THERE is a clear and present threat that an additional 0.4% to 2% of the world’s population will die by the end of the COVID-19 pandemic. As the crisis shows no signs of abating, there is an international scramble for vaccines that has been complicated by nationalism and geopolitical tensions.

Two crucial issues with vaccines are effectiveness and safety. The SARCov2 virus belongs to a family of viruses that commonly mutates, thus making an effective vaccine for COVID-19 is difficult.

Vaccines created based on past strains may be less protective when used against future mutated strains. The second issue is the vaccine’s safety. Vaccine trials are powered to detect common side effects. As we plan to vaccinate whole populations, infrequent side effects may become frequent.

“Vaccine nationalism” (when governments sign agreements with manufacturers to supply their own populations) has resulted in some countries enacting policies to develop and procure sufficient vaccines for their population before engaging with other multinational agencies. The advantage of this strategy is guaranteed access to the vaccine under development.

Another strategy is developing bilateral vaccine trade deals with favoured partners. The benefits of this policy are guaranteed access to a vaccine in development, direct cost negotiations and better diplomatic relations.

An important risk to both these strategies is that all resources are put into a smaller basket of possible vaccine targets. An alternative strategy is the establishment of broad coalitions or consortiums comprising multiple international agencies that countries can join. With a larger basket of vaccine targets, and due to the inclusive nature of collaboration, this strategy is likelier to produce a vaccine that is more accessible and equitable.

However, the price-setting formulations, along with guaranteed commitments to purchase, may differ.

A significant cost determinant is the stage of development. However, price negotiations must be valuebased, incorporating measures of effectiveness and safety. The first generation of approved vaccines may not be cost-effective as a public health intervention for the whole population as subsequent generations are likelier to incorporate newer knowledge of the virus that will make for better vaccines.

Governments are in a challenging position now. Delaying a national vaccination campaign of first-generation vaccines may result in more people getting COVID19; however, utilising first-generation vaccines may lead to muted benefits and lowered cost-effectiveness.

DR SANJAY RAMPAL

Universiti Malaya (UM)

Note: The article was a letter written by Professor Dr Sanjay Rampal to the Star Newspaper and was published on the 2 Oct 2020.