There are billions of vaccine doses coming along later this year. Biden says he will give excess doses to other countries, so the US is expected to be a huge donor later this year. Even if the US fully vaccinates everyone, adults and children, twice over, now and in the fall, the US has secured so many doses for 2021 that it will be able to fully vaccinate 1.3 billion people outside the US as well.
However, many countries are facing big problems right now. The US has stockpiled tens of millions of unused AstraZeneca doses that it will probably never use. COVAX is asking if any country with unused doses is able to swap batches with them, in the queue for ten million early doses. The USA could answer this requiest by releasing just part of its stockpile to COVAX now, so that the doses go straight into arms in Africa instead of sitting on shelves in the USA.
COVAX (the COVID19 vaccine alliance) works and has done a great job of supplying at least some early COVID vaccines to nearly all countries in the world. However 36 countries are yet to start vaccination. Dr Tedros told the world that COVAX will get the vaccines to 16 of those countries by 10th April, but there are 20 other countries that COVAX still won’t be able to reach in the first 100 days of 2021
These 20 remaining countries are ready to vaccinate, and they continue to wait for their first does, because wealthy countries have already secured nearly all the early doses for their own use. Dr Tedros of the World Health Organization is asking for any countries with early doses they aren't using to release 10 million of them, so these 20 remaining countries can start to vaccinate their most vulnerable including front-line health care workers. COVAX is asking the wealthy countries with unused doses to swap batches so that their vaccines go straight into the arms of people who need them. The swap means that one of COVAX's batches will go to the wealthy countries in the place of the batch they donate to COVAX.
A loan of 10 million doses to COVAX is equivalent to less than one day of doses in the world as a whole and only 2 days of doses for UK / US / EU / Canada combined.
This summarizes what is happening:
Vaccinations started almost everywhere
But 36 countries are yet to receive their first dose
COVAX will deliver to 16 of those in the next week
But 20 won't be reached yet unless COVAX gets 10 million more extra doses. Health care workers in those countries are still dying unvaccinated.
Meanwhile the USA has a stockpile of 10s of millions of AstraZeneca doses that it will likely never use awaiting FDA approval
Dr Tedros for the WHO is asking for a loan - to swap batches with the early doses secured by the USA and sitting on shelves unused.
Background shows the countries vaccination status from the WHO Coronavirus (COVID-19) Dashboard
Yesterday Dr Tedros reminded countries of his request of a loan of 10 million early doses for 20 countries and tells us that COVAX hasn't got doses for yet. He says his request has been heard but there has been no response yet. He is still hopeful that some forward-looking and enlightened leaders will step up. At 25:49
TRANSCRIPT: COVAX has already delivered 35 million doses to more than 78 countries, but there is still a serious challenge on vaccine equity and availability.
Last week I made an urgent request to countries with those of vaccines that have WHO emergency use listing to share 10 million dollars immediately with COVAX.
The extra 10 million dollars would be an urgent stop-gap measure so that 20 countries which are ready but haven't got the supply needed to start vaccinating their health workers and older people could begin before the 100th day of 10th April.
I also requested manufacturers to help ensure that the countries that step up can rapidly donate those doses.
This challenge has been heard but we're yet to receive commitments for these doses. I'm still hopeful that some forward-looking and enlightened leaders will step up.
I know this is a challenging time for many countries as cases and hospitalization are spiking but conversely it's when cases and when cases are spiking that it's the most important time to share vaccines equitably and protect health workers and at risk communities.
The race is on to get vaccines to those places and groups where they can have the greatest impact. We're not in a race against each other. We are in a race against the virus.
The USA keeps its stockpile of doses on the remote chance of some hiccup in supply of Pfizer / Moderna / Johnson and Johnson that delays it by a day or two in its target of 200 million doses in Biden’s first 100 days of office.
Although his target is ambitious, Biden is expected to over-achieve on his target. The US has already relseased 4 million doses to Mexico and Canada. Other countries also may have early unused doses they can release in a batch swap.
USA has 10s of millions of AstraZeneca doses sitting on shelves that it likely will never use
2 days of the doses for the USA / EU / UK / Canada ...
... to vaccinate all front-line health care workers and more in 20 countries not yet able to get early doses
In 20 years the USA alone trained 300,000 of these workers! Hard to replace.
Graph from Daily COVID-19 vaccine doses administered - explore to add / remove countries etc.
