Shedding Light on the COVID-19 Vaccine: What We Need to Know
By, Dr. Pia Rebello Britto, UNICEF Representative to Lao PDR and Dr. Mark Jacobs, WHO Representative to Lao PDR
2020 has been one of the most unusual years of our lifetime. The COVID-19 pandemic changed our lives like never before. The virus spread very quickly and crippled lives across the world. To date – 15 January 2021, there have been about 93 million cases and 2 million deaths globally. This is a tragedy, and of course the pandemic is far from over.
Here in Lao PDR, the Government took swift and early action to contain the virus and fortunately this has produced an impressive outcome to date: just 41 confirmed cases in Lao PDR and no deaths have been reported.
During the initial lockdown here, life came to a complete halt. Schools were closed, and about 1.5 million children were affected, essential health services such as immunization were severely impacted, and children were at bigger risk of facing violence.
Now that 2021 has begun, we have started to see some light at the end of the tunnel with the COVID-19 vaccine being already administered in some countries. Producing a vaccine against a previously unknown disease in less than a year is a major achievement for medical science globally. WHO and UNICEF are working to ensure the new vaccine, or vaccines, can rapidly be made available to all countries, including Lao PDR, on a fair and equitable basis.
While we have seen how other countries in several parts of the world have started to vaccinate their populations, there are still questions about the vaccines themselves and how populations will be vaccinated around the world. These questions are all the more relevant considering Lao PDR's plans to use COVID-19 vaccines in 2021. In this article, we will try to answer some of the questions on vaccines and vaccinations.
Did you know that there are several COVID-19 vaccines being developed?
All of them are trying to achieve the same thing: immunity to the COVID-19 virus. Vaccines work by training and preparing the body’s natural defenses – the immune system – to recognize and fight off the viruses and bacteria they target. If the body is exposed to those disease-causing germs later, the body is immediately ready to destroy them, preventing illness.
There are presently 223 vaccines being developed (candidate vaccines), 57 of them are currently undergoing clinical trials (phase I to III) and 166 haven’t yet reached that phase in their development. Never before has vaccine development moved at this speed. The process to develop new vaccines is long and complex, often lasting 10 to 15 years. The first COVID-19 vaccines have arrived, though, in less than a year. This has been possible because of years of previous research on related viruses and faster ways to manufacture vaccines, enormous funding that allowed firms to run multiple trials in parallel and regulators moving more quickly than normal to address a global pandemic that has caused unprecedented death toll and has slowed down economies. It is also helped by many different researchers working on developing different vaccines, as this makes it much more likely that we would have effective vaccines quickly.
How are COVID-19 vaccines being certified?
With so many COVID-19 vaccines being developed, it is unclear how many will eventually become available to be used. There are many steps in this process, designed to ensure that vaccines available to be used are both safe and effective. This includes applying for national licensing of the new vaccine in the country of production and for prequalification (approval) by WHO once quality, safety and efficacy of the vaccines have been fully documented through the clinical trial processes.
In the short term, it is anticipated that authorization for emergency use listing by WHO or emergency authorisation issued by stringent regulatory authorities (SRA) will be most likely the approval mechanism.
Do we know if COVID-19 vaccines will end the pandemic?
There is no silver bullet. No single measure will stop this pandemic. Stopping a pandemic requires using all the tools we have available. Vaccines will be a big help if they are widely available and accessible globally (and this will take time), but testing, tracing, treatment and preventive actions like handwashing, mask wearing, covering coughs and sneezes and avoiding crowded places will continue to be crucial. We cannot afford to relax our efforts on these other key actions.
Is there global guidance on who should get COVID-19 vaccination, if there is not enough for everyone?
COVID-19 vaccines must be a global public good. The overarching goal is for the COVID-19 vaccines to contribute significantly to the equitable protection and promotion of human well-being among all people of the world. WHO global advice is that access should be guided by six core principles:
- Human Well-Being - Protect and promote human well-being including health, social and economic security, human rights and civil liberties, and child development.
- Equal Respect - Recognize and treat all human beings as having equal moral status and their interests as deserving of equal moral consideration.
- Global Equity - Ensure equity in vaccine access and benefit globally among people living in all countries, particularly those living in low-and middle-income countries.
- National Equity - Ensure equity in vaccine access and benefit within countries for groups experiencing greater burdens from the COVID-19 pandemic.
- Reciprocity - Honor obligations of reciprocity to those individuals and groups within countries who bear significant additional risks and burdens of COVID-19 response for the benefit of society.
- Legitimacy - Make global decisions about vaccine allocation and national decisions about vaccine prioritization through transparent processes that are based on shared values, best available scientific evidence, and appropriate representation and input by affected parties.
