Samantha Vanderslott

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Intergenerational Justice Review1/202120Vaccination strategies and policies:  What can be done by whom, when and where?by Samantha Vanderslott China were not included in the ranking due to lack of  available data). However, what did go well and was an exceptional health achieve-ment, was the development of safe and effective vaccines against SARS-CoV-2, which happened much quicker than for previous vaccines, and will set standards for vaccines in the future.3,4COVID-19 vaccines against SARS-CoV-2 were developed  quickly because they built on existing research that has sought to understand coronaviruses.5 For example, the Oxford-AstraZeneca uture generations will think we were completely unpre-pared for a predictable pandemic. We had numerous warnings from AIDS, Avian flu, SARS, MERS, Ebola, Zika1 that should have acted as a catalyst for better preparedness. In the end, complacency and overconfidence, among other fail-ures, led to disastrous handling. According to Sydney’s Lowy Institute Europe, five South American countries (Peru, Mexico, Colombia, Argentina, Ecuador), Iran – which was hit badly in the first wave, and the US – which had the highest number of deaths, fared the worst on six criteria.2 The criteria included confirmed cases, confirmed deaths and testing metrics (note Brazil and FIntergenerational Justice Review1/202121vaccine used learning from developing a vaccine for MERs, which was already in early-stage clinical trials. Also, the mRNA vaccines have come of age at the right time. While these technologies are new, they have been researched over the past decade in other trials and have offered the opportunity for fast development. Having Chinese scientists find and publish the SARS-CoV-2 virus genetic sequence sped up the initial phase of determining how to produce an immune response.6The resources, funding, and focus that a global pandemic has brought meant that time was not wasted waiting for funds or making the case for research attention.7 Arranging for industry partners and organisation of international testing sites has hap-pened much more easily because of the concentration of efforts. There has not been an issue with the recruitment of trial volunteers either, as people have been very willing to take part. The number of people these vaccines have been tested on in fact constitute a higher number and from a broader range of countries than is usual for vaccine testing. Such an emphasis on fast working has also meant that stages of the trial overlapped, and the  vaccines were manufactured at risk, so the quantities needed for each stage and for the anticipated rollout have already been produced. The advance purchase agreements and pre-orders are additionally bol-stering the funding for the vaccine developers.Regulatory agencies have also been working very closely with vac-cine developers. Regulatory agencies in the United States, Europe, and Japan, in particular, have a historically developed capacity in regulating pharmaceuticals.8 As vaccines are normally given to healthy people, they are among the most closely evaluated medical products. Even before trials begin, they have to pass ethical review boards to be allowed to begin – and data and safety  monitoring boards independently assess the trial throughout.9 Regulators are able to set out what requirements of efficacy and safety data they will be expecting for approval. In addition, regulators have been conducting in-time assessments as a ‘rolling review’, so instead of waiting for data to be sent at one time, they have been receiving this incrementally as they become available. Rolling reviews are a tool that regulators use to speed up the assessment of a promising medicine or vaccine during a public health emergency.10 The process happens before a formal application for authorisation is submitted.The development of vaccines cannot be a success in itself. Next comes producing enough vaccines at scale, making sure the roll-out happens efficiently and people are willing to be vaccinated. Countries who negotiated the best supply deals with pharmaceu-tical companies have fared better,11 but the lasting failing will be in vaccine nationalism and the