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Mass vaccination offers hope for a return to normal prepandemic. But the distribution process also comes with some potentially ugly side effects: Vaccination without a careful plan could inadvertently make the world even more unequal than a year ago. The two initial vaccine candidates, from Pfizer-BioNTech and Moderna, can have particularly problematic consequences for inequality. But the candidate who could have looked like a finalist in the vaccine race at Oxford-
AstraZeneca,
has a strong potential to end up as the most essential vaccine to end the pandemic.
Governments are taking steps to prioritize vulnerable people, but two groups stand out as potentially facing consequences from unequal vaccine launch programs: those living in rural areas and those in developing or underdeveloped countries.
Two factors are highlighted. First, the vaccines that have been authorized so far have different “supply characteristics” in terms of their cold chain requirements and shelf life. The Pfizer-BioNTech vaccine, the first to be approved by UK regulators, followed by Canada, the United States and the European Union, has strict temperature requirements for storage and handling at -70 degrees Celsius (-94 F) for a period of shelf life of 3.5 days after thawing. Less strictly, the Moderna vaccine requires storage at freezer temperature and has a shelf life of up to 30 days after thawing. The Oxford-AstraZeneca vaccine, approved yesterday in the United Kingdom, can be stored and transported at normal refrigerator temperature (35-46 F) as influenza vaccines, with a shelf life of more than six months.
Second, different geographies have different “demand characteristics.” Urban cities concentrated high demand, while rural areas spread low demand. The launch of the Pfizer-BioNTech vaccine in the UK is concentrated in large hospitals and primary care clinics that are in sufficient demand to deliver at least 975 jabs within the 3.5-day shelf life. In the US, some rural hospitals cannot provide tampons because they do not have the necessary specialized freezers or do not have enough staff. This is not just an American problem: three Canadian territories could not receive supplies during the initial launch because they did not have freezers.
If advanced nations face such difficulties, imagine how favorable disadvantaged rural communities around the world will be. Especially in developing countries, rural areas risk being left behind in urban areas in the recovery of Covid. But this fate is not inevitable.
The Oxford-AstraZeneca vaccine could protect billions of people around the world, allowing equitable and affordable access. While the developer is conducting a study to increase its effectiveness, combining it with the Sputnik V vaccine developed by Russia, the true potency of the Oxford-AstraZeneca vaccine lies in its ability to overcome the distribution challenges faced by its counterparts.
The first way that the Oxford-AstraZeneca vaccine can boost the effectiveness and fairness of mass vaccination is by allowing public health authorities to allocate the right vaccine to the right geographies to reduce waste. Rich countries have ordered millions of doses of multiple vaccines under development. Australia alone has ordered over 140 million doses for a population of just 26 million people. The key is not only to ensure sufficient doses, but also to strategically allocate different types of waste reduction vaccines, taking into account the characteristics of supply and demand.
Given these two factors, along with the availability of cold chain and ultra-cold storage infrastructure, it is most effective to use the Pfizer-BioNTech vaccine in the densest cities, to allocate the Moderna vaccine to cover both high-density areas. as well as medium-density ones, and use the Oxford-AstraZeneca vaccine to cover rural areas. By doing so, we can reduce the risk of wasting the first two vaccines in rural areas, a critical factor when each dose can save a person’s life.
Secondly, we can be inspired by the world of chocolate. Because many developing countries do not have a sophisticated cold chain distribution network, it has often been a challenge for many food producers to sell in these emerging markets. Typical chocolate products melt at 86-90 F. To reach consumer markets in developing countries with warm climates such as India, confectioner Cadbury has developed a temperature-tolerant chocolate formula that can withstand temperatures up to 104 F to minimize damage. The Oxford-AstraZeneca vaccine is the equivalent of warm climate Cadbury chocolate. Its easy storage and temperature handling requirements make reaching these regions much more promising. India’s Serum Institute, backed by the Gates Foundation, says it has already manufactured 40-50 million doses of Oxford-AstraZeneca vaccine.
The Oxford-AstraZeneca vaccine can be given as conventional vaccines for other diseases, for which many low-income countries have developed transferable experience over the years. To further address staff shortages and the risks of human error in regions where qualified health professionals are limited, it can be administered using pre-filled, ready-to-administer injection devices that require little training. These single-dose syringes minimize potential human error and simplify administration. They have seen many success stories in developing regions, including mass vaccination of hepatitis B in infants in rural Indonesia.
The Covid pandemic hit us all, but not equally. The closure of borders has closed the supply of seasonal agricultural workers in some rural areas, the OECD reported, leaving producers in short supply and reducing earnings for these low-income workers. There are many other examples. The recovery of the world depends on successful mass vaccination. The last thing we want is to allow inequitable access to the vaccine to further aggravate our pre-existing state of systemic geographical inequality.
At the end of the day, the development of effective Covid vaccines is not the ultimate goal. Mass vaccination in every corner of the world is. Oxford-AstraZeneca looks like a vaccine that can make it happen.
Ho-Yin Mak is an associate professor of management sciences at the Saïd School of Business at Oxford University. Christopher S. Tang is a Distinguished University Professor and Edward W. Carter Professor of Business Administration at UCLA Anderson School of Management.