The USA is the largest world donor to the sub Saharan Africa health care system. In 20 years it trained more than 300,000 health workers. Many of them could get better paid jobs in the USA. Yet, doctors in sub Saharan Africa are dying unvaccinated because of their dedication to their own people, while their wealthier colleagues in the USA were vaccinated months ago.
Please share this article and the WHO videos or write your own articles, to help spread awareness of what is being done in our name. This is a big story for the weaker economies yet hardly talked about in the news of wealthy countries. I release this article as public domain, for details see the last section, so you can re-use any of the material as you like with no need to credit me.
We can so easily change this, save so many lives and help countries rapidly make the pandemic history, first the deaths and the hospitalizations, and then to suppress it right down. This benefits everyone worldwide, the USA included.
WHY IS THE USA NOT RELEASING ITS ASTRAZENECA DOSES? BIDEN’S PLEDGE
You can hear Biden make his pledge here:
The FDA has not yet approved AstraZeneca for emergency use but will likely approve them before 30th April. The doses are likely to be never used, as the USA has plenty of the Pfizer, Johnson and Johnson and Moderna vaccines.
However, in case there is some major issue in the supply such as a spoiled batch of Pfizer / Moderna / J & J, the AstraZeneca doses could fill that gap in the last week in April to be sure to achieve the target. So it seems to be a kind of insurance policy for their goal to achieve 200 million doses in the arms of Americans by 30th April 2021.
Batches do get spoiled, this is normal.
“All vaccines have batches that don’t meet specifications and need to be discarded, even vaccines with decades of experience. Vaccines involve biology even more than chemistry, and so there is variability. And human beings are involved at every step,”
However the USA is expected to achieve its target without the AstraZeneca doses.
The USA has already loaned 4 million AstraZeneca doses to Mexico and Canada. Press Briefing by Press Secretary Jen Psaki and Secretary of Housing and Urban Development Marcia L. Fudge, March 18, 2021 | The White House I.e. it’s going to give them some of their doses, in return for a promise to give doses back to the US later on when the US needs them.
This donation is enough to vaccinate an extra 2% of Mexico's population with their first dose of a vaccine. They were at less than 5% coverage at the time of the announcement.
USA loan of unused AstraZeneca doses is enough to vaccinate 2% of the Mexican population - to increase from nearly 4% to 6%
This donation of unused doses is going to make a significant difference to deaths in Mexico at these early stages when it is still vaccinating its elderly and vulnerable and frontline workers.
However the USA has many more to spare. The US has a stockpile of 10s of million AstraZeneca vaccines for approval a few weeks from now.
The USA could supply the WHO’s request all by itself by loaning 10 million more of its stockpiled unused doses of AstraZeneca to COVAX, to swap position in the queue of its batches with COVAX.
The USA would still have tens of millions of doses in its stockpile after doing that. I haven’t been able to find an exact figure of how many unused doses but “tens of millions” suggests that after loaning 10 million to the WHO it would still have at least 10 million and probably much more that it can use if some batch of Pfizer or Moderna or Johnson and Johnson doses is unexpectedly spoilt later this month.
USA has 29 days to deliver another 100 million vaccines
USA needs to average 3.45 million doses per day but is expected to achieve this without AstraZeneca
AstraZeneca will help in remote case it falls short by a few days at the end
But meanwhile health care workers in sub Saharan Africa are dying
And USA likely never needs the AstraZeneca doses
Is this the right priority? Biden is acting in your name.
Graph from: Coronavirus (COVID-19) Vaccinations - Statistics and Research (you can explore it to add / remove countries etc)
By the time the USA completes approval of AstraZeneca a few weeks from now, experts in the US say it may not even need them, but it has kept a stockpile “just in case” - mainly in case there are problems with its Pfizer / Moderna / Johnson and Johnson supplies to achieve its ambitious target.
The United States may only briefly, or never, need the AstraZeneca doses if they are cleared for emergency use.
“If we have a surplus, we’re going to share it with the rest of the world,” Mr. Biden told reporters on Wednesday, speaking generally about the U.S. vaccine supply. “We’re going to start off making sure Americans are taken care of first.”
The White House did not respond to a request for comment.
The administration’s hesitation is at least partly related to uncertainties with vaccine supply before a benchmark of late May laid down by President Biden when he promised enough vaccine doses to cover every adult in the United States. Vaccine production is notoriously complex and delicate, and problems like mold growth can interrupt a plant’s progress.
