By World Healthcare Journal-
As we have seen over the course of this year, the impact of a lack of a vaccine has never been clearer. Around the world, we have seen the global economy grind to a halt, tens of millions have lost their jobs, and hundreds of thousands have lost their lives.
Yet, until the day when a Covid-19 vaccine finally comes into existence, we will not see society return to “normal”.
But while we deal with the fallout of the Covid-19 pandemic, and wait for a vaccine, it is imperative that we do not lose sight of many other crises around the world which can be tackled through vaccination.
In the wake of the hugely successful Gavi Global Vaccine Summit, examining the important issues surrounding global vaccination and immunisation policy which are vital as we begin to emerge from the pandemic, Public Policy Projects (PPP), and Public Policy Projects International (PPPi), collaborated with the All Party Parliament Group (APPG) on Vaccinations for All and MSD delivering a timely and highly meaningful interactive round table with leading voices in vaccination from around the globe.
Co-chaired by Baroness Nicola Blackwood and Philippa Whitford MP, Chair of the APPG, the round table began by outlining the key aims of the session.
“Our intention is to make sure that the agreement set out at the Gavi Summit turns into real policy commitments and actionable insights,” says Baroness Blackwood.
“We will predominantly examine issues surrounding universal access and affordability of vaccines for low-income countries, including lessons from Covid-19 and previous epidemics like Ebola and SARS, such as identifying digital solutions to access hard-to-reach communities; the risk of vaccine-preventable disease outbreaks due to the disruption of immunisation services over this period, and long-term challenges like scaling up global manufacturing capacity and vaccine hesitancy. ”
The need to achieve full vaccination coverage for children across the world
One of the most vital issues surrounding immunisation is full vaccination coverage, and how anti-vaccination misinformation can not only impact populations within the developed world, but also have drastic knock-on effects for developing and poorer nations.
“At our very first event we learned that, while about 85 per cent of children across the world were receiving some vaccinations, less than 10 per cent were actually receiving the full range of WHL-advised vaccinations,” says Co-Chair, Philippa Whitford MP.
“This showed us that, rather than patting ourselves on the back, we really needed to aim higher to have universal access to vaccination and universal access to full vaccination. We all know how cost-effective they are. We know how much vaccines can prevent serious harm and damage.
“We think of vaccine hesitancy as something that we see in Europe, in the UK and in America – but it can affect the uptake of vaccination right across the world. ”
Distribution and vaccine procurement in poorer nations
It is quite frightening to imagine the situation that we were in as recently as 20 years ago. New vaccines were being developed at a breakneck pace through research, but the countries which needed them most, and which would benefit from their distribution, could not access them.
As a result, organisations such as Gavi and the Vaccinations for All groups were created: to provide those in need with the vaccines that they require. However, this is much easier said than done.
Speaking about the need to collaborate to provide equitable access to vaccines for populations, and how vaccination coverage can be achieved through partnerships and collaboration, was Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance.
“We estimate that about 90 per cent of children in the world receive at least one routine dose. But that means, obviously, 10 per cent don't. And that group is really important because two-thirds of those communities are living below the poverty line. And, of course, if they do get sick, they're more likely to die,” says Seth.
“So far, we’ve successfully immunised more than 760m children, more than 900m people through campaigns, and contributed to a large reduction in child mortality by reducing the number of deaths from vaccine-preventable diseases.
“The idea is that we will try to immunise an additional 300m children by the end of 2025, saving a further seven to eight million lives. Additionally, this would have a furthersaving of $80-100bn in economic costs - this is the cost-effectiveness and power of vaccines. ”
Supply and demand
However, in order for essential vaccines to be affordable enough for those in need, and for supply to meet demand, one sector of vaccine creation needs to be expertly utilised: manufacturing.
Not only is it vital to have a global supply chain to meet the ever-growing population needs, but it is also essential that manufacturing is maintained at a level where prices are competitive enough to allow nations to benefit.
“Of course, poorer nations need to be able to afford to pay for their vaccines, and we have to work with manufacturers to try to increase the volume of production and bring in others to drive down the cost,” says Seth.
In doing so, this makes vaccines more affordable not only for Gavi-eligible countries, by enabling them to scale up their vaccine development and transition into individual models of procurement, but it also has a secondary effect on middle-income nations by driving the price down, enabling them to strengthen their vaccination programmes in turn.
“In terms of market-shaping, we expect in this next period about a $900m saving to donors, due to the work with manufacturers and the competition to reduce prices,” says Seth.
“We’ve also faced major challenges recently. We were limited in the number of HPV vaccines that we could get out for the next period – meaning that, potentially, millions would go unvaccinated. But the manufacturers came together and said that they would scale up to supply enough for the full demand, resulting in an estimated 84m girls being able to receive that vaccine – which is remarkable. ”
Preparing for unavoidable outbreaks
By the very nature of the world that we live in, facing more outbreaks of disease in the future is not just a fear – it is a certainty. Despite our best efforts to control disease, new diseases will appear, such as Covid-19, and previous preventable enemies such as Ebola and many others will continue to rear their ugly heads for many years to come – unless we prepare and vaccinate accordingly.
“It is evolutionarily certain that we will have outbreaks and something like Covid-19 will happen again. Bill Gates did a TED talk recently, and people have called him a ‘visionary’ because he pressed the absolute certainty of it – but it’s true,” says Seth.
“Which is why it’s important that Gavi continues to play a role here. We need to continue funding vaccine stockpiles for common outbreak-prone diseases, including Ebola, meningitis, measles, yellow fever, cholera, and many other vaccines that are important for outbreaks like typhoid. ”
Furthermore, it is crucial that we have dedicated organisations that continue to prepare for outbreaks of avoidable disease, and provide solutions to battle these crises when they do occur.
