Text size
Images of Vincenzo Pinto / AFP / Getty
A cosmetic vaccine hopes to return to normal. But the circulation process also comes with some potentially very serious side effects: Vaccination without a careful plan could have made the world even more unequal than a year ago. Inequality may be particularly affected by the two original vaccine candidates, from Pfizer-BioNTech and Moderna. But the candidate could be like a runner in the vaccination race, from Oxford-
AstraZeneca,
it has a strong ability to terminate as the most essential vaccine to eradicate the pandemic.
Governments are taking steps to prioritize vulnerable people, but two groups stand out as a possible consequence of unsustainable vaccine distribution programs: those living in rural areas and those in developing or underdeveloped countries.
There are two distinct features. First, the vaccines authorized so far have different “supply characteristics” in terms of their cold chain requirements and shelf life. The Pfizer-BioNTech vaccine, first approved by regulators in the United Kingdom, followed by Canada, the United States, and the European Union, has strict temperature requirements for storage and handling at -70 degrees Celsius (- 94 F) with a shelf life of 3.5 days after disinfection. Less intensive, the Moderna vaccine needs to be stored at freezer temperature and has a shelf life of up to 30 days once frozen. The Oxford-AstraZeneca vaccine, approved in the UK yesterday, can be stored and transported at a constant fridge temperature (35-46 F) like the flu vaccines, with a shelf life of over six months.
Second, different areas have “demand characteristics”. There has been a high demand in urban cities, although rural demand is scattered in rural areas. The UK distribution of the Pfizer-BioNTech vaccine is based in major hospitals and primary care clinics with sufficient demand to provide at least 975 jobs within a 3.5-day shelf life. In the US, some rural hospitals cannot offer jobs because they do not need the special freezers or do not have enough staff. This is not just an American problem: three areas in Canada were unable to get supplies during the first release because they also did not have freezers.
If advanced countries have advanced problems, think about how rural communities around the world can thrive. Especially in developing countries, rural areas are at risk of falling further behind urban areas in overcoming Covid. But this adventure is not inevitable.
The Oxford-AstraZeneca vaccine has the potential to protect billions of people worldwide by enabling affordable access. While the developer is conducting a study to increase efficacy by combining it with the Russian-developed Sputnik V vaccine, the real strength of the Oxford-AstraZeneca vaccine lies in its potential overcome the circulatory challenges facing his peers.
The first way in which the Oxford-AstraZeneca vaccine is able to promote efficacy and equity in mass vaccination is by allowing public health authorities to dispense the right vaccine for the right areas to reduce waste. Rich countries have ordered the development of millions of doses of multiple vaccines. Australia alone has prescribed more than 140 million doses for a population of just 26 million people. The key is not just to secure enough doses, but to strategically dispense different types of vaccines to reduce waste by paying attention to supply and demand characteristics.
Considering these two features, along with access to cold chain and ultra-cold storage infrastructure, it is more efficient to use the Pfizer-BioNTech vaccine in the most densely populated cities, distributing the Moderna vaccine to cover both high and medium densities, and use the Oxford-AstraZeneca vaccine to cover rural areas. By doing this, we can reduce the risk of the first two vaccines in rural areas, which is very important when every dose could save a person ‘s life.
Second, we can draw inspiration from the world of chocolate. With many developing countries lacking a cold chain distribution network, it has been a challenge for many food manufacturers to sell into emerging markets. Typical chocolate yields melt at 86-90 F. To reach consumer markets in developing countries with hot climates such as India, the Cadbury confectioner developed a temperature-tolerant chocolate formula. can withstand temperatures as hot as 104 F to reduce damage. The Oxford-AstraZeneca vaccine is the equivalent of Cadbury’s climate chocolate. The mild temperature storage and handling requirements make it far more promising to reach these regions. The Serum Institute of India, with support from the Gates Foundation, says they have already produced 40-50 million doses of the Oxford-AstraZeneca vaccine.
The Oxford-AstraZeneca vaccine can be given as standard vaccines for other diseases, and many low-income countries have gained a portable experience over the years. To further address staffing shortages and the risks of human error in departments where qualified health care professionals are limited, it can be provided by the use of pre-filled, administration-ready injectable devices that require minimal training. These one-dose filters reduce potential human error and simplify administration. They have seen many cases of success in developing sectors, including the large Hepatitis-B vaccine in rural parts of Indonesia.
Covid’s pandemic has affected us all, but that’s not the same. Border closures have closed seasonal agricultural workers in some rural areas, the OECD said, leaving producers short and reducing employment for the low-income workers. There are many more examples. The recovery of the world depends on a very successful vaccine. The last thing we want is to allow an unstable vaccine to further alleviate our preexisting situation of systemic geographic inequality.
At the end of the day, effective Covid vaccine development is not the endgame. There are big vaccines all over the world. Oxford-AstraZeneca looks like the vaccine that can make it happen.
Ho-Yin Mak is an associate professor of management science at Saïd Business School at Oxford University. Christopher S. Tang is a distinguished university professor and chairman of Edward W. Carter in business administration at UCLA Anderson School of Management.