vast vaccine inequity globally. The COVAX initiative (by GAVI, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization) to support research and development, raise fund-ing, and negotiate the purchase and distribution of COVID-19 vaccines, was an attempt at avoiding such a situation.12 However, it has not achieved the cooperation needed. Future pandemics will need better arrangements to ensure protection via vaccines throughout the whole world.Notes1 Reperant / Osterhaus 2017: 4470–4474.2 Lowy Institute, Sydney n.d.3 Almond / Hacker / Harwood et al. 2020.4 Bloom / Cadarette / Ferranna et al. 2021: 410-418.5 Vanderslott / Pollard / Thomas et al. 2020.6 Amodio / Vitale / Cimino et al. 2020: 51.7 Hanney / Wooding / Sussex et al. 2020: 61.8 Fonseca / Jarman / King et al. 2021.9 Yao / Zhu / Jiang et al. 2013: 94–106.10 Mahase 2021.11 Wouters / Shadlen / Salcher-Konrad et al. 2021: 1023–1034.12 The Lancet 2021: 941.ReferencesAlmond, Jeffrey / Hacker, Jörg / Harwood, Colin et al. (2020):  Development of Vaccines at the Time of COVID-19. In:  MicroLife 1 (1). https://doi.org/10.1093/femsml/uqaa003. Viewed 2 September 2021.Amodio, Emanuele / Vitale, Francesco / Cimino, Livia et al. (2020): Outbreak of Novel Coroavirus (SARS-CoV-2): First Evidences From International Scientific Literature and Pending Questions. In: Healthcare 8 (1), 51. https://doi.org/10.3390/healthcare8010051. Viewed 2 September 2021.Bloom, David E. / Cadarette, Daniel / Ferranna, Maddalena et al. (2021): How New Models Of Vaccine Development For COVID-19 Have Helped Address An Epic Public Health Cri-sis. In: Health Affairs 40 (3), 410–418. https://doi.org/10.1377/hlthaff.2020.02012. Viewed 2 September 2021.Fonseca, Elize M. da / Jarman, Holly / King, Elizabeth J. et al. (2021): Perspectives in the Study of the Political Economy of COVID ‐19 Vaccine Regulation. In: Regulation & Governance. https://doi.org/10.1111/rego.12413. Viewed 2 September 2021.Hanney, Stephen R. / Wooding, Steven / Sussex, Jon et al. (2020): From COVID-19 Research to Vaccine Application: Why Might It Take 17 Months Not 17 Years and What Are the Wider Lessons? In: Health Research Policy and Systems 18 (1), 61. https://doi.org/10.1186/s12961-020-00571-3. Viewed 2 September 2021.Lowy Institute, Sydney, Australia (o.J.): COVID-19 Performance Index. https://interactives.lowyinstitute.org/features/covid-perfor-mance/. Viewed 1 June 2021.Mahase, Elisabeth (2021): Covid-19: Where Are We on Vaccines and Variants? In: BMJ Clinical Research, 8282 (597). https://doi.org/10.1136/bmj.n597. Viewed 2 September 2021.Reperant, Leslie A / Osterhaus, Albert D. M. E. (2017): AIDS, Avian Flu, SARS, MERS, Ebola, Zika… What Next? In: Vaccine, 35 (35 Pt A), 4470–4474. https://doi.org/10.1016/j.vaccine.2017.04.082. Viewed 2 September 2021.The Lancet (ed.) (2021): Access to COVID-19 Vaccines: Looking beyond COVAX.” In: The Lancet, 397 (10278), 941. https://doi.org/10.1016/S0140-6736(21)00617-6. Viewed 2 September 2021.Intergenerational Justice Review1/202122Vanderslott, Samantha / Pollard, Andrew / Thomas, Tonia (2020): Coronavirus Vaccine: Here Are the Steps It Will Need to Go through during Development. In: The Conversation. https://theconversation.com/coronavirus-vaccine-here-are-the-steps-it-will-need-to-go-through-during-development-134726. Viewed 2 September 2021.Wouters, Olivier J. / Shadlen, Kenneth C. / Salcher-Konrad,  Maximilian et al. (2021): Challenges in Ensuring Global Access to COVID-19 Vaccines: Production, Affordability, Allocation, and Deployment. In: The Lancet, 397 (10278), 1023–1034. https://doi.org/10.1016/S0140-6736(21)00306-8. Viewed 2 September 2021.Yao, Bin / Zhu, Li / Jiang, Qi et al. (2013): Safety Monitoring in Clinical Trials. In: Pharmaceutics, 5 (4), 94–106. https://doi.org/10.3390/pharmaceutics5010094. Viewed 2 September 2021.Dr Samantha Vanderslott is a University Research Lecturer at the Oxford Vaccine Group at the University of Oxford.Email: samantha.vanderslott@paediatrics.ox.ac.uk

Vaccination strategies and policies: What can be done by whom, when and where?

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Vaccination strategies and policies: What can be done by whom, when and where?

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