How will Lao PDR be able to get supplies of COVID-19 vaccine? There are three different ways for the Lao Government to get vaccines: (i) through the COVAX Facility which ensures that the vaccines will be prequalified by WHO; (ii) through direct procurement of COVID-19 vaccines directly from manufacturers or global suppliers which may not be prequalified by WHO; and (iii) through donations of vaccines from international organizations, governments or private entities, which again might be or may not be prequalified by WHO.
The COVAX Facility is a platform created in June 2020 to accelerate the development and manufacture of COVID-19 vaccines, and to guarantee fair and equitable access for every country in the world and co-lead by Gavi the Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations (CEPI) and WHO. Many of the Gavi Board members have presence here in Lao PDR – these include Germany, France, Luxembourg, UK, USA, Australia, Japan, Korea, Canada, and, Sweden - and have been generously supporting this platform to achieve its 'One World, Protected' objective. Through the COVAX Facility, UNICEF is the largest procurer of the COVID-19 vaccine, globally.
How the vaccine will be rolled out in Lao PDR?
The objectives of COVID-19 vaccination are to a) reduce deaths and disease burden from the COVID-19 pandemic; b) reduce societal and economic disruption; and c) protect the continuing functioning of essential services.
The Government of Lao PDR, through the National Immunization Programme (NIP) and in collaboration with WHO, UNICEF and the World Bank, has developed a Plan for COVID-19 which targets priority groups for vaccination such as health care workers, older adults (≥60 years), individuals with underlying health conditions, essential workers, and essential travelers. Additional groups of people will be targeted later for vaccination as soon as vaccine supply increases.
Vaccination will be conducted progressively based on the vaccine supply availability. It is expected that the vaccine supplied via the COVAX Facility could arrive as early as March 2021 thus mass vaccination could begin in April 2021.
Although immunization against COVID-19 is considered to be an essential public health intervention to control the epidemic in conjunction with other public health and social measures, the supplies of the first vaccines to be authorized will be limited in the short to medium term. In this context of limited supply, prioritization of groups for vaccination will be crucial.
Will COVID-19 vaccines need to be transported and stored carefully to make sure they will work?
UNICEF will procure the vaccine to the Government through the COVAX Facility and will support the logistics to ensure effective and timely supply chain, including cold chain support, which is the chain of very well coordinated activities to ensure that the vaccines are stored, managed and transported in the appropriate temperature controlled conditions. Maintaining the right temperature is important so that the vaccine does not lose it ability to protect against the disease. Once that ability is lost, due to incorrect temperature, then the vaccine is not effective any longer. Storage and transport equipment such as cold rooms, refrigerators, freezers, cold boxes and vaccine carriers must comply with performance standards defined by WHO. Stock management procedures must also follow WHO guidelines specific to each type of vaccine.
The Vaccines will travel by plane from the manufacturer as refrigerated cargo to the country where they will be used. Once they land in Lao PDR, they will be stored in cold rooms before being distributed to the provinces and districts cold storage facilities by refrigerated vehicles. From storage facilities down to the village level, health workers will carry vaccines in cold boxes and vaccine carriers, traveling by car, boat, motorcycle, bicycle, or on foot. to immunize every last child, or in the case of COVID-19 vaccines every last member of a priority group, even in the most remote of villages.
UNICEF has provided five walk-in cold rooms and about 1,000 refrigerators for health facilities with the support of Gavi to upgrade the cold chain capacity of the National Immunization Program and facilitate the introduction of new vaccines, including those being procured through the COVAX Facility.
Did you know how important have vaccines been in Lao PDR, beyond COVID19?
Vaccines are key to growing up strong and healthy. They are safe, effective and life-saving tools to prevent outbreak of infectious diseases like measles and polio. In Lao PDR, between 2007 and 2017, immunization coverage for the first dose of measles-containing vaccine increased from 40% to 82% and the three-dose DPT vaccine increased from 50% to 85%. This has greatly contributed to improving child survival.
Globally, immunization saves two to three million lives each year. By protecting children against serious diseases, vaccines play a central role in ending preventable deaths. The National Immunization Programme (NIP) under the leadership of the Ministry of Health, which WHO and UNICEF support, helps identify children who have been left behind by health systems and brings them life-saving care like vaccination. The Programme has also had experience in rolling out novel vaccines, which will be useful when COVID-19 vaccines become available here.
The pandemic will be with us for a long time yet, and as long as the virus is circulating anywhere, all countries remain at risk. We are very hopeful that approved vaccines will become increasingly available here in Lao PDR, but for as long as the virus is with us, those basic but effective public health measures, like physical distancing, handwashing with soap, wearing masks, covering coughs and sneezes and staying home when sick, will continue to be crucial if we are to protect ourselves from COVID-19.