. The U.S. Is Sitting on Tens of Millions of Vaccine Doses the World Needs (New York Times)
USA HAS CONTRIBUTED $100 BILLION IN 20 YEARS AND TRAINED MORE THAN 300,000 OF THESE HEALTH WORKERS IN AFRICA NOW RISKING THEIR LIVES ON THE FRONT LINE TO FIGHT COVID
The USA is the largest donor in the world to the health care system of sub Saharan Africa, donating $100 billion in 20 years to build up their health system and training more than 300,000 health workers for their countries.
The US have donated to COVAX, a major donation of $4 billion doses. This will help sub Saharan Africa later this year. However, it's finance they need right now, not early doses.
These health care workers who are dying are also on the frontline saving COVID patients in Africa and also helping the country to be healthier working to fight other diseases like HIV, cholera, yellow fever etc.
A healthier Africa means a healthier workforce making the goods that the USA imports from Africa and a faster recovery from the pandemic globally.
A pandemic continuing for longer in Africa also means that American tourists will be wary about visiting countries with unvaccinated people and ongoing epidemics as the vaccine doesn’t 100% prevent you getting sick with COVID - and some Americans either refuse the vaccine or can’t be vaccinated - it directly increases their risk.
Also the longer the disease spreads amongst more people, the more the risk of new variants.
Finally the more intense community spread in the world, the greater the opportunity for the virus to jump to new animal reservoirs, which potentially could make it harder to control.
By saving the lives of health workers in Africa the USA can benefit the entire world.
FRONTLINE HEALTH WORKERS DYING AROUND THE WORLD AS THE USA DELAYS THE RELEASE OF DOSES FROM ITS STOCKPILE
This is the obituary of Professor James Gita Hakim, a specialist on HIV and foremost heart specialist at the university of Zimbabwe, who died in of COVID on 26th January;
Professor James Gita Hakim, HIV specialist, Foremost heart specialist at University of Zimbabwe
Died 26th January of COVID
Never offered vaccination against COVID
"He has left a void that will be so difficult to fill"
This man shouldn’t have had to die. We had vaccines for him. In storage, some of it not even going into people’s arms. Him and many others like him.
Just by sharing a percentage of our vaccine doses from the wealthier countries, we could have vaccinated all the health workers and doctors in Africa.
In Zimbabwe in 2018 (latest WHO data) there were 2.1 doctors per 10,000 in Zimbabwe.
Zimbabwe has only 2.1 doctors per 10,000, Professor Hakim was one of the few that stayed in his country instead of emigrating to high paid jobs elsewhere
With a population of 14.65 million that’s a little over 3000 doctors.
Just a few thousand doses would have made a huge difference to them, given early.
Africa already have so few doctors for their population compared to the USA. US states have between 19 and 45 doctors for every 10,000 people. In this graph blue is for active medical doctors and black for active doctors of osteopathic medicine.
Massachusetts, 44 doctors (MD) per 10,000.
Zimbabwe has 2 doctors per 10,000. Sub Saharan African doctors are dying right now of COVID
Mississippi 17 doctors (MD) per 10,000
Those 3000 doctors were unvaccinated when not only all health workers were vaccinated in the USA and EU / UK but in the UK we were already vaccinating everyone in their 60s. I am 66 and I got my vaccine at about the same time he died. I am almost zero risk. I can do my paid work (selling my own music software over the internet) and voluntary work (writing these blog posts and helping scared people over the internet) with no COVID risk.
But Professor James Gita Hakim couldn’t do that. As a medic who continued work on the frontline in clinical work alongside his research, his job was to work with people with COVID and he put his life at risk on the frontline like frontline health workers the world over, and he died of COVID.
Countries like Zimbabwe have a huge problem retaining health workers. I am sure professor Hakim could have got a far better paid job at some university in the USA. Someone like him would have been welcomed with open arms, and then he would have been vaccinated early. But he was dedicated to his people, stayed in Zimbabwe, so wasn’t offered a vaccine, and died.
It’s just not right. Of course we need to keep vaccinating everyone in the UK / US / EU but we need other countries to vaccinate too.
IT’S NOT FAIR, IT’S SIMPLY NOT FAIR
As Dr Mike Ryan of the WHO put it, it’s not fair, it’s simply not fair
Vaccines are a major thing. We don't know for sure yet if they're going to completely stop transmission, but what we do know is that they stop people dying. But we cannot have a situation where frontline workers, health workers, risking their lives every day, and the most vulnerable people are not accessing vaccine.
If we reach a situation in the developed world where perfectly healthy people have been vaccinated and those front-line workers and vulnerable people are not, it is not fair it is simply not fair.
