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The rush to develop a coronavirus vaccine might have finally produced a winner. Despite Russia claiming that it has a cure with its Sputnik-V inoculation, a claim many health experts question, Pfizer appears to now be in the lead for deploying the first wide scale COVID-19 vaccine. 

On Nov. 9, the company in partnership with Germany-based BioNTech, revealed its phase three trial had produced results that had 90% efficacy, NBC News reported. The implication was that the vaccine candidate had checked all the boxes and the company could prepare for a global roll-out. However, distributing the vaccine will pose more significant challenges.

Pfizer is Ramping Up Production, But Not Fast Enough

First, there is a supply and demand problem — Pfizer cannot meet the needs of the entire world immediately and not even for all of next year. Furthermore, the doses require specific handling conditions, creating a logistical nightmare. Finally, some of the world’s most vulnerable populations are also its poorest — how can they afford the cure?

Pfizer CEO Albert Bourla immediately tried to set expectations when he announced the success of the trial. For the remainder of 2020, the company will produce only 50 million doses, he said.

However, a single round of treatment requires two dosages, that is only enough to vaccinate 25 million people, the New York Times reported.

In 2021, it plans to have enough for 630 million people, but that is still less than 10% of the earth’s population.

Logistical Nightmare

During storage and shipment, Pfizer’s vaccine must remain at minus 70 degrees Celsius. While shipping cold items is presently doable, the extreme temperature required for the COVID-19 forced the manufacturers to develop new processes and equipment. 

The standard glass vial that proves adequate for most vaccines would shatter in the frigid, Antarctic-like cold of Pfizers shipping boxes. Corning, the company that manufacturers the glass screens found on iPhones, was enlisted to create special vials that can withstand the extreme cold.

The vaccines will be shipped in trays stacked inside custom cooler boxes. All of them will include GPS-enabled sensors allowing Pfizer to track their location and temperature. Once they arrive, hospitals and pharmacies will have several options for storing them, none of which are entirely conventional.

Absent ultra-cold freezers, organisations can keep the trays inside their freezers for five days. Alternatively, they can reuse the shipping cooler for up to 15 days if they continue to fill it with dry ice and limit access to twice a day.

These storage and shipping challenges make distributing the vaccine to remote areas — even rural America — a considerable burden.

Nations Race to Secure Supplies

In the US, the company plans to ship directly to distribution centers, which will in turn supply medical facilities via ground transport, said spokesperson Kim Bencker.

“We have developed detailed logistical plans and tools to support effective vaccine transport, storage and continuous temperature monitoring,” Bencker said. “Our distribution is built on a flexible just-in-time system, which will ship the frozen vials to the point of vaccination.”

Because the Pfizer–BioNTech vaccine were developed in the US and Germany, they are logically catering to their home populations first. The US could receive up to half of the initial production run this year, meaning 12.5 Americans will be potentially vaccinated in that phase of the rollout.

The European Union has signed a deal for up to 300 million doses, securing an even better price than the US. According to a senior EU official, the bloc is getting the vaccine for $19.50 per inoculation, undercutting the American price.

Therefore, Pfizer and BioNTech are certainly open to cutting deals, depending on quantity, Channel News Asia reported.

Organization Tries To Solve Vaccine Inequality

However, what happens for states that can’t afford the large sums of money to protect their people? That is where the COVID-19 Vaccines Global Access (COVAX) group comes into play. 

COVAX is led by the World Health Organization, the Gavi vaccine alliance, and the Coalition for Epidemic Preparedness Innovations. Essentially, it is a coalition of states that agree to prioritize vaccinating high-risk people regardless of nationality or background, CNBC reported. 

This voluntary coalition already includes 168 states including China, a recent signatory to the agreement. Notably, the US and Russia refuse to join.

COVAX is designed to facilitate the fair distribution of vaccines. As of September, it had 92 lower income states which would have vaccines provided for them. Currently, it has raised less than half of the $2 billion I estimates it will need before the end of the year, however. 

It has to compete not only for the generosity of its signatories, but also against the self interested deal-making of individual governments.

In an ideal scenario, once a vaccine is approved for disbursement, WHO proposes to give each state enough quantities to vaccinate 3% of their populations. A second phase would raise that number to 20%, Science Mag reported.

The organisation also recommends states receive priority status based on the severity of coronavirus outbreak and the level of their healthcare systems.

More Options Could Soon Help

Ultimately, although a COVID-19 cure is almost here, the reality is that for most people it will be unobtainable perhaps long into next year. Production levels and shipping logistics create bottlenecks in the global rollout for Pfizer and BioNTech’s candidate.

Furthermore, deals struck by governments like Washington limit the supply available for the rest of the world, including impoverished states. The most optimistic scenario is for more companies to finalize their vaccine candidates. With additional options introduced to the marketplace, the world would be less reliant on Pfizer’s solution.

China is pushing to have the WHO certify its products and could potentially add them to COVAX’ offerings. Other vaccines in their late-stage trials from companies such as Moderna could also take some of the load off Pfizer.

Until that point, however, the world must get in line for Pfizer’s cure.