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As governments, research organizations, and pharmaceutical companies scramble to find viable vaccines for the novel coronavirus, a recent survey published in The Lancet found that only 67 percent of the United States (US) population I would accept a vaccine for COVID-19 if recommended. for them. Within weeks of the survey, a major trial of a vaccine at Oxford University was halted after one participant fell ill.
This can confirm the suspicions of those who fear vaccines. However, the pause in vaccine development after one of the 30,000 participants fell ill shows that researchers are following strict safety protocols. The question is: once vaccines hit the market, what then? From the perspective of maximum social welfare, everyone should be vaccinated.
Globally, as of September 19, 2020, there have been more than 30.6 million confirmed cases of COVID-19. Asia has contributed some 9.2 million cases, surpassing Europe with 4.3 million cases. More than 956,000 people have died and the numbers continue to rise. Estimates of the cost to the world economy range from $ 5.5 trillion to $ 8.8 trillion, according to the Asian Development Bank (ADB).
Sadly, no one knows if or when humans can fully control this pandemic, and the world can return to normal. Prominent research institutes and Big Pharma have been working fiercely to develop the antivirus, and some of them are now reaching Phase III, the last stage of clinical trials. The pandemic has significantly changed the way vaccines are developed and approved, accelerating development from years to months.
7.5 billion doses
When a vaccine is ready for mass production, the world will need more than 7.5 billion doses. And if each person needs two doses, that number doubles. It’s a massive demand that producers can’t meet by 2021, even if the vaccines get approval by the end of 2020. Equitable vaccine allocation will be the most challenging task due to supply shortages.
Two critical questions arise: Should the government make it mandatory? How should COVID-19 vaccines be assigned?
For the first question, we can apply the economic theory of “meritorious goods”. Merit goods are characterized by their meritorious impact and, although they are not usually public goods, public funds can be used to provide them for mass consumption. Economic discourses may question the position of merit assets, but public policy applies them in practice. Primary education and health care are among the most common assets of merit recognized in many countries, especially in important welfare states.
How does the COVID-19 vaccine fit into this analysis?
Arguments in favor of coercion to consume worthy goods include the potential for people to act irrationally, increased consumption of goods important to beneficiaries, and maximization of social welfare. Social welfare is the most critical argument for the COVID-19 vaccine seen as a good of merit. Culyer, a leading British health economist, argued that externalities in merit goods could serve as a justification for the government to intervene in the market. The global loss from the COVID-19 pandemic is huge and will continue to grow if the world does not stop its progress.
There are both positive and negative externalities in the imposition of the COVID-19 vaccine. Positive externalities include additional protection for large populations, which can reduce the transmission of infections, thus reducing the burden on healthcare workers and freeing up spaces in hospitals for non-COVID-19 patients.
It also reduces the public and private costs of treating COVID-19 patients and prevents loss of productivity for infected people. Treatment costs for a COVID-19 patient could run into the tens of thousands of dollars, far higher than the vaccine’s maximum estimated price of $ 40 per dose.
On the other hand, the negative externalities of not being vaccinated come mainly from negative impacts. An unvaccinated person potentially becomes a virus transmitter and infects other people who are not yet vaccinated and those who have been vaccinated but have not yet developed the antibodies. The economic costs include: high treatment costs, lost productivity, overwhelmed healthcare workers, and displacing patients who do not have COVID-19.
Mandatory vaccination is concerned with maximizing social welfare. It is not about the government overriding individual preference for the risk of isolated impacts. There is no room for selfish choices at this stage of the pandemic. Each country also has a responsibility to control the virus. Especially since global connectivity is essential for economies, while the period of immunity is still unknown, not containing this virus in one country means a higher risk of unleashing the next pandemic wave in others.
The World Health Organization (WHO), together with the Coalition for Epidemic Preparedness Innovations (CEPI) and Gavi, the Vaccine Alliance, have formed COVAX, an initiative that aims to accelerate the development and manufacture of COVID-19 vaccines, and guarantee equity. and equitable access globally. Some countries have secured purchase agreements with several large pharmaceutical companies currently developing COVID-19 vaccines, through COVAX or independently. However, given limited supplies and the critical nature of time, there are still concerns about the race between high-income economies and the risk of leaving low-income economies behind.
Distributing resources
The limited and incremental production of COVID-19 vaccines poses difficult challenges in the criteria of ‘fair and equitable access’. Based on some assumptions, WHO chief scientist Soumya Swaminathan expects that there will be 2 billion doses available worldwide by the end of 2021. To achieve herd immunity, the portion of the population with immunity must be less than 70 to 90 percent. In other words, at least 5.5 billion people must be vaccinated for global herd immunity, and if two doses per recipient are required, 11 billion doses will be required. They are not likely to reach 11 billion doses by 2021. This limitation requires close and genuine cooperation between countries. The provision and distribution of vaccines is a collective responsibility because this is not a race that produces a single winner.
Paying the price for the vaccine is a major hurdle for many citizens in developing economies, many of whom are already struggling through the protracted pandemic. Another challenge comes from people who are unwilling to get the vaccine because of their beliefs. Combining both challenges means a closed door to achieve herd protection. This, in turn, will not only hurt people through illness, but also through an economic recession.
Neither tourists nor companies and investors will arrive in a country with a high rate of COVID-19 infections. And citizens of high-risk COVID-19 countries will be barred from entering pandemic-free countries. It will also drain the health budgets of the hardest hit countries because the costs of treatment are much higher than the price of COVID-19 vaccine injections. It is clear that the protection of public health is intertwined with the goals of socioeconomic recovery.
If the authorities are willing to consider the COVID-19 vaccine as a worthwhile good and provide a mass vaccination, how should it be done?
Since vaccines will be available only incrementally, an effective way to allocate scarce assets is required to maximize transmission control and minimize deaths and treatment costs. Emmanuel et al. In the New England Journal of Medicine, he proposed four criteria of ethical values used to ration scarce health resources, namely: (1) maximize the benefits produced by scarce resources, (2) treat people equally, (3) ) promote and reward instrumental value, and (4) prioritize the most disadvantaged.
The authors presented six specific recommendations for the allocation of medical resources during the COVID-19 pandemic: maximize benefits; prioritize health workers; do not give in order of arrival; respond to tests; acknowledge participation in research; and apply the same principles to all patients with COVID-19 and without COVID-19.
Country experts can build a multi-valued framework for resource allocation, including COVID-19 vaccines, using these ethical values as a reference. Governments must maintain or develop at least three things: (1) transparent and equitable vaccine allocation drawn from the framework initiated by the expert panel and open to public discussion; (2) the vaccine logistics system, which includes production, storage, projection, transportation and distribution, and contingency scenarios; and (3) complete the regulatory compliance necessary to work in the planning and implementation phases, including the participation of subnational governments, private entities, and international communities.
For countries with challenging connectivity, they need to pay close attention to distribution and storage. Vaccine transport and storage generally requires a specific controlled environment, which can be prepared by responsible stakeholders from now on. Governments can think of the best way to set up the vaccine logistics system. You may also need to secure agreements with potential contractors, build additional facilities, and upgrade the skills of key people.
Time is ticking, and in the midst of health emergencies, the government must maintain its focus on protecting public health to protect its socioeconomic well-being.
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