It is not yet clear when or how the future vaccine against covid-19 will arrive. But the debate about its cast is here. The World Health Organization (WHO) has put two proposals on the table. The first, to prioritize the vaccination of health workers, risk groups and those over 65. And a second, to distribute doses according to the population of each country. Now, a score of experts in philosophy and ethics claim through the journal Science that the distribution of vaccines prioritize the most disadvantaged nations, where the pandemic can cause more deaths and more economic damage.
The debate on the distribution of future vaccines against covid-19 intensifies with the expectation that the first doses could arrive at the end of this year. At least that is how it has been announced by some of the companies that are leading this race and that are already testing their injections on a large scale. Meanwhile, governments around the world are fighting to ensure these drugs. China and Russia have already patented their respective formulas, although their safety and effectiveness have yet to be proven. And, from the United States, Trump says he will have a vaccine ready before the presidential elections in November.
“We are in a dangerous rush to see who is the first to reach the goal of the vaccine,” warns a recent editorial in the journal Science. The competition to see which country is the first to patent an injection or who is the one that reserves the most doses has turned into a sentiment of “vaccine nationalism”, which is reflected both in politics and in public opinion. But “the right of people to access resources that save lives should not depend on their nationality”, claim the experts from an ethical perspective.
This new proposal, dubbed the Fair priority model, calls for the first vaccines to be used to reduce mortality. In other words, it would be necessary to vaccinate first the groups that, in case of contracting the disease, have a greater risk of developing serious sequelae or dying. Once these bands are protected, the next doses should go to the groups that are most affected by the economic crisis derived from the pandemic and that need to resume their activity. And, finally, the third round of vaccines would go to the bulk of the population. Always prioritizing the countries with the highest infection rate. At the end of this process, between 60% and 70% of the population should be immunized.
This approach implies that, for example, countries that succeed in curbing infections should share their vaccines with countries where the virus continues to rise. Because, deep down, the pandemic is not limited to what happens within each border, but it is a global problem. This new proposal for the fair distribution of injections, therefore, poses a more supportive alternative to the collection and hoarding of vaccines that some states are already encouraging.
The possible application of this proposal collides with a much more pragmatic reality, in which the race for injections advances at two speeds. On the one hand, the countries with more purchasing power engage in the pre-sale of a product that is not yet ready. And, on the other, international organizations are working to ensure access to this resource for low- and middle-income countries. The bioethical debate on the distribution of injections would only apply in this second group.
Right now, the fight for the vaccine continues to rage in laboratories and clinical trials. Once you have a safe and effective formula, you will be faced with the challenge of large-scale production and distribution. It will be then when the ethical debate goes from theory to practice. It is estimated that seven to fourteen billion immunizations could be needed, depending on whether one or two doses are needed, to immunize the bulk of the population. And, in addition, it must be taken into account that probably the first vaccines that come out will not be 100% effective.
“The discussion about the future vaccine should take into account that right now the degree of uncertainty is still very great. It is difficult to establish priorities if we do not know what vaccine it will be ”, explains Rafael Vilasanjuan, member of the board of directors of GAVI (the Global Alliance for Vaccination). “What if the vaccine that comes out has not been tested in people over 65? What if we know that it is 80% effective in children and 20% in adults? There will be vaccines that are more effective in one segment of the population than another. All these factors will determine the distribution ”, argues the expert, also director of the Department of Global Analysis and Development of the Barcelona Institute of Global Health (ISGlobal), a center promoted by the La Caixa Foundation.
There are currently more than 30 vaccines that are being tested in humans. Six of these are already in the final phase of clinical trials. It is not clear which will be the first to get the green light for distribution. But, according to Vilasanjuan argues, everything indicates that next year there will be several vaccines in circulation around the world. Likewise, it is likely that within each country different types of injections are provided depending on the population, timing, or availability.
Price is important
“It is essential to ensure that all countries have access to a vaccine. This also has to do with the price at which it is sold. If the doses are worth more than 10 euros, the vaccine would not be available to almost any African country ”, he argues. In GAVI, in fact, a fund has already been opened so that the future vaccine against covid-19 reaches where it is needed.
The philosophy in any case remains the same. If the future vaccine against covid-19 does not reach everyone, no one will be really protected.