Unless we start to bring all countries out of this, we won't recover together. There will be long-term economic impacts if we leave countries behind. We're all in this together. We've seen things over the last number of years that scare us all for the future. This pandemic, climate change, racism, authoritarianism. We simply need to now start doing the things that turn the tide on this.
This is one of the first opportunities we have this century to send a signal to the future that this will be a fairer world. We will share more, we will do more together to make our planet and our environment and our populations healthy.
US HAS DOSES AS PRE-ORDERS FOR 2021 TO VACCINATE ITS POPULATION THREE TIMES OVER AND STILL LEAVE ENOUGH TO VACCINATE OVER 12% OF THE REST OF THE WORLD
The US has already pre-ordered so many doses for 2021 that by the end of the year it will have excess enough to vaccinate 1.6 billion people outside of the US, or enough to fully vaccinate a fifth of the world population.
For the background, cites and the calculations see my
- . WHO Say We Can Vaccinate Entire World Fast If Wealthier Countries Permit Transfer Of Technology To Weaker Economies
The reason for such a huge excess is that it pre-ordered enough of multiple vaccines to vaccinate its population, and remarkably all the vaccines are being approved in stage 3. Even if the US vaccinates everyone in its population three times over, it will have excess doses at the end of 2021 for nearly a billion people, or about 12% of the world’s population. Biden says they will release unused doses for other countries but he hasn’t said when.
Meanwhile COVAX has only managed to secure enough doses to vaccinate 27% of the 90% of the world population that it supplies doses to. The US vaccines will make a huge difference to COVAX once it releases it to them later this year. The US has also donated $4 billion to COVAX making it by far the largest donor.
However the USA can do so much more right now to help them by swapping position in the queue for the AstraZeneca doses, which it might not even need a month from now. This will not harm the USA in any way and make an absolutely enormous difference to COVAX.
GENEROUS COUNTRIES - INDIA IS AN EXAMPLE TO THE WORLD ACCORDING TO DR TEDROS
India is getting bad press right now for temporary suspending exports of its doses of AstraZeneca to the wealthy countries such as the EU in order to cope with a sudden health crisis in its own country with rising cases of COVID which have been falling for a long time.
Journalists in the West are not explaining why India has done this. After a fall in cases for many months it is seeing a recent huge increase again, and vaccines can stop this.
Also deaths are starting to rise too.
Meanwhile India has given a little under 5 doses per 100 of its population compared to over 17 for the EU, nearly 50 for the USA and over 50 for the UK.
When asked about India’s suspension of exports, Dr Tedros opened up his reply by thanking India for its generosity, saying
If you would call just one country who has contributed more than any other country on Earth in terms of sharing vaccines it's India.
To thank India for its generosity - India has shared lots of vaccines globally. If you would call just one country who has contributed more than any other country on Earth in terms of sharing vaccines it's India. So I would like to thank its prime minister and its government for its support. India gives away half of its doses to its neighbours such as Bangladesh and Sri Lanka. It started doing that even well before it vaccinated all its frontline workers and the most at risk.
You can see that here, Bangladesh and Sri Lanka actually have a higher percentage vaccinated than India itself, although they are depending on free doses from India for their vaccinations.
If only other countries were as generous as India.
TO SHARE VACCINE TECHNOLOGY AND DONATE VACCINES IS RATIONAL, LOGICAL, SENSIBLE AND ETHICAL
These vaccines were made with tax payer dollars underwriting all risks. It normally costs around a billion dollars to make a new vaccine and a company risks losing all of that if it fails and has to recoup their investment. But these vaccines were developed by the vaccine companies through public funding at no financial risk to themselves. These are some of the top funded vaccines based on known funding:
The public have a say in what happens to these vaccines developed with their own funding, and what is happening right now is unethical, illogical, and harms the wealthy countries too, economically and adding to the risk of new variants.
This is not rational, and I think few in our populations would agree to what is being done in their name if they fully understood what was happening. I think few of the politicians fully understand either.
US IS MAJOR FINANCIAL DONOR TO COVAX
One of President Biden's first acts in office was to sign up the US to Covax.
Covax has raised $6bn (£4.3bn), of which the USA provided $4 billion, or two thirds of the COVAX doses.
This is great. Though the scheme says it needs at least another $2bn (£1.4bn) to meet its target for 2021. The rest are optional doses for now. It has the doses secured, but only as options and can’t yet pay for them.
But surely the funding will come in. The problem is though, that early doses are being stockpiled and pre-ordered by wealthy countries.
