The end of 2020 may have been met with a damper following the latest COVID-19 outbreak at Samut Sakhon but there is also cautious optimism as vaccines are finally rolling out. Finally, the end of the pandemic is in sight.
So too is the end of the economic devastation that pushed almost 37 million people below the extreme poverty line worldwide, disrupted global supply chains, and – as frequently seen in the local news – caused suicides.
While worthy of excitement, this celebration may come too soon; the pandemic is far from over. As inequality has been exacerbated by the pandemic thus far, so too will it be by unequal access to a vaccine for COVID-19. The world will eventually be on the road to recovery and growth, but it will be the kind of growth marked by inequity.
While wealthy nations have already brought enough doses to vaccinate their populations at least three times over according to GAVI, Thailand’s goal is more modest. The Ministry of Public Health (MOPH) has announced that they aim to inoculate 50 percent of the population, relying on both internationally-sourced vaccines and domestic ones. Yet this goal still faces with herculean challenges. From production to procurement, the race to inoculate the population will define our year.
Production and Development
Of the few vaccines that have passed regulatory approval in other countries, the AstraZeneca-Oxford University vaccine is the most promising for Thailand. We have already signed an advance agreement to purchase doses and transfer technology for local production by Siam Bioscience. This looks even more favourable considering that the vaccine was just given emergency authorization by the United Kingdom’s medicine regulator on December 30. While the Pfizer-BioNTech vaccine is equally if not more promising as they have been approved in the UK, US, and Canada, Thailand has yet to procure doses of the latter vaccine. Likewise, Thailand has not procured the US-approved Moderna vaccine.
Yet Thailand cannot rely on the AstraZeneca vaccine alone for its population; the MOPH has put the country’s eggs in many baskets. While some vaccines have been authorized, it must be remembered that most are still in the works. The question, then, is which baskets Thailand should invest in given that research is ongoing for many vaccines.
Other vaccines that Thailand may consider have passed a more controversial approval process, such as the Russian Sputnik V vaccine or the Chinese Sinopharm vaccine. Some may have not passed phase three clinical trials yet, including the Sanofi-GSK vaccine that has recently suffered a setback in interim results. On top of this, new strains of COVID may complicate vaccine development efforts: the one first found in the United Kingdom has now spread to over thirty countries and is rapidly proliferating; more variants in Nigeria and South Africa have also been found.
Thailand places much of its hope on local vaccine development – namely the BioNet, Chulalongkorn University, and Baiya Phytopharm vaccines. Although their efficacy is yet to be known, it is clearly much slower in the works. The Chulalongkorn University mRNA vaccine, for instance, is estimated to start the first phase of clinical trials in April and be ready by the end of 2021. The University has also turned to a fundraising “Covid-19 Vaccine for Thais” campaign in an effort to cope with the costs.
Procurement and Distribution
In addition to the above hurdle, Thailand faces an even larger one: even with ready vaccines, they will be unequally distributed among developed and developing nations. The G20 international forum may have highlighted the importance of vaccine access worldwide, but this does not fly in the face of reality: vaccines often go to those with the most money, not to those who need it the most.
The starkest example of this is the Access to COVID-19 Tools (ACT) Accelerator, an initiative to secure COVID-19 vaccines for developing countries, which Prime Minister Prayut Chan-o-cha has pledged financial support for.
The ACT Accelerator’s COVAX Facility, a global initiative led by the World Health Organisation and supported by public and private institutions including GAVI the Vaccine Alliance, and the Bill & Melinda Gates Foundation, aims to subsidize vaccines for low and middle-income countries at an affordable price. It has already reached deals with manufacturers to access almost two billion doses, of which more than half is allocated for developing nations. But the ACT has yet to secure enough funding to be effective, with 5.6 billion USD raised and a further 23.9 billion needed this year.
While AstraZeneca committed 64% of their vaccines for developing nations, all of Moderna’s and 96% of Pfizer-BioNTech’s doses have been acquired by rich countries according to UNAIDS. According to UNAIDS Executive Director Winnie Byanyima, rich nations representing just 14% of the world’s population have bought up 53% of all the most promising vaccines so far. Meanwhile, Oxfam’s report shows that for developing countries, only one in ten will be vaccinated in 2021.
Thailand aims to secure vaccines through the COVAX Facility, which would be a challenge given the scarce supply and manufacturing limits, with vaccine supply agreements favouring developed nations; unsurprisingly, wealthy countries that funded vaccine efforts have ensured in the contract clauses that said vaccines will go to their citizens first.
The Thai MOPH has recently announced that they will supply 52 million doses, covering 26 million people (as each person will need two doses), and they have already secured two million doses after negotiations with AstraZeneca and other sources. While heartening, it still remains short of their original goal to inoculate 50% of the population. Given this, we will have to see whether placing our bets on domestic vaccines pays off.
Another logistical limit pertains to the US Pfizer-BioNTech and Moderna vaccines. While its efficacy rate (at 90% and 95% respectively) is higher than AstraZeneca’s 70%, it needs to be kept at -70°C and -20°C respectively. Even if Thailand decides to and successfully orders the US vaccines, there will be logistical hurdles. As the government rightly noted, Thailand will need to buy special freezers to transport them.
Lastly, once vaccines reaches the country, the main question will be how they are distributed. Rightly, the government prioritizes frontline workers and health volunteers, but implementation is trickier. With limited supply, which of those at risk will be prioritized? In a country where officials brag about hoarding masks during a shortage on Facebook, will the vaccines truly go to those who need it the most? Or – like in the international scene – will it go to those with the most wealth and power?
Despite all these obstacles, it is important to remember the astonishing progress we have made. We have produced vaccines in less than a year, demonstrating the astonishing power of the collective human mind in advancing progress. This goes to show that, in the face of the worst crisis to define our generation, the best of humanity succeeds. While most vaccines are still in the works, enough will eventually be made.
The real remaining challenge is a humanitarian one: ensuring that people prevail over profit and politics. Vaccine development may be driven by science, but society’s inoculation is driven by compassion. In this crisis, there is no room for self-interest, pharma greed, and corruption. We must not forget that, in the fight against the virus, we are all in the same boat. The vaccine must reach everyone, from the vulnerable in nursing homes to poor migrants from Myanmar who are necessary for the Thai economy. Remember, no vaccine is a hundred percent effective – indeed, no one is safe until everyone is safe.