highlighted that, if anything, there is being more caution and care talked with COVID-19 trials as there is so much at stake, particularly the participants' safety and, more generally, the reputation of the pharmaceutical sector in general due to the hightened media attention globally on this topic. 

For further information, please contact:

Genevieve Mathews, Senior Associate Health & Community Services 
Lockton Companies Australia
M +61 474 174 317 | 
E Genevieve.Mathews@au.lockton.com

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