PLENTY OF VACCINES FOR THE FUTURE
Some people will tell you we can never vaccinate the whole world, in less than several years (like the smallpox vaccine which was a very slow rollout over the entire world). But this is nonsense, fails basic fact check.
We will have plenty of vaccines later in the year for most of the world population already in 2021.
This graph is for both secured and optioned doses. Some of these are not yet approved but so far all the vaccines that have entered phase 3 were approved. The Johnson and Johnson one needs just one dose most of the others need two doses.It’s clear that the US, and EU together have secured enough doses together, to more than double the COVAX supply even after they have vaccinated everyone in their countries.
The vaccine market dashboard is here:
DOSES AS NUMBERS OF PEOPLE - HOW THE WORLD CAN VACCINATE EVERYONE IN 2021 AND VACCINATE TWO BILLION TWICE, IF ALL LEADING VACCINES PASS APPROVAL
Here I have converted those total doses into numbers of people by taking account of the Jansen and Jansen vaccine which requires only one dose. Based on that:
- COVAX has secured enough doses for 2021 for 2.03 billion people.
Some of those depend on more funding to purchase them, which they are likely to get.
- US has secured enough for 1.96 billion people.
Based on its secured doses, the US could fully vaccinate all its citizens twice in 2021 and have enough left over to fully vaccinate 1.3 billion people outside the US.
- EU has secured enough for 1.495 billion people.
Based on its secured doses, the EU could fully vaccinate all its citizens twice in 2021 and have enough left over to fully vaccinate 600 million people in the rest of the world.
- World total - enough to vaccinate 5.45 billion people in 2021 leaving only 2.45 billion unvaccinated.
If the US and EU fully vaccinate everyone twice over, their excess doses are still enough to increase the COVAX total from 2.03 billion to 3.63 billion people in the rest of the world.
Even if a billion people are fully vaccinated twice in 2021, with a second full vaccination in the fall, the world can still fully vaccinate 4.95 billion out of 7.9 billion or 62.7% of the world population at least once in 2021.
But we can make many more than these advance orders suggest. So far there have been no failures of any vaccines at phase 2 or phase 3, a remarkable 100% record. It’s likely that all the vaccines are approved.
- Total vaccine capacity in 2021, if all the vaccines are approved - 11.15 billion.
That’s enough doses in the pipeline, if all the leading vaccines are approved, to fully vaccinate the entire world population of 7.9 billion and then fully vaccinate 2.25 billion people a second time - e.g. a second vaccination in the fall for new variants.
WORKING OUT THE NUMBERS FOR DOSES
COVAX has 3.56 billion doses, 500 million from Jansen and Jansen only single doses so that's enough for 1.53 + 0.5 = 2.03 billion people. Some of those depend on more funding to secure them.
The US has 3.46 billion doses, 0.4 billion Jansen so that's enough for 1.56 billion + 0.4 billion = 1.96 billion people.
EU has 2.79 billion doses, again 0.4 billion for Jansen so that's enough for 1.195 + 0.4 = 1.495 billion people.
Total secured by all countries10.6 billion doses, of those 1.3 billion from Jansen, enough to vaccinate 8.3/2 + 1.3 = 5.45 billion
Total capacity is 21 billion doses for 2021 - that's including vaccines that are still in phase 3 but all the vaccines in phase 3 so far have been approved.
That’s enough for at least 11.15 billion (21–1.3)/2 + 1.3 (more than that since some of the other vaccines are single dose)
Now look at the data for 2022 and the capacity is 37.2 billion, again if all the leading vaccines are approved. That’s enough for two doses each for 4.7 times the entire world population.
- World total - enough to vaccinate 5.45 billion people in 2021 leaving only 2.45 billion unvaccinated.
So, as long as we fund it:
- In 2022 we will have vaccine capacity to fully vaccinate the entire world population every quarter
It's only funding stands in the way not technology.
WHO ARE ALSO CALLING ON THE WEALTHIER COUNTRIES TO EMPOWER WEAKER ECONOMIES TO MAKE THEIR OWN VACCINES
The WHO call say we can vaccinate the world very fast if we can share technology from wealthy countries to weaker economies, as is already happening with AstraZeneca and Novavax.
India and South Korea are already making AstraZeneca vaccines, Brazil has just started, and Japan, South Africa, and Australia will also be making them soon.
The EU is benefiting from this technology transfer when it buys its doses of AstraZeneca from the Serum institute in India. The Serum institute can make AstraZeneca and its own native doses but can’t make J & J, Pfizer, Moderna, Novavax or any of the other vaccines.
We see the value of the AstraZeneca approach acutely in Brazil.
