Moving From Pandemic to Endemic: Ensuring Vaccine Access to All

by Dr Gajendra Singh

Two years after the COVID-19 outbreak, the world continues to feel the ripple effects of the pandemic on global economies, industries, and livelihoods. According to the World Health Organization (WHO), as of February, there have been 400 million confirmed cases of COVID-19 and 5 million deaths reported worldwide – with Southeast Asia coming in third in the highest number of cases by region, highlighting the irreversible impact the pandemic continues to inflict on our daily lives.¹ And the count is still on. In addition, virus mutations with variants like Alpha, Delta, and Omicron, which lead to the rise of new COVID-19 strains, continue to threaten the state of our well-being, livelihoods, and healthcare systems.

In the history of humankind, the role of vaccines in controlling infectious diseases is unparalleled. This has reached a critical stage in the case of COVID 19. Vaccines save lives by assisting our bodies in building an immune response through producing antibodies to protect itself. As such, governments worldwide have been aggressively pushing for nationwide vaccination rollouts, encouraging their citizens to get vaccinated as early and as quickly as possible. While Southeast Asian countries including Singapore, Indonesia, the Philippines, and Vietnam to name a few,² are on track to reach WHO’s target to vaccinate 70 per cent of their population by mid-2022, much remains to be done especially as Southeast Asian economies continue to be one of the regions in the world to be badly hit by the pandemic.³

Globally, vaccine supply is affected by political inclinations and concerns around waning immunity against the Omicron strain have prompted countries to start administering booster shots urgently.⁴ The fight against COVID-19 continues at full speed ahead and ensuring that people are fully vaccinated and protected remains a key driver in mitigating the effects of the pandemic. To do so, tackling vaccine inequity and driving vaccine access is paramount.

 

Barriers Impeding Vaccine Access

However, several key challenges continue to impede the global distribution, administration, and access to vaccines.

Primarily, access is an issue. Getting into remote and secluded areas impede vaccine access for populations living in those areas, such as in Papua New Guinea – a country with one of the lowest vaccination rates in the world. This difficulty may be further exacerbated by civil unrest, conflicts, and natural disasters,⁵ thereby worsening the vaccine inequity gap. Clearly, much remains to be done to ensure that these groups are well-supported in critical times.

Aside from this, another challenge hindering vaccine access and administration is vaccine hesitancy amongst the public, which is driven by a multitude of motivations and concerns. This could stem from misinformation, insufficient knowledge on vaccines, lack of confidence in its benefits, distrust in the medical system, overconfidence in one’s ability to avoid the disease,⁶ to tangible considerations such as fear of needles. To curb this hesitancy and encourage everyone to get vaccinated as early and as quickly as possible, government leaders and policymakers must proactively work together to propagate the right information about vaccines, address the public’s concerns, and increase their overall confidence.

Finally, political inclinations also affect vaccine access. According to the COVAX Independent Allocation Vaccine Group (IAVG), a group established by WHO to ensure transparency in the decision-making of the allocation of vaccines, the prioritisation of bilateral agreements over international collaboration and solidarity, and export restrictions made by government leaders and policymakers around vaccine administration remains a key concern. Described by IAVG as a “lack of political will” displayed by certain countries,⁴ the group asserts that continued advocacy for vaccine equity is needed to tackle this as it not only hinders the implementation process but also the successful development of vaccination drives.

As a key influencer of public confidence,⁷ governments play a crucial role in procuring and facilitating citizens’ access and acceptance towards vaccines. As such, they must make informed decisions as a misstep can make or break a country’s progress towards full vaccination and recovery. In fact, the social implications that arise from these decisions may further contribute towards vaccine inequity and hinder vaccine distribution amongst marginalised and vulnerable groups.

 

Solutions to Drive Vaccine Access

Nevertheless, there are ways for us to move forward to enhance global vaccine access and equity. One of which is to explore more vaccine options in the market to satisfy the need for mass vaccination.⁸ Given the wide array of novel technologies available today,⁹ modern vaccine development is no longer a shadow of its past, but it has progressed and advanced drastically – no doubt driven by the urgency and demand for vaccines at the height of the pandemic in 2020 – thereby spurring new vaccine opportunities.

