Effective Covid-19 Vaccine: What is the Way Forward?

The Covid-19 pandemic has taken the US through a wringer. Many believe without a vaccine the US would not achieve pandemic control. This is surprising for a nation with world renowned public health institutions such as the CDC and USAID. In many nations though, simple public health policies have been used with varying degrees of success.

The poor pandemic control has been attributed to many problems in the US. One that comes quickly to mind is the American love for individual freedom above group identity. I however believe our challenges in controlling the pandemic go beyond our immediate actions or inactions. The US has neglected and defunded many structures required for effective control of epidemics and pandemics over several decades. The uncontrollable spread of SARS-CoV-2 is the result of decades of poor investments in our public health infrastructure. This vulnerability has always been worse in Southern and Midwestern States with weak state economies.

Since the summer the intensity of the pandemic has moved from our coastal regions to the South and the Mid-West. Unfortunately control in these states has been more challenging. In Georgia the Governor filed a law suit against the Mayor of Atlanta for instituting mandatory mask rules. In this political climate with certain high level officials and political leadership challenging the science of Covid-19 control many including President Trump have placed their hopes on a vaccine. The question that we need to be considering is if a vaccine would be the magical elixir we are hoping for.

Effective vaccine control of Covid-19 will be very much dependent on good vaccination rates. The vaccination rates that would be required for control of Covid-19 is at this time unknown. To determine our capabilities at achieving good vaccination rates we will need to look at previous performance. Among general adult populations our vaccination rates have not been that great. In 2019 our influenza vaccination rate among adults 65 years and above was 68.7%. Coverage among adults ≥18 years was 45.3%, an increase of 8.2 percentage points from the 2017–18. This is an improvement but may fall short of what will be required to achieve effective control of Covid-19 using a vaccine. At the state level the vaccination rates ranged from 33.9% in Nevada to 53.6 in Rhode Island.

There are reports that Trump’s administration is attempting to push for a FDA Emergency Use Authorization for a Covid-19 vaccine. This has raised a lot of questions and concerns in many circles. Two important questions raised are the safety of such a move and its impact on vaccine roll-out and implementation.

Currently there are 3 major Covid-19 vaccines in phase 3 under Operation Warp Speed. This program whilst geared towards quick implementation as explained many times by Dr. Anthony Fauci focused on reducing the time required for vaccine production capacity development by making that concurrent with required trials. Thus these three vaccines in phase 3 are already being produced at close to production capacity to deliver up to 300 million doses of the vaccine by January 2021.

Concerns of undue political pressure in Covid-19 vaccine development have been raised. These concerns are real, as such it is very important that the steps in the process related to developing and evaluating the necessary data to ensure safety and efficacy are not shortened. This is very important on account of the impact on perceptions on effective implementation and roll-out. There is enough paranoia about vaccines, we do not need to make things any worse by any appearance of laxity.

Currently nine pharmaceutical companies involved in Covid-19 vaccine development have signed a pledge assuring the public that their FDA submissions will be based on complete data not interim analysis. Hopefully this will reduce paranoia over a potential Covid-19 vaccine which unfortunately is worse among minorities. Ensuring good trust in vaccine development process by one of the populations most affected by Covid-19 is a very important step in effective implementation.

The summer is over and we are moving quickly into the fall of one of the most eventful year of our lives. We all hope we would be starting the year 2021 with hope for a better world. Hopefully if not free of Covid-19, having an effective plan for elimination.

While some are hoping to find this in the ballot box I would suggest all of us including our congress men and women push for a more long term solutions free of executive interference.

Leonard Sowah is a physician in Baltimore, Maryland

Feature photo: Coronavirus vaccine from pxfuel.com