December 10, 2021 - Developments on COVID-19 are coming thick and fast. Dr. Anne Stolle and Hendrik Harbers summarize the developments and share an update on the status of the supply chain and distribution of COVID-19 vaccines on our blog.
What is the latest news on COVID-19 and the pandemic?
Anne: As expected, the delta variant of Sars-Cov-2 has become the most prevalent strain in the US and in many other parts of the world (Intelligencer 2021; Robert Koch Institut 2021). Until recently, it was the most transmissible, and might also have come with a higher risk of severe illness. This is certainly not good news. But while governments and health care systems are busy fighting this most prevalent variant, an even more transmissible strain has just emerged: Omikron, as named by the WHO, is the fifth variant of concern. Albeit currently still at low numbers, it has the potential to lead to rapidly rising numbers of cases due to its even higher transmissibility which is probably the result of the very high number of new and apparently jointly acquired mutations (ABC News 2021; DocCheck 2021). Preliminary data shows that it has already spread to the US and many European and other countries.
Vaccinating children and adolescents has become possible in many countries including the US (ages 5+ NS Healthcare 2021; FDA News Release 2021) and Europe (ages 12+ , European Medicines Agency 2021, for children 5- 11 years it is under review by the EMA). This will help in the endeavor to keep schools open and to get closer to herd immunity, which, at an Ro of the delta variant of nine, currently stands at 89% (cnbc.com 2021).
However, if the Omikron strain takes over, Ro will likely be significantly higher, thereby again increasing the percentage of immune people necessary to achieve herd immunity. What’s worse, our current vaccines may not be highly effective against this new variant: Initial laboratory tests show that neutralizing activity of vaccination-induced antibodies, one way of the immune system to fight viral infections, is greatly reduced in the case of only 2 doses of vaccine given (Sandra Ciesek on Twitter 2021). Fortunately, Pfizer/ BioNTech were able to demonstrate that this effect can be reversed by a third/booster shot (Pfizer news 2021). It has to be noted, though, that cell-related immunity against the virus that protects against severe Covid19 may probably be only slightly affected by the mutations of the omikron strain. Nonetheless, both Moderna and BioNTech/Pfizer are planning to develop an omikron-specific vaccine (ABC News 2021 ; Pfizer News 2021).
What does all of this mean for the supply chain of these vaccines?
Anne: Vaccine doses and logistics to ship them to their respective destinations continue to be in high demand in most countries. While supply exceeded demand in the Western World during the past months due to a lack of interest in the shot in parts of the population, the need for a booster shot has changed the situation there completely. Moreover, only a small fraction of people in many low- and middle-income countries have been immunized against the virus yet. In stark contrast, the Serum Institute of India, the world’s largest vaccine maker, is ramping down production of Covishield due to a lack of new orders (BBC News 2021).
As the EMA recently approved a new formulation of the BioNTech/Pfizer vaccine that may be stored at refrigerated temperatures (2/8°C, BioNTech Press Release 2021), the need for shipments at ultra-low temperatures may decrease significantly. Most vaccines can be transported and stored at 2/8°C.
Is the supply chain ready for the booster shots?
Anne: Although the increased need for vaccine doses because of the booster shots could have been expected, some countries appear not yet fully prepared to supply accordingly. In order to increase the number of vaccination sites, Germany for example is thinking about having not only physicians but also pharmacists, dentists and veterinarians deliver the shot, in addition to reopening the regional vaccination centres (ARD WDR German News 2021). In the US, president Biden plans to expand outreach and access to Covid19 vaccines by launching a nationwide booster campaign and opening new family vaccination clinics (healthline.com 2021). In Portugal and Spain, long lines for getting vaccines have returned, despite having high inoculation figures (Vaccine champions Spain, Portugal focus on the reluctant few (msn.com 2021). In contrast, many EU countries impose restrictions on the unvaccinated in an attempt to convince the reluctant to get the shot and to avoid a lock-down (Express.co.uk 2021; Euronews 2021).
What is the outlook for the upcoming winter months in Europe?
Anne: As could be expected, case numbers are increasing again in many European and other countries with cooler temperatures outside and people spending more time indoors (Süddeutsche Zeitung 2021); The situation is likely to be exacerbated by the emergence and potential spread of the omicron variant. Whether the fourth wave can be contained will depend heavily on the percentage of fully vaccinated and ‘boostered’ people within a population and on other measures (like wearing face masks) to be taken.
With a fast-moving pandemic, what are recent developments in low- and middle-income countries (LMIC)?
Hendrik: While some countries already demand a third (booster) shot, in other countries only a small part of the population received a first vaccination. There is a widening gap between high income countries and LMIC. Access to vaccines is much lower in many LMIC and as a result, the vaccination rate of the population is only a fraction of what it is in high income countries.
Making vaccines available is more difficult in countries where there have been insufficient investments in public health care for years. Yet that is not the main reason why vaccines are less available. Funding availability, politics, self-interest in high income countries are some of the reasons why testing and vaccines are not widely available in LMIC. Due to the urgency of the pandemic, additional funding is available, which will help to close part of the gap in public health infrastructure. Yet arguable most important are the intentions.
India is just one country showing that with joint efforts enormous results can be achieved. In September, India achieved 1 billion COVID-19 vaccines in nine months time (!). Soon the world will reach a state where there is sufficient production of the vaccine, and then the uneven distribution and availability of the vaccines remain the bottleneck.
Why should high-income countries share their vaccines with LMIC?
Hendrik: Because it is the right thing to do. And it is the smart thing to do. Berlinger joins the WHO call for vaccine equity. It is a common-sense investment in the global recovery, which will help people around the world to recover after the pandemic has impacted their livelihoods and incomes. It is also an investment in global health, as the longer the virus can spread in large numbers, the more likely new mutations will be. As we recently experience with Omicron, these mutations can occure anywhere and affect all countries.
The health- and economic reasons alone should be strong motivators for rich countries to support vaccine equity and ensure that vaccines are universally available. These rational considerations are however trumped by the moral imperative: safe lives and reduce suffering.
The most important reason to make vaccines equally available to all humans: it saves lives. It is the right thing to do for all of us.
About the authors:
- Dr. Anne Stolle has conducted postdoctoral research in the spread of infectious diseases at leading UK universities. At Berlinger & Co. AG, Anne is the Global Key Account Manager for Clinical Trials.
- Hendrik Harbers is the Global Health Business Development Director at Berlinger & Co. AG.
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