Brazil has its own vaccine manufacture plant and they built a new huge vaccine factory which opened in early 2021 to make the COVID vaccine as well as other vaccines.
Brazil’s planned new vaccine factory which opened in early 2021 to make Astrazeneca’s vaccine. It is designed to make the AstraZeneca vaccine, and they started the project already, before the vaccine was approved.
This factory is already making vaccines for Brazilians and will make 100 million vaccines by July 2021. This will have a huge impact on the current desperate situation in Brazil.
Brazil also has vaccines from other countries and using them has vaccinated 8% of their population already. They reached 4% already at start of March so should see a fall off in the deaths amongst the vaccinated by about mid April - it's about a six weeks delay from the vaccination first dose to the effect on deaths.
It's a really rough time in Brazil. Cases still rising fast, cases per day - many not taking precautions and intensive care beds full. It's going to get worse for a month or so but then then deaths and the hospitalizations / intensive care should start to ease off a bit. Meanwhile, this is one chink of good news for the Brazilians.
Novavax will follow the same approach. Like AstraZeneca, Novavax has been a CEPI funding recipient partnering with Takeda in Japan, SK Bioscience in South Korea, Baxter in Germany, and Biofabri in Spain if its vaccine is approved.
Novavax has good early results. It has 86% efficacy and like the Johnson and Johnson vaccine, it is effective against the variants too, including the South Africa variant.
Novavax works in a new way from the other vaccines, instead of triggering cells to make the protein spikes, it has the protein spikes already stabilized to trigger the antibodies and immune reaction to fight COVID. It is the first vaccine nearing approval to use this new technology - and the results suggest it works well.
So there are positive developments here.
Why though, is our most effective vaccine so far, Pfizer, only made in the wealthier countries? It would not even impact on their bottom line to transfer technology since they would continue to sell it at full price to the wealthier countries - and remember they developed it with public funding in Germany? Or Moderna, developed with Operation Warp Speed funding in the US?
It’s the same with the therapeutics. All countries can afford the generic drug dexamethasone which significantly reduces deaths for those needing oxygen and intensive care, but not many countries will be able to afford more expensive drugs such as the antiinflamatory antibody tocilizumab (promising new drug from a UK trial).
We have over 400 therapeutics in clinical trials, some of them very promising. Even if less than 1 in 10 pass phase 3 we may well have several dozen new therapeutics to use with COVID by the end of the year. But some of those are likely to be available only to wealthy countries that can afford them unless we do something to change this.
. Promising landscape for therapeutics - expect several more by the end of 2021 - but we can’t know in advance that any particular drug will be a winner - there’s a reason we need to do clinical trials for promising drugs
As more drugs are approved for therapeutics then some will be new expensive drugs that may be very effective, but not be available to the weaker economies. This happened with the AIDS therapeutics which eventually did get to the weaker economies but much later than for the wealthy countries. The WHO are concerned it may happen with COVID therapeutics too, and again this benefits nobody.
There are many solutions proposed here. The WHO has already tried most of them - but it needs the wealthy countries to participate. There is even a mechanism that a weaker economy can use to make drugs for itself in an emergency situation such as a pandemic, through issuing a compulsory license. This compulsory license lets a weaker economy make the therapeutics for itself and for other weaker economies that invoke TRIPS - it doesn’t let them sell low cost drugs to the stronger economies. They are also expected to give fair compensation to the owner of the patent on the therapeutics (which obviously will need to be much less for a weaker economy).
This is part of the World Trade Organization rules, called TRIPS, but countries are nervous about using it because of fear of sanctions, expensive legal cases, and the wealthier countries withdrawing supplies of other drugs if they issue compulsory licenses (all those things have happened in the past).
The wealthy countries, such as US, UK and Canada are blocking this proposal by group of countries lead by India and South Africa to use TRIPS to make their own vaccines and therapeutics.
As Dr Tedros said:
Many countries with vaccine manufacturing capacity can start producing their own vaccines by waiving intellectual property rights, as provided for in the TRIPS agreement.
Those provisions are there for use in emergencies. If now is not a time to use them, then when? This is unprecedented time, and WHO believes that this is a time to trigger that provision and waive patent rights.
This is not even being discussed in wealthy economies. I watch the news regularly on the BBC in the UK and read the news on the BBC website - and to my knowledge they haven’t yet mentioned TRIPS. Yet it is headline news in the weaker economies that the wealthier countries are blocking use of TRIPS to permit the weaker economies to make therapeutics and vaccines with compulsory licenses for the duration of the emergency.
