Pharmaceutical companies across the world are racing to develop and test possible vaccines for COVID-19. But identifying an effective vaccine is just one step toward protecting billions of people from the disease.
Can enough vaccines be manufactured in time to stop the pandemic? How will vaccines be distributed across high- and low-income countries? And will people value and trust a vaccine developed under extraordinary circumstances enough to seek out vaccinations?
Three Duke experts discussed those challenges on Thursday, Sept. 24, as part of the Duke Global Health Institute’s Think Global webinar series. Watch the webinar below, or scroll down to read highlights from the conversation.
Watch DGHI's webinar on the challenges...
On the development of a COVID-19 vaccine...
Thomas Denny, chief operating officer, Duke Human Vaccine Institute
“We’ve made tremendous progress in a short period of time. It’s probably unprecedented, at least in my lifetime.”
On vaccine manufacturers producing vaccines “at risk,” or before regulatory approval has been granted: “Given that we are in a pandemic, the vaccine manufacturers have, with a lot of funding from government entities, decided to go ahead and manufacture doses so that if a vaccine is shown to be safe and effective, we will have materials ready for deployment. We won’t have enough for 7 billion people immediately available, but there will be vaccines that are made and ready to be deployed to start to get some of the most vulnerable people coverage.”
On whether a COVID vaccine will be a one-time or recurrent vaccine: “I think right now we’re pretty comfortable in that we’re not seeing a lot of mutations such as you see with some viruses that would indicate that every year you have to make a new vaccine. So we’re hopeful that we will be able to get a vaccine product that gives you some sustained period of protection. But there are still a lot of unknowns.”
On whether a vaccine will be distributed equitably...
Osondu Ogbuoji, deputy director, DGHI Center for Policy Impact in Global Health
“The biggest question right now on the table is, who gets any vaccine that is developed? Should it go to the country that can pay the most, or should it go to the places where the pandemic is hitting the most? Those questions are still unresolved, even as we speed through the process of developing the first vaccine.”
“What we are seeing right now is that high-income countries that can afford the money are able to sign contracts with vaccine manufacturers, while some low- and middle-income countries do not have that. Without those resources, they will not be able to secure those vaccines. Is that the best way we can allocate these vaccines? Probably not.”
On the challenges of deploying a COVID-19 vaccine in low-income countries...
Osondu Ogbuoji:
“In most countries around the world, vaccine delivery is usually restricted to targeted populations – children under five, elderly populations – and so the infrastructure that will be required to deliver vaccines to the entire population is not there.”
On the possibility that COVID-19 vaccines may require “cold chain” temperature control: “Most countries have cold chain in place to take care of their routine immunization systems, but we know that there have been variations in how successful routine immunization programs have been around the world… There are countries where the capacity to deliver existing vaccines is very weak, and it will be a very big challenge for them to also take on the additional responsibility to deliver a COVID-19 vaccine.”
On how vaccine hesitancy may affect a COVID-19 vaccine...
Lavanya Vasudevan, assistant professor, family medicine, community health and global health
“In the field that I work in, the success of any vaccine is not defined by the clinical trial data or whether a vaccine is successful in any regulatory approval, but rather by the number of people who accept it. So a vaccine that is well accepted is a successful vaccine. And vaccine success is really determined by the concerns that people have about the vaccine.”
“When there is a vaccine available, we (usually) see increased acceptance in the context of an outbreak. But I would say the current context of COVID is a little bit different. We have this urgent need, there is a pandemic going on. But it’s also a new vaccine, and that’s where I think we run into an issue.”
“in many of the low- and middle-income settings we work with, people are still familiar with vaccine-preventable diseases, much more than parents in the U.S. And we find that they are more willing to accept vaccines because there are cases in their communities or the stories are more recent.”
“We need more investments in understanding vaccine hesitancy and trying to identify interventions that could help address it… Even though we have seen dropping confidence in vaccines in the last 10 years, we haven’t seen a rise in research funding. So we are in a situation right now where we are playing catch-up. It’s not just the COVID-19 pandemic; it’s also the pandemic of vaccine hesitancy and the pandemic of misinformation. We are fighting this battle on many fronts.”
On herd immunity...
Lavanya Vasudevan:
“If you are not vaccinated, it doesn’t matter where you are; it doesn’t matter if there is herd immunity. If you come in contact with an infected person, your risk of infection is high.”
“I don’t like to use herd immunity as the reason people should get vaccinated, because in many cases people who don’t vaccinate cluster. So when we say the herd immunity is 70% or 80%, there may still be communities where the vaccination rates are so low that they don’t have herd immunity.”
Osondu Ogbuoji:
“The very nature of an infectious disease is such that until everyone is safe, no one is safe. We live in a world where there is global travel and a lot of interactions.”
On the safety of a potential vaccine...
Thomas Denny:
“There’s a higher bar for safety with vaccines than typically there is with other drugs. With vaccines, you’re giving them to healthy people, and if for some reason they have an adverse event, it can be devastating. There will be full transparency coming out of these large efficacy trials, and if we don’t see many adverse events, that will be a positive signal to people that the vaccine will be safe.”
Lavanya Vasudevan:
“Usually people don’t pay attention to vaccine development processes. They don’t pay attention to clinical trials until there is a vaccine on the market. But I think this is such a unique situation -- there is so much scrutiny of the vaccine development process that people have questions about it. People are justified in asking questions, and what we are doing is communicating about the process. That’s what public health agencies are focused on.”
On the balance of speed versus safety...
Thomas Denny:
“The challenge is balancing the need to do this fast and get something available for the world versus the rush of short-cutting the science and transparency that is needed to help make this acceptable to everyone… We need help, we don’t have a lot of tools in the toolbox. And so we desperately need some vaccines. But if we do it too quickly and we don’t have full transparency to show the safety, then I think that will create hesitancy and unwillingness for people around the world to say let’s get this vaccine. And it that occurs, we’re just going to continue to have the spread of disease and a lot of sickness. We’re going to have a delicate balance, and I hope we get it right.”
