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This month Australia signed a partnership with AstraZeneca, the pharmaceutical company behind the Covid-19 vaccine proposed by the University of Oxford, securing rights to locally manufacture the vaccine, should it meet safety and efficacy requirements. The Oxford Vaccine Group has been one of the pioneers in the global race to develop a Covid-19 vaccine, with at least 25 additional vaccine candidates in clinical trials globally and more than 100 in earlier stages of development.
But as the prospects for a viable vaccine become increasingly accessible, the focus is now shifting to how a Covid vaccination strategy should and would be.
While Australian leaders have set an impressive target for 95% vaccine coverage, limitations in manufacturing and distribution are likely to cause a phased rollout of any new vaccine. And if so, as we seek to address a disease that unashamedly discriminates based on socioeconomic class, race, and comorbidity, how do we choose who will get vaccinated first?
Three key considerations should guide an effective and equitable vaccine distribution strategy for Australia and how Australia helps its neighbors.
An imperfect vaccine: letting go of the silver bullet idea
Unlike the panacea many wish for, any Covid-19 vaccine that hits the market is likely to be flawed at best. This requires a paradigm shift in our expectations for a Covid vaccination strategy.
The influenza vaccine is probably the most useful comparison: with an estimated effectiveness between 30% and 60% (in preventing influenza presentations at the local doctor or hospital), and requires an annual vaccination to reflect the changes in circulating viral strains, fluvax is not a miracle solution in preventing influenza. Coronavirus vaccines are likely to face similar limitations in terms of efficacy and duration of protective effect.
A Covid-19 vaccination strategy will be far from a one-time wonder, and will instead require a long-term commitment to viral suppression.
However, unlike fluvax, the goal of a vaccination strategy against Covid-19 will be to achieve herd immunity, where the proportion of individuals with immunity to the virus is high enough to stop viral transmission. Estimates to date have indicated that around 2 in 3 people would need to be immune to Covid-19 to achieve herd immunity.
It is not yet clear how many people would need to receive the vaccine to reach this level of protective immunity, and it depends on the effectiveness of the vaccine to generate a protective immune response. Simulations from the US suggest that for a vaccine to be 80% effective, 75% of people would need to be vaccinated. However, a less effective vaccine may require almost complete coverage in the community, raising a broader question about the ethics of requiring vaccination.
The evidence to date also suggests that the immune response to vaccination is likely to decline over time, meaning that regular repeat vaccinations are likely to be necessary. In either sense, a Covid-19 vaccination strategy will be far from a one-time wonder, and will instead require a long-term commitment to viral suppression.
An uneven virus: who gets the vaccine first?
Viruses may not be able to choose their hosts, but the last six months have shown without reservation that Covid-19 discriminates. Indeed, data from the US, where the virus has run an aggressive and widely spread course, has revealed higher incidence rates of Covid-19 among racial and ethnic minority groups and individuals from lower socioeconomic strata, with outbreaks concentrates that occur in prisons and the elderly. care facilities.
It is in this context of inequity that the focus is now shifting towards developing a priority model to distribute a Covid-19 vaccine in Australia. Traditional approaches to planning mass vaccination for pandemics such as influenza have focused on vaccinating people at increased risk of severe infection and mortality (such as those with underlying illnesses) and people such as healthcare workers who have a high risk of exposure and can serve as vectors. for transmission.
The models for a Covid-19 vaccine are largely based on these principles, but are undoubtedly shrouded in ethical complexity. Even if a tiered approach to vaccine access is designed, such as prioritizing essential workers or people with multiple medical problems, constant attention will be needed to ensure that people from minority groups are not left behind. This will depend on a broad engagement with community leaders to ensure accessible, culturally appropriate (and correctly translated) information, and will require that vaccine distribution go hand in hand with a comprehensive surveillance strategy.
Neighbor Duties: Investing in Asia-Pacific Leadership
Finally, at a time when national introspection has become the norm, Australia has the opportunity to assert itself as a leader and advocate within the Asia-Pacific.
Amid growing geopolitical uncertainty, Australian leadership in supporting vaccine access and distribution for Asia-Pacific neighbors is likely to advance broader diplomatic interests, as well as demonstrate a commitment to health equity. global.
While Australia has successfully negotiated access to the Oxford vaccine intellectual property, lower “ability to pay” and / or lack of manufacturing capacity may prevent similar access for other nations. Australia has indicated its willingness to implement a working vaccine in the Pacific island nations and in the countries of Southeast Asia. Taking advantage of this collaborative opportunity has the potential to build stronger links between Asia and the Pacific and, at the same time, can enable earlier resumption of travel within the region.
Indeed, as Australia is on the brink of the next phase of the Covid challenge, the decisions we make in developing our vaccine strategy will be best measured by those we leave behind.
