News that early results from Covid-19 vaccine trials by Pfizer and BioNTech have been greeted with elation across the world. Both the speed of the vaccine’s development, and the novelty of the technology it applies, are cause for celebration at the end of a grim year. The reported efficacy of the virus – 90% – is well above expectations. Considering that the virus causing Covid-19 was only identified at the start of this year, it is an extraordinary scientific feat to have come this close to a workable vaccine and with it, the prospect that the restrictions on our lives will be eased over the coming year.
This elation should be tempered, however, in four respects. First, these results are only from a relatively early stage in the vaccine’s development, and Pfizer has yet to release them in full. The checks on any new vaccine are rigorous – as we should hope – so there is still a chance that this breakthrough fails down the line. Vaccines are a safe and successful medical technology – arguably the most successful we have, instrumental in the successful eradication of some diseases (such as smallpox) and the containment of others (such as hepatitis). That doesn’t mean they’re a magic wand – things can go wrong, the public health dangers of a rush to release are very real.
Second, while the RNA genetic technology the vaccine uses should reduce the cost and difficulty of mass production since it doesn’t require the incubation period of classical vaccines reliant on dead or inactive pathogens, it also makes it far harder to store and distribute: the new vaccine needs to be stored at -70C. Facilities to do this are not yet widely available, even in richer economies – which leads us to the third problem.
Even if production difficulties can be eased, the logistical challenges of delivering two doses of a new vaccine requiring specialist storage to very large numbers of people are dramatically high. It is not necessary to vaccinate everyone: once a certain level of the population is immune, the rest will be protected. This is the fabled “herd immunity”. The number of people who can be left without immunity is determined by how infectious the virus is. With SARS-Cov-2, the virus causing covid-19, it’s estimated that each infected person will infect somewhere between two and three people on average. This “basic reproduction number” doesn’t sound like much, but it is key to understanding how a virus can blow up out of control: if one person infects 2 people a day, they both then infect four the next day, who then infect eight the next, who infect 16 the day after…infecting the entire population of Britain would take less than a month in this scenario, from just a single initial case.
The more infectious the virus, the more people need to be immune for herd immunity to work. This is the reason why attempting herd immunity in the absence of a Covid-19 vaccine was so unethical since at least 60% of the population would have needed to be immune for it to work. In the absence of a vaccine, that means a very large number of vulnerable people would die on the way to achieving herd immunity. It was an appalling suggestion. Those who suggested we lock away the vulnerable – the elderly, those with pre-existing conditions – whilst letting the rest lick bus handrails lack basic human solidarity.
But with a vaccine, herd immunity becomes plausible without all the deaths along the way. The government has secured some 40m doses – enough for 20 million people, going at least some distance towards herd immunity in the UK. The Joint Committee on Vaccination and Immunisation has produced a provisional priorities list of who should be among that 20 million, targeting those most vulnerable to the disease and those most exposed to it.
Surveying the government’s successive failed attempts to handle comparatively easier pandemic logistics – test and trace, PPE – it is hard to see how they will get on top of this far more complex logistical challenge: making use of storage facilities that do not yet exist, co-ordinating revaccination – all within a short space of time, as the public will demand. Reassurances from a health secretary who has presided over a series of failures do not reassure. Plans to scale back existing NHS care, in order redeploy GPs to vaccine delivery, will ramp up pressure on those services in the absence of additional resources. At the very least, keeping private logistics companies out of the distribution supply chain in favour of transparent and accountable public bodies would be a step in the right direction. So too would be local control of the final stages of the vaccination programme, as a joint report from the Royal Society and the British Academy on the challenges of mass vaccination suggests. An earlier report, also from the Royal Society, suggested roll-out of a programme could take a year or more.
This is where the fourth concern comes in. We do not yet know how long immunity to Covid-19 lasts. Early signs are not promising: we appear to have no long-term immunity to the six other coronaviruses known to infect humans. There are early reports of Covid-19 reinfection, and evidence that antibody response to SARS-Cov-2 decays rapidly, meaning that part of the immune system quickly loses its ability to fight off the disease infection or vaccination. Evidence of T cell immunity, our other immune system, is more promising, but inconclusive.
If immunity does not last, there is a good chance we will be tied to continual rounds of vaccination and revaccination for the foreseeable future, an ongoing and inescapable commitment of resources that will need to be backed up with ongoing monitoring. It is this prospect that is reportedly now causing much anxiety in Whitehall.
The vaccine’s development should be a clarifying moment, in four ways. First, the prospect of a working vaccine available in the near future should reinforce to the government the need for effective social distancing in the present. Having lost control of the virus over the summer, we are now deep in a second wave. The lower the rate of infection can be kept, the more successful a vaccination programme will be. But the lockdown that has been introduced to repress infection rates will not work unless proper financial support is provided to enable people to self-isolate. Chancellor Rishi Sunak has been pressured to restart the furlough scheme; but this scheme, which left some 3 million people without adequate support, was not good enough the first time, and it is not good enough now. We should make this lockdown the last we will need – that means making it effective.
Second, the crisis has busted open the idea that markets are essential to the functioning of society. It was pleasing to hear deputy chief medical officer Jonathan Van-Tam make the case for rationing a vaccine when questioned about possible queue-jumping by private customers. But competition isn’t something that only occurs in a market: we can already see ugly inter-state competition appearing in the production and distribution of future vaccines, as countries seek to both protect their own populations and potentially exercise leverage over others.
The economic historian Adam Tooze has written on the likely tensions that functioning coronavirus vaccines will provoke in a world system built around international competition but now expected to deliver a high-tech new product to the vast majority of its 7.6 billion citizens. Thankfully, China has now joined the World Health Organisation’s Covax programme, with the US expected to follow suit. Demands from global civil society on big pharma to make the intellectual property for vaccines freely available and to supply the vaccine at cost (which Pfizer has not committed to doing) are well-founded. Co-ordination between countries to prioritise delivery to those who most need it will be essential.
Third we must recognise that, while the end of this particular pandemic may be in sight, further pandemics are unavoidable should we allow climate breakdown to continue. The environment is becoming more unstable, crop failures more frequent and pressure on water sources is increasing, even in Britain. Covid-19 has made painfully clear that these consequences of environmental decay are now unavoidable – and not just for the poor, but for every person on the planet.
This shouldn’t be cause for despair. A realistic assessment of where we are can act as a spur for the political left, to ensure our adaptation to this changing environment is fair for all.
James Meadway is an economist and Novara Media columnist.