While the race to develop a safe and efficacious vaccine in a timely manner has been successful, lack of clarity on immunity duration, reinfection, transmission, demographics, among other factors, continue to impact uptake. The varying levels of Covid-19 vaccine acceptability range from 90-50% across countries, which further plagues the timeline to reach herd immunity and bring an end to the pandemic. As developed countries begin inoculating citizens with the Covid-19 vaccines, equitable access, stringent storage and distribution requirements remain the lynchpin of efforts behind large scale immunisation in low- and middle-income countries.
With Pfizer-BioNTech and Moderna vaccinations underway, low- to middle-income countries placing bets on the successful rollout of the Oxford-AstraZeneca vaccine
It is estimated that ~18 billion doses will be required to immunise the global population. By the end of 2021, Frost & Sullivan predicts that ~4.12 billion COVID-19 vaccine doses will be delivered globally to immunise priority target groups, namely healthcare workers, adults above the age of 65 and adults with co-morbidities. However, ~50% of the expected production capacity of leading vaccine candidates has been secured by developed economies – US, Canada, EU, UK and Japan, which constitute <20% of the global population. Other rich countries like Singapore, South Korea, Qatar, KSA and Bahrain have also inked their own bilateral deals. Developing countries like China and India have reached local manufacturing agreements like Oxford-AstraZeneca and Novavax, leveraging capabilities of the Serum Institute of India. They have also developed promising vaccine candidates, like CanSino, Sinopharm and Sinovac in China, some of which have received emergency use and are in Phase III clinical trials. By contrast, the dwindling supplies for ~90 low- and middle-income countries will make widespread availability for their general public unrealistic in 2021. These countries are relying on the COVAX Advanced Market Commitment (AMC), a global collaboration between various stakeholders such as GAVI, WHO and CEPI, which has managed to secure ~1.30 billion doses of leading vaccine candidates to vaccinate high-risk population groups comprising 20% of their population coverage. Apart from securing the Oxford-AstraZeneca vaccine, COVAX is placing its bets on the approval of the Phase 3 Johnson & Johnson and Novavax candidates. This disparity of rich countries hoarding enough doses to vaccinate their entire populations twice, while some countries may not have enough doses to vaccinate even healthcare workers, has raised concerns around access. A partnership between the developed and developing economies is required in the prevention, detection, containment and cure of an infectious disease pandemic.
Key Implications for a Successful Global Covid-19 Vaccine Rollout in 2021:
- Local manufacturing deals and partnerships in small population and developing countries with strong fill & finish capabilities, storage capacities would be needed to progressively export to other countries. Moderna has partnered with Catalent, Lonza, ROVI (Spain) and Recipharm, while AstraZeneca has partnered with ~20 companies, including Novasep and Emergent, in more than 15 countries.
- Investments in exemplary supply-chain and robust cold-chain network which involves building capabilities for direct shipment to the point of use, local cross-docking of cooling boxes and local warehousing. Small to mid-sized cold storage companies like Cryoport and PCI Pharma are witnessing investor enthusiasm from Blackstone, Kohlberg and Mubadala, respectively.
- Post-market surveillance and management activities post-vaccine administration will be the need of the hour. Microsoft and Salesforce have launched enterprise vaccination management platforms to administer and monitor vaccine programs at scale.
- Increased marketing, education and activism are needed to overcome unwillingness and increase general acceptance towards vaccine uptake. Governments, public health authorities and local leaders are undertaking awareness and outreach campaigns. Organizations like the WHO, NHS and the Ad Council include influencers in their promotions.
- Accelerating the development of effective COVID-19 therapeutics alongside vaccines is necessary to contain the pandemic. To date, no drugs are approved globally for the treatment of COVID-19, however, Gilead Sciences’ remdesivir, Fujifilm’s favipiravir and dexamethasone are approved in certain geographies. Some other promising drugs include convalescent plasma, Eli Lilly’s bamlanivimab and Regeneron’s antibody cocktail.
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