Okay - if they want to block TRIPS - what is THEIR solution? For instance there was a proposal in the USA for a new “global operation warp speed” to apply the proven methods of Trump’s Operation Warp Speed to the entire world to increase vaccine capacity. But this proposal has not succeeded either and is not even discussed.
But we are in this together, the world can stop this pandemic together and empowering weaker economies to make their own vaccines is one of the most effective things we can do right now to end it fast.
PERSPECTIVE OF OUR FUTURE CIVILIZATION LOOKING BACK AT OUR TIMES 100,000 YEARS FROM NOW
Skip to next section: Many promising vaccine developments
This is another way of thinking bout it. Our generations great, great, great … grandchildren, 3000 generations in the future likely still have access to the historical records of our time. For them our technology will seem more primitive than paper tape and punched cards seem to us. We will seem to be little advanced beyond stone axes and the early technology to be able to make a fire by rubbing two sticks together.
They won’t call us a civilization for our technology.They won’t be impressed by our technology.
What they will call civilized is our ethics, human rights, and our basic rationality and logic. They will see our response to the COVID pandemic and to the climate crisis as the first beginnings of true civilization and of true species wide rationality.
Let’s help make this happen soon!
MANY PROMISING VACCINE DEVELOPMENTS
We will likely have the pandemic largely over later this year, with the very effective vaccines, especially if we ramp up vaccine production as the WHO suggest.
Or we will be well over it some time in 2022, when, so long as we continue the funding, we'll be able to fully vaccinate everyone in the world every three months.
These are just first generation vaccines so far. The Pfizer vaccine is already 94% effective at stopping transmission of the B 1.1.7 variant in Israel. This is far more effective than flu vaccines, typically 40 to 60% effective.
This is our first ever experience of a coronavirus vaccine, an unrelated virus to flu, and it seems to have an effectiveness closer to a measles vaccine than a flu vaccine.
At that level of effectiveness, then COVID would be classified as an eradicable virus using the vaccine alone. If everyone in a population is vaccinated with the Pfizer vaccine, then 94% effectiveness in stopping transmission is more than enough to stop it. Though every community has to have that level of coverage. E.g. Israel can’t eradicate it using vaccines alone until the Palestinians in the West Bank are also vaccinated - and we do have to vaccinate children, before we can eliminate it using vaccines alone - otherwise it could be eliminated in adults but continue to circulate in children, occasionally leaping to adults.
IS COVID AN ERADICABLE DISEASE?
In the Social media Q/A yesterday, Dr Mike Ryan and Dr Maria Van Kerkhove were asked if we can eradicate COVID. You can listen to their answers here:https://youtu.be/SLGKNAc9VZQ?t=1993
They talk about how at present their aim is suppression, that for the foreseeable future it can’t be eradicated but that we can suppress it right down from community transmission, to clusters, to sporadic cases and then to keep the sporadic cases down suppressing them immediately as they arise, as for instance Australia and New Zealand are doing.
But he talks about how there is good data on vaccines stopping transmission and that in the future we can have second and third generation vaccines, including also ones delivered nasally which means the vaccine is delivered to the place where defence is most needed.
There, dr Mike Ryan mentions criteria for an eradicable disease. But he doesn’t go into the details. So, I thought it would be interesting to look at the criteria for an eradicable disease
- It needs to be and an infectious disease
- We need to have ways to either prevent or treat the infection
Both of those conditions are satisfied with COVID.
Then these requirements make eradication more likely:
- How many pathogens cause the disease?
- Does the disease-causing pathogen have one or more hosts?
[it likely has another host, perhaps pangolins, not yet known]
- Are there any identifiable symptoms of the disease?
[yes, diagnostic tests available]
- Has regional disease elimination proven possible?
[yes, in New Zealand, Australia, Taiwan, Vietnam and China]
See: 20% of the world population is like this already - without a vaccine - what can we learn from them?
- Is the perceived disease burden high and is financial and political support available?
. Eradication of Diseases
Regional elimination there means eliminated local transmission, only imported cases.
This is our progress towards eradicating several diseases
COVID would seem to satisfy the requirements for an eradicable disease, except, that it will likely persist in its original animal host. This is where it is so important to find the origins of the virus, as then we can prevent it jumping to humans again. It also is why it is so important to do what we can to prevent it establishing new animal reservoirs. The longer the pandemic continues, the greater the chance of it establishing wild animal reservoirs.
