Vaccines are here in record time, with more to come. Less than a year since the coronavirus began to devastate the world, the first shots spark hopes of wiping the COVID-19 pandemic off the face of the earth.
Current programs in the US and UK are precursors to vaccination campaigns aimed at reaching the entire world population – all 8 billion people in every corner of the world.
There is reason for optimism. Vaccines are the best and perhaps the only way to eradicate infectious diseases: smallpox has been eradicated and polio is on the verge, with only two countries continuing to transmit. But global vaccination campaigns take time – usually decades – suggesting that even with the latest technologies, money, and power behind the unprecedented global push to take out COVID-19, the disease is unlikely to be eradicated anytime soon.
“I would be surprised to see an actual eradication of this virus now that it’s around the world,” said Walter Orenstein, associate director of the Emory Vaccine Center in Atlanta and former chief of the immunization program at the Centers for Disease. Control and Prevention. “I would be shocked given how contagious it is.”
Hurdles to supply and distribution have already arisen during the opening days of the US campaign, and the UK, the first Western country to start immunization, vaccinated only 138,000 people in the first week. In the meantime, Europe has yet to start with vaccinations, and probably won’t do so until after Christmas.
Concern is growing about how long it will take to immunize large parts of the world outside of a group of wealthy nations that have picked up early supplies. A global program called Covax, which aims to deploy COVID-19 vaccines around the world, has struck deals with developers including Johnson & Johnson and AstraZeneca PLC. But some of those deliveries are expected to come from an experimental inoculation from Sanofi and GlaxoSmithKline PLC that has been delayed and may not be ready until the end of next year.
“It’s really, really complicated to make sure that we produce and distribute those vaccines fairly globally, for both moral and economic reasons,” Mark Suzman, CEO of the Bill & Melinda Gates Foundation, told reporters about a 9 December call.
Suzman pointed to research showing that wide access to vaccines can bring significant economic benefits to all countries and save many lives. Since wealthy countries will likely have more than enough doses to vaccinate their entire populations, they should consider reallocating certain supplies to the most deprived, he said.
Mass vaccination is one of the most successful public health interventions in the world and has played a significant role in increasing life expectancy in the US by more than 50% over the past century. About a third of deaths in the US in 1900 occurred in children under 5 years of age, many of them due to diseases such as smallpox, measles and whooping cough that are now preventable through immunization.
Some new vaccines have also been used quickly and widely, such as injections that prevent pneumococcal infections that can cause serious illness in children and adults. The introduction of the shingles vaccination has provided millions of people with prevention of the painful disease over the past two decades.
A veteran of the World Health Organization’s effort to eradicate smallpox, Orenstein often immunized himself in front of entire villages to allay fears about safety. The agency decided to try to eradicate the disease in 1959, when it was still affecting many developing countries, but the effort didn’t pick up gear until 1967 when more money and staff were deployed by the WHO and its members.
The smallpox effort initially targeted entire populations, but it turned out to be impractical, recalls William Schaffner, an infectious disease specialist at Vanderbilt University who advised the government on vaccination. The turnaround came when the strategy shifted to identifying cases and then vaccinating everyone in the neighborhood, sometimes hundreds of households.
However, this approach to creating a vaccination ring around cases was only possible because smallpox can be a disfiguring disease, making it easy to identify and spreading relatively slowly.
“It has a reputation for spreading quickly, but it’s actually spreading quite slowly,” Schaffner said. “You also need pretty close contact for the transfer to take place.”
These characteristics allowed vaccination teams to identify patients when they became contagious and close all avenues for transmission. Still, it took two decades for the worldwide effort to contain the last outbreak in 1977.
A better comparison to COVID-19 might be polio, an intestinal virus that sometimes causes permanent, serious illness. Polio is similar to COVID-19 in that only a minority of infected people – about 1 in 100 – become extremely ill.
That has caused one of the problems expected with widespread COVID-19 vaccination: People who don’t believe they are vulnerable to the disease may not want to be vaccinated, even though others may benefit from it through the intensive care units from hospitals and possibly prevent the transmission of the disease.
A key difference from polio, however, is that it can cause serious illness in young children, paralyzing them for life, Orenstein said. This is in contrast to COVID-19, which mainly affects the elderly and chronically ill. That has left some parts of the public indifferent.
“We get more than one death per minute – two deaths per minute on some days,” he said. “It is very disturbing to see the lack of concern in other people.”
But even with the specter of children paralyzed by polio and a vaccine that has been available for some 65 years, the global eradication of that disease has still not been achieved. According to the Global Polio Eradication Initiative, two countries, Afghanistan and Pakistan, continue to spread due to insufficient vaccination coverage.
To beat COVID-19, “we need to convince people to take the vaccine,” Anthony Fauci, the US government’s top infectious disease specialist, said in an interview. “If you have a very effective vaccine and only 50% of people take it, then you don’t have the impact you would need to basically get a pandemic so low that it no longer threatens society. And that’s the purpose of a vaccine, just like measles, like polio, like the world with smallpox. “
Most standard immunizations provide protection for years to decades. We still don’t know how long COVID-19 vaccines last, Fauci noted. And it’s not clear whether they prevent transmission along with protection against symptoms, although studies may shed light on that soon.
The logistics and supply chain challenge facing the world today is “more complicated than usual as, for the first time in history, we are introducing multiple vaccines against the same target at the same time,” Rajeev Venkayya, president of Takeda Pharmaceutical Co. The vaccines company said in an interview.
That means countries need databases to track the rollout and make sure people are getting the doses at the right time, as well as systems to track potential side effects and share the information with the public, he said.
Countries early on plan to prioritize the most vulnerable people, as well as health workers and other critical personnel, which will significantly reduce deaths and suffering, said Venkayya, former Biological Protection Special Assistant to US President George W. Bush.
“But the broadcast will not decrease dramatically at first. It will take a while for us to reach a sufficient level of vaccine-mediated population immunity before we begin to dampen transmission. “
Possibly by the middle of next year, countries like the UK and the US will see a “real dampening of the transmission,” he said. “That timeline will be delayed in many other parts of the world that do not have this kind of early access to vaccines.”
Unvaccinated populations are always at risk of reintroducing disease in areas where herd immunity appears to have taken over. Last year, the annual number of measles cases reported worldwide more than sixfold to about 870,000, the highest since 1996, when vaccination coverage declined.
The world will likely see the same level of viral persistence from the coronavirus, said Klaus Stohr, a former Novartis AG vaccine manager and WHO official who championed efforts to prepare for pandemics.
“The prediction is pretty clear: the virus will never be eradicated,” he said. “Why? Because there will always be a large portion of the susceptible population in the community.”
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