Vaccines for covid-19: reasons for hope, but first for concern

Covid-19 has spread around the world causing fear and global economic disruption. The rate of transmission has not been reduced effectively and natural herd immunity is currently far from a reality. All hopes are being placed on the development of a vaccine. This process is happening remarkably quicklythere are 167 vaccines candidates, 30 of which are in clinical evaluation

The World Health Organization (WHO) has exercised some leadership, and launched the Access to COVID 19 Tools Accelerator (ACT) in April 2020. The vaccines pillar of ACT’s efforts is targeted at ensuring promising, safe, and effective vaccines, appropriate for regulated production.

This is commendable, but it’s not enough. Rather than opting for international collaboration, which would have better harnessed collective scientific energy, an international commercial race has been set up to see who develops a vaccine first.

We believe that pharmaceutical companies should not be announcing preliminary results. This only raises the companies’ share on the stock market. Fundamental stages of the vaccine development process must not be skipped or under-reported, as we saw when the Russian president announced that it was the first country with a vaccine. The UK and US have ordered enough doses of vaccine for about 5x their population, the EU around 3x the population; all this limiting access to vaccination for those most in need globally. This mass pre-ordering also runs a risk for the buyers: invest all your budget in a vaccine that proves unsafe, or ineffective, and how do you afford the next ones in line that do work? This possibility has been thrown into sharp relief recently with concerns over the Astra-Zeneca vaccine’s safety. 

We are facing not only commercial interests, but also nationalism spiced up by the politics of the crisis. Our aim should be to ensure substantial evidence where the benefits outweigh the risks. At present, the situation in which vaccines are developed is medically, socially, and morally unclear, and we need an ethical way forward

To minimise the problems and maximise the benefits associated with covid-19 vaccines, we think the following are essential.

Research and development

Reliable information on safety and efficacy is indispensable. The WHO, or a delegated entity without commercial or political interests linked to the country behind the vaccine, should monitor and report on vaccine development to ensure there are no inappropriate shortcuts. 

Given that vaccines may contain preservatives, adjuvants, or additives (to prevent contamination, enhance antigen-specific immune responses and stabilise live, attenuated viruses), the detailed composition of every covid-19 vaccine should be transparent to ensure the best fit of candidates for each vaccine. 

Assuming there will be several final vaccines to choose from, thorough protocols should be developed detailing safety, side-effects, effectiveness and composition to tailor who will receive what (by age group and vulnerability). ​ 

Access and surveillance

To safeguard fair access to vaccines once they are available, we need coordination and strategies. At the international level, the European Union, WHO and United Nations should play an active role in ensuring universal, equal access to covid-19 vaccines

Given that presumably vaccine(s) will have to be distributed progressively within each country, then we will have to define who is vaccinated first, for example prioritising vulnerable groups and frontline health professionals. 

An institutional focal point for the covid-19 immunisation programme must be to enable a proper communication and delivery strategy. 

It will be crucial to ensure the physical safety of the vaccines, and the workers guarding and administering them. Faced with a possible shortage, there might be people willing to attack frontline staff to get the covid-19 vaccine. 

Before launching immunisation programmes, seroprevalence and safety surveillance studies must be operationally prepared. We need to ensure the effectiveness of vaccination programmes and to know when we reach a sufficient level of herd immunity to overcome covid-19

Reliable communication

Social media misinformation is a considerable threat to vaccine acceptability. According to recent evidence, only 30% of people in the countries surveyed would want to receive a covid-19 vaccine soon after it became available. Increased mass communication to inform the public about vaccine availability, effectiveness and safety is crucial.  

In brief, the evaluation of covid-19 vaccines should be objective, rigorous, transparent, equitable and appropriately communicated. This is essential if we are to understand the vaccines’ composition, safety, and effectiveness in terms of immunity response, duration and potential side-effects. This will be challenging, but the expected reward is worth itto end this pandemic once and for all. 

Jose M Martin-Moreno is Professor of Preventive Medicine and Public Health at the Medical School and INCLIVA-Clinical Hospital, University of Valencia, Spain.

Sandy Laham is Master of Public Health student at École des Hautes Études en Santé Publique, France.

Ranjeet Dhonkal is Master of Public Health student at HAW, University of Applied Sciences, Hamburg, Germany.

Manfred Green is Professor, School of Public Health, University of Haifa.

John Middleton is President of the Association of Schools of Public Health in the European Region (ASPHER).

Competing interests: none declared.