Before the West Africa Ebola outbreak, there was no organisation that could fit this role adequately – which is why CEPI, the Coalition for Epidemic Preparedness Innovations, was created. Adding her experiences with epidemics to the conversation was Melanie Saville, Director of Vaccine Development for CEPI.
“We were really set up in the wake of the Ebola crisis in 2014, where, despite years of research, nobody thought that they would see an Ebola outbreak of such a size and and gravity,” says Melanie.
“When it came to January this year, and we first heard of the mystery illness that very rapidly emerged as Covid-19, we really felt we needed to respond immediately, even before anyone knew that it was a public health emergency of international concern. ”
By using the Covid-19 crisis to test their rapid response programmes without prompt, CEPI was able to get a virtual “head-start” on responding to the Covid-19 crisis, and had the ability to understand what needed to be done months before the full reality of the outbreak was understood.
“As things progressed and we moved deeper into the pandemic, we recognised the need to advance our response portfolio, which we now say is based on the vital aspects: speed, scale and access,” says Melanie.
“Today, nine vaccine candidates are in development, which called upon a number of different platforms. We don't know yet which of these vaccines is going to be successful. Seven of those nine candidates are already in clinical trial testing, and we have also funded some scaled-up manufacturing, very early, at risk, to try and ensure that the ones that are successful will be made available as soon as possible.
“This is a huge task for a very small organisation. This is a very complex situation. And I have to say that it is only through an end-to-end partnership that we will succeed in delivering these vaccines, which will also ensure that other vaccination programmes will be able to continue. ”
The impact of Covid-19 on vaccination programmes
The Covid-19 pandemic has affected the global healthcare ecosystem in a way which we have never seen before. As already noticed by governments around the world, the disease has disrupted cancer diagnoses, dental care, outpatient care, prenatal care… the list goes on – and vaccination is not exempt from this phenomenon.
We know for a fact that when one disease takes hold, it is all too easy to overlook other growing healthcare issues – as Professor Kate O’Brien, Director of the WHO Department of Immunization, Vaccines and Biologicals began to explore.
One key example was the Ebola outbreak in the Democratic Republic of Congo, and the massive measles outbreak that coincided with it as a result of weak immunisation programmes.
“There were a little over 2,000 Ebola deaths, which was the subject of intense local and international concern. But in contrast, there were almost 7,000 measles deaths that occurred at the same time in that country – which really shows that when an outbreak of one infectious disease happens, it can severely impact parallel situations,” says Kate.
As a result of the necessary, immediate response to deal with Covid-19, healthcare systems, particularly in poorer nations, are beginning to slide back – and lose traction in vaccination campaigns which are vital for strengthening the population.
“What we know is that many countries have either stopped or substantially disrupted immunisation programmes, meaning that somewhere between 25 per cent and 75 per cent of services are no longer functioning. It also means that outreach is not happening, and campaigns are substantially interrupted. In our latest count, there are 64 countries that are affected by pausing immunisation campaigns and 121 campaigns that are not happening as a result of Covid,” says Kate.
Even more worryingly, if we translate this into a number for children alone, it means that around 178m children are likely to miss out on the measles vaccine this year, setting up the world and many individual countries for a potential resurgence of measles. This means that in future healthcare systems may have to respond to a second health threat while they are already overwhelmed by Covid-19.
In addition to Covid placing us at a further vulnerability to the resurgence of vaccine-preventable diseases, we may even be more unaware of diseases which are developing due to services moving away from conventional monitoring in favour of Covid-19.
“We're flying blind if we don't know what's actually happening in terms of disease,” says Kate.
“From a WHO perspective, we've issued support and guidance to countries to try and guide them through this really treacherous period – and that means some guidance to temporarily pause campaigns while countries are able to prepare for Covid, and establish methods so that parents can safely get their kids vaccinated. At the moment, we are definitely seeing some countries coming back, although many countries are continuing to slide in a negative direction. ”
Vaccination moving forward
Despite the severe impact that Covid-19 has had on vaccination efforts, the pandemic presents an opportunity to reform our methods of immunisation and systems of achieving full vaccination coverage.
Even at the present time, we can prepare for developing vaccination systems with the lessons we have learned from Covid-19, and create stronger, more efficient, and safer systems of vaccination as we begin to move out of lockdown.
“We need to build back our immunisation methods, and build them back better. First of all, we need to be ensuring that we're integrating all services as much as possible when parents are coming for services – they really need to get everything that they possibly can at that time,” says Kate.
“If we don't have a resilient system, and we don't have communities that believe in vaccines, that understand the safety and efficacy of them, we're not going to have a setting in which communities will access Covid vaccines. ”
And as we move forward together towards more equitable access and deeper understanding of vaccination, it is imperative that health organisations create sustainable, beneficial partnerships with industry manufacturers and vaccine developers to develop a self-sustaining system of betterment within healthcare. Elaborating on the absolute need for collaboration was John Markels, President of MSD Global Vaccines.
“At MSD, we really are inventors – using science and rigorous clinical study to create breakthrough medicines and vaccines,” says John.
“But our innovations are truly limited if they fail to reach the people who need them most. Our mission of global impact is not fulfilled if those people in areas of greatest need aren't served. And this is where the partnership with the Gavi Alliance is so fundamental to MSD, because without Gavi, we would find it very difficult to reach a large fraction of the world's poorest populations.
“In partnership with our vaccines and Gavi’s procurement, delivery and capability, we can change the course of lives and communities and populations – that’s really where the magic happens. Let's remember that we're in this together – and be relentless in creating a healthier and safer world. ”
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