For instance, the Pfizer-BioNTech and Moderna COVID-19 vaccines are some of the first COVID-19 vaccines that utilise the messenger RNA (mRNA) technology, which is authorised and approved for use. While other vaccines put inactivated germ to trigger an immune response in our bodies, mRNA vaccines use mRNA created in a laboratory to teach our cells how to make a spike protein that can trigger an immune response, thereby producing antibodies to fight off the infection.¹⁰ The outcome of this process is such that our bodies would learn how to protect itself against future infections without having to risk the potentially serious repercussions of getting infected with the COVID-19 virus.¹⁰ Furthermore, given that these vaccines can be developed in a laboratory using readily available materials, it means that vaccines can be produced in larger quantities, faster than other methods.¹⁰ This has the potential to improve vaccine access and equity. Yet, mRNA technology is not something new. Discovered in the 1960s, research into how mRNA could be delivered into human cells has been studied for decades and has come a long way since.¹¹

Although there have been clinical studies comparing the efficacy of vaccines with each other,¹² authorities do not support comparison as different vaccines use varying approaches in designing their studies. Ultimately, what is paramount is that all vaccines that have achieved WHO Emergency Use Listing are highly effective in preventing the consequences of COVID-19.¹³

Nevertheless, vaccine development doesn’t stop there. Given the global shortage of vaccine doses and the ongoing issue of vaccine inequity, there is a need to constantly evaluate the effectiveness, safety, and quality of vaccines, and to create new generations of vaccines that can combat emerging COVID-19 variants and serve the ever-changing needs of everyone.⁸ Thankfully, modern-day advancements in vaccine development mean that we are able to create safer and more efficacious vaccines using new technologies, including viral vectors produced in animal cells.

One such vector vaccine is the Sputnik V COVID-19 vaccine, the world’s first registered vaccine based on a well-studied human adenovirus vector platform – vectors that have caused the common cold and plagued humanity for millennia. As a two-part adenovirus viral vector vaccine, it is designed to trigger the production of antibodies against spike protein, much like mRNA technology. However, by using two different vectors, Sputnik V can generate a more sustainable immunity response compared to vaccines that utilise the same delivery mechanism for both shots. Although it is the world’s first registered adenovirus vaccine, its safety, efficacy, and lack of long-term adverse effects of adenovirus vaccines have been studied and proven in over 250 clinical trials over two decades,¹⁴ suggesting that it is a vaccine that countries worldwide, including Southeast Asia, should keep a keen eye on to bridge the vaccine inequity gap and ensure that there are sufficient vaccines to go around, especially in light of new virus strains.

Another solution that would greatly help to facilitate vaccine access is to involve key stakeholders such as government leaders and policymakers. As decision-makers and influencers of public confidence, they play an undeniably crucial role in improving vaccine equity and in developing and implementing effective vaccination programmes. They must be aware of the numerous challenges that are impeding vaccine access such as political considerations, difficulties in administrating vaccines in remote areas, issues around manufacturing and supply, maintaining Research & Development incentives to ensure the safety of vaccines, financial and ethical considerations as well as public hesitancy, and misunderstandings.⁷ From there, targeted solutions can then be strategised and implemented at scale.

According to research conducted in December 2020 by the Vaccine Confidence Project in partnership with ORB international, it was reported that across 32 countries, the strongest indicator of willingness to accept a COVID-19 vaccine was confidence in the government’s way of managing the COVID-19 pandemic.⁷ This means that not only is expanding and expediting vaccine supply and production important in curbing vaccine inequity, but educating and building the confidence of the public is also crucial. As such, government leaders must continuously implement and tailor programmes to suit local contexts to successfully engage communities and convey the effectiveness of vaccines, prompting them to get vaccinated as quickly as possible.

 

The Way Forward

WHO’s real-time COVID-19 dashboard is a fervent reminder that the COVID-19 pandemic is not disappearing anytime soon.¹ With the rise of new virus strains such as the Delta and Omicron variants, enhancing vaccine access and accelerating vaccination drives to ensure that everyone is fully vaccinated remain a global priority. In this piece, we have mapped out the barriers that are impeding vaccine access, as well as possible solutions that could tackle the issue – including exploring a variety of vaccine options such as mRNA and vector COVID-19 vaccines. While ensuring sufficient vaccine production and supply is paramount, so is international collaboration and global solidarity. To truly overcome vaccine inequity, government leaders and policymakers have to come together to address these concerns and extend help to those that may not have the adequate resources and capabilities to do so. Only then, can humanity emerge victorious against COVID-19. [APBN]

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About the Author

Gajendra Singh, Public Health Consultant
Dr Singh is a Medical Graduate and Public Health Specialist with 15 years of diverse experience in Health System Strengthening and Programme Management (Immunisation, Maternal & Child Health, Family Planning, Reproductive Health). He has worked in many reputed international public health organisations like WHO, UNICEF and Jhpiego. He also holds various other credentials like General Management (IIM Ahmedabad), Leadership and Change Management (IIM Raipur, Public Policy, Population studies, Public Health & M Phil in Health System Management. He is an innovative, visionary, and influential thinker with strategic planning