Iqbal Mochtar

Doha

The Indonesian government has preordered 50 million doses of a potential COVID-19 vaccine from Chinese pharma giant Sinovac Biotech. The potential vaccine will be delivered in the form of vaccine bulks and is scheduled to arrive gradually, starting in November.

State-owned pharmaceutical company Bio Farma will examine and modify the potential vaccine as needed while waiting for completion of phase 3 of the clinical trial. If all goes well, the government plans to begin a COVID-19 vaccination program in early 2021. For this project, the government has allocated Rp 37 trillion (US$2.5 billion), with Rp 3.3 trillion disbursed this year for the down payment for the order.

The question is whether the vaccine procurement program is a proper strategy to handle the COVID-19 pandemic.

There is still no specific and permanent treatment for COVID-19. Although health protocols such as maintaining physical distance, wearing masks and handwashing can lessen the reproduction number of the virus up to a point, their effects are temporary. Various types of available drugs, including antiviral, anti-inflammatory and immune-based therapies, have not provided effective outcomes.

In the face of such circumstances, a potential vaccine has become a pedestal of hope. Vaccines have proven to be one of the most effective means of controlling infectious diseases. In the United States, they have been successful in reducing disease rates dramatically, with the effectiveness varying from 87 percent in pertussis to 100 percent in diphtheria, smallpox and polio.

The Centers for Disease Control and Prevention (CDC) have reported that for children born between 1994 and 2013, vaccination programs have prevented 322 million illnesses, 21 million hospitalizations and 732,000 deaths during their lifetimes. In adults, the existing flu vaccine decreases the risk of getting the flu by 40 to 60 percent. The success of vaccination programs in the containment and eradication of a number of diseases has led to confidence that the COVID-19 pandemic can be tackled by the same means.

Hundreds of institutions are involved in COVID-19 vaccine projects. Some have referred to the phenomenon as the “vaccine race”. Regulatory Professional Affairs reported that as of early September 2020, 42 vaccine projects were ongoing worldwide. Thirty of them had entered clinical trials. The World Health Organization reported that 169 vaccine projects were underway worldwide and that 30 of them had entered clinical trials.

The WHO hopes to provide COVID-19 vaccines to 2 billion people by the end of 2021. To realize this goal, the organization is supporting the COVAX project, a global vaccine initiative to facilitate cooperation among vaccine manufacturers to provide fair and equitable COVID-19 vaccine access for all countries.

Almost all nations agree that a vaccine is the only solution that can permanently contain the pandemic. However, they have used different strategies to pursue a vaccine.

The first such strategy is multilateral or global engagement. Under the WHO-backed COVAX project, 172 countries have agreed to work together to identify, facilitate, produce and distribute vaccines to participating countries.

The project shows that although priority is given to the participating countries, its final target is the provision of effective, safe and equitable vaccines to the world, including people in less developed countries.

The second strategy is the independent pursuit of a vaccine. Some countries have decided to produce their own potential vaccines, primarily for domestic use and export. China, Russia and India are among the countries who are pursuing vaccine self-production. In China, vaccine manufacturers have produced some potential COVID-19 vaccines that are currently in phases 2 and 3 of clinical trials.

In Russia, the government has registered and authorized the Sputnik V vaccine for public use. Despite criticism of the quality of the clinical trials used to determine this vaccine’s efficacy, several countries have expressed their interest in buying the vaccine, such as Vietnam and the Philippines.

The third strategy is bilateral involvement. A number of countries have preordered potential vaccines directly to manufactures to secure their availability if they are shown to be effective. The United Kingdom has ordered 340 million doses of potential vaccines from six vaccine manufacturers. The US has entered into agreements with various manufacturers to secure 800 million doses of potential vaccines, costing more than $7 billion.

Some call this phenomenon “vaccine nationalism” and criticize it as selfish. But the countries pursuing this strategy have maintained their stance, saying that preordering a large variety and volume of potential vaccines anticipates the possibility that some candidate vaccines will be ineffective or incompatible with populations. Indonesia's preorder strategy falls into this category.

Although hundreds of vaccine projects are ongoing, there is no guarantee that any these projects will produce a safe and effective vaccine. The effectiveness and safety of the potential vaccines may only be confirmed if they pass clinical trials and obtain regulatory approval.

Assuming that one individual needs one dose of a vaccine, the world will require 7.8 billion doses for its entire population. But if it turns out that a vaccination booster of 2 to 3 times per year is needed, the demand for the vaccine will jump to 16 to 24 billion doses per year, which all the current vaccine manufacturers combined cannot meet.

Manufacturers cannot just produce a future COVID-19 vaccine exclusively. They must also continue to produce other existing vaccines. Not to mention the fact that a large number of developed countries have preordered vaccines in large quantities so that if a vaccine becomes available, they will be the first to receive it. All these conditions point to a high likelihood of a vaccine shortage.

Indonesia has chosen the right strategy as it has anticipated the likely scarcity and high price of the vaccine when it becomes available. When the bird flu outbreak struck in 2007, Indonesia was one of the countries that was hit hardest, but it was unable to buy the vaccine because a number of developed countries had ordered it. Similar difficulty occurred with bird flu vaccine procurement in 2009.

To optimize its strategy, the government should not rely on one vaccine manufacturer as not all vaccine candidates will be effective and safe. The government needs to prepare a contingency plan, including preordering vaccines from other manufacturers or joining a multilateral vaccine project.

This is not selfish but a sensible step to protect the people.

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The author is a medical doctor and health observer who graduated from Adelaide University and the Imperial College of Medicine, London.