FUTURE IMPROVEMENTS IN VACCINES - 2P TWEAK AND HEXAPRO VARIATION
Future generations of vaccine will be more effective, e.g. the hexapro modification should end up with the mRNA from the Pfizer vaccine producing ten times as many stabilized spikes once it enters a cell and the vaccine will be stable at fridge temperatures for at lest several days, able to be heated to 55 C and able to survive three freeze thaw cycles.
. The 2P tweak - Why Pfizer and Moderna are so effective as vaccines - this tweak could be used by other vaccines like AstraZeneca - and 2nd generation vaccines may use the even more effective Hexapro tweak published July 2020
MIX AND MATCH OF VACCINES
Other things we can do include mix and match of vaccines with a different vaccine for the first and second dose. This has worked with other vaccines in the past and is expected to work with the COVID vaccines with several trials underway including mixing Pfizer with AstraZeneca and the AstraZeneca with Sputnik V.
All the medical evidence we have from mixing vaccines suggests it boosts immunity. It’s a rare thing to do mainly because most diseases only have one vaccine in regular use. COVID is unprecedented with so many vaccines for a single disease.
So we don’t have the data yet but expert opinion is that likely mix and match like this makes the immune system response far stronger.
Ross Kedl, PhD, a vaccine researcher and professor of immunology at the University of Colorado in Aurora, says that mixing is likely a better option, as interviewed by Medscape:
"Each vaccine has a number of components in it that influence immunity in various ways, but between the two of them, they only have one component that is similar.
In the case of the coronavirus vaccines, the one thing both have in common is the spike protein from SARS-CoV-2.
In essence, this gives you two shots at generating immunity against the one thing in each vaccine you care most about, but only one shot for the other vaccine components in each platform, resulting in an amplified response against the common target."
So - take the AstraZeneca and Pfizer vaccines. Both have the spike protein. But the AstraZeneca also has a harmless adenovirus from chimps, and Pfizer also has a way of packaging its vaccine to get it to the cells. The immune system develops a response to both the vaccine and the parcel that delivers it. But if you use two different types of parcel to deliver the same spike then the second dose will produce an amplified response only for the thing in common, the spike.
He agrees that it’s best to stick with one manufacturer for now but adds
"I would be very surprised if we didn't move to a mixing of vaccine platforms for the population," .
The UK trial will also study mixing other vaccines as they are approved for the UK.
OTHER VACCINES THAT USE DIFFERENT TECHNOLOGIES
We also have many more vaccines on their way. Prima facie [on the face of it, subject to further evidence] it’s unlikely the first vaccine to be approved, Pfizer, is the best of all the first generation vaccines.
It’s also unlikely that the specific doses and interval used for Pfizer are optimal for that vaccine.
DEALING WITH THE VARIANTS
As for the variants then we can use vaccines with multiple variants in the same vaccine shot.
Moderna, Pfizer, and AstraZeneca are already testing various mixes including a booster to stop a variant after the original full vaccination, a second dose for a variant after a first dose of the original, and multiple variants in the same shot.
Novavax will be testing a “bivalent” vaccine with vaccinating against the original variant and then the South African variant in April.
And the UK is also saying that by the fall they will have trivalent vaccines, able to vaccinate against three variants in a single shot.
Then we have over 400 therapeutics in clinical trials, some of them very promising. Even if less than 1 in 10 pass phase 3 we may well have several dozen new therapeutics to use with COVID by the end of the year.
. Promising landscape for therapeutics - expect several more by the end of 2021 - but we can’t know in advance that any particular drug will be a winner - there’s a reason we need to do clinical trials for promising drugs
WE NEED TO DO PUBLIC HEALTH MEASURES TOO, #DOITALL AND WE CAN MAKE THIS PANDEMIC HISTORY
As Dr Mike Ryan says, if we follow the example of Australia, and add vaccine equity as well, we can make this pandemic history.
As the WHO said in one of their earlier Social Media Q/As, we can all be super heroes - we already have practical solutions we can use to bring down this pandemic quickly. We have a tool kit full of these, not magical but practical solutions we can apply right now, and now we have vaccination too, to add to our toolkit.
COVID-19 TOOLBOX - Face coverings, Contact tracing, Vaccination [when ready], Hand Hygiene, Quarantine, Mass Testing, Physical distancing, Stay Informed.
#DoItAll - Not magic - Practical
Spiderman graphic from here
This is a WHO tweet about the need to #DOITALL as we vaccinate:
#COVID19 vaccines are part of the solution, but alone they won’t end the pandemic. Please keep:
↔️ physical distancing