Controlling and eradicating diseases is a desire of mankind since ancient times, and turning a desire into an achievable goal depends on the development of medical technology. Vaccination is regarded as one of the greatest achievements of medical science, and it is also regarded as the public health investment with the highest return rate, both for individuals and populations. American infectious disease expert Anthony Fauci wrote in the journal Science that “in the face of a pandemic, the development of effective vaccines is always the most urgent priority”, which seems to represent the general consensus of the medical community.
After the Second World War, vaccines and antibiotics against a variety of infectious diseases came out one after another, which once brought endless optimism to people. In 1980, the World Health Organization announced the complete elimination of smallpox worldwide, which is the only disease that humans have so far eliminated through vaccination. So, will the new coronavirus vaccine be the answer to this epidemic?
It can be said that vaccines are the answer to the new crown epidemic, but the answer is still incomplete. As pointed out by the World Health Organization, the success of the global immunization campaign must depend on achieving and maintaining a high vaccination rate. To achieve a high level of vaccination rates, there are still several problems to be overcome.
If we look back at the history of smallpox eradication, we can find that vaccinia vaccine as an effective way for humans to block the spread of smallpox was born as early as the mid-18th century, but humans have completely eliminated smallpox for more than 200 years.
In fact, the history of vaccine invention has always been accompanied by a history of “anti-vaccine”, which has scientific rationality, but also contains various forces such as politics, commerce, national security, culture and religion. The WHO Working Group of Experts on Immunization Strategies defines vaccine hesitancy as: a behavior that is affected by multiple factors in vaccination, that is, a group of people in a continuous range from complete recipients to complete rejections.
Vaccine hesitation is a complex issue in a specific context, which varies according to time, place and vaccine. The influencing factors include misleading information (accepting the propaganda of anti-vaccination organizations or related remarks by influential public figures), lack of confidence (not believing in vaccines or distrusting medical staff and the health care system), complacency (believing that they do not Vaccines are needed, but vaccines are not paid attention to), convenience (longer vaccination journey), higher cost, and doubts about the safety of vaccines. In today’s self-media era, true and false news about the safety of the new coronavirus vaccine has spread rapidly, intensifying people’s hesitation about vaccination.
Controlling the epidemic through technical means such as vaccines has not always been smooth. The vaccination policies of various countries in the world vary greatly. Some countries have introduced mandatory vaccination policies very early, while others have been very late. For example, before 1902, France had no mandatory vaccination policies. In 1840, the British Vaccination Act stipulated that the poor should be vaccinated free of charge. However, when some countries pass compulsory vaccination laws and start to implement them, vaccination work often encounters resistance.
The United Kingdom passed mandatory vaccination legislation in 1853 and strictly enforced it in 1867 and 1871. Due to the smallpox outbreak, the government used penalties such as fines and imprisonment to force vaccination work, but the compulsory measures have triggered fierce resistance. In the 1880s, there were about 200 anti-vaccination organizations in the UK. Finally, the state abolished the practice of compulsory vaccination. In 1898, a new vaccination bill was passed. On the surface, vaccination was still mandatory, but in fact, it opened a side to moral boycotts, which allowed infants to be vaccinated. The rate has dropped significantly.
The American society’s resistance to compulsory vaccination is stronger than that of the United Kingdom. Although the situation in each state is very different, its overall vaccination rate is lower than that of most European countries that have passed mandatory legislation. In rural areas of the United States, the vaccination rate is often less than 10%. Therefore, the incidence of smallpox in the United States is quite high. It was not until the 1980s that vaccination became routine in the United States.
The World Health Organization carried out a campaign to eradicate smallpox in the few remaining countries. The recommended standard practice at the time was to carry out a large-scale immunization target with the support of some form of mandatory legislation, and set a target of covering these areas within three to five years. At least 80% of the population of each country. In 1964, the WHO Smallpox Eradication Expert Committee established a higher vaccination rate recommendation, requiring 100% coverage of the population in this area. This recommendation data is based on Indian experience. Due to the high incidence of smallpox in densely populated India, an 80% vaccination rate is considered insufficient to stop the spread of smallpox vaccine virus.
Vaccine safety crisis
In 1882, German bacteriologist Robert Koch identified tuberculosis causative bacteria-Mycobacterium tuberculosis. In the early 1920s, French scientists Albert Kamet and Camille Géran invented the tuberculosis vaccine, so the vaccine was called Bacille Calmette-Guerin (BCG). This is currently the only vaccine named after the name of the inventor. They began to conduct human trials in 1921. According to accumulated cases and statistics, the death rate of vaccinated tuberculosis patients was about 2%. This series of trials was regarded as strong evidence that the BCG vaccine was effective, and then they vaccinated a baby at the Charles Hospital in Paris with the vaccine. The child’s mother died of tuberculosis after delivery, and the child did not get sick after oral administration of the BCG vaccine. Since then, as more and more children are vaccinated, the acceptance of BCG has also increased, especially in France and the Nordic countries.
In 1928, the League of Nations Health Organization recommended that BCG vaccination should be widely used in newborns, but a tragedy almost ruined the future of BCG vaccination. The health department of Lübeck, Germany began to implement infant vaccination on February 24, 1930. A total of 256 newborns received oral BCG. As a result, 76 infants died and 131 infants became ill.
Subsequent investigations confirmed that it was because the vaccine accidentally contaminated the virulent strains of Mycobacterium tuberculosis during the production process. The pathogenicity and death were not the problem of the BCG vaccine itself. However, due to concerns about the safety and effectiveness of the vaccine, Germany suspended BCG vaccination. The occurrence of this tragedy delayed the promotion of BCG vaccine in the United Kingdom and the United States. During World War II, tuberculosis revived in Europe and Asia, and BCG vaccine was used on a large scale.
At present, many countries around the world have started the new coronavirus vaccination work, but in this global vaccination campaign, there is a serious uneven distribution of vaccines. The Director-General of the World Health Organization Tan Desai warned that this unequal vaccine policy has caused the world to face catastrophic moral failure. The world’s poorest countries need to pay the price of their lives and livelihoods for this failure. United Nations Secretary-General Guterres also pointed out that the current immunization work is “severely unequal and unfair.” Of all vaccinations that have been completed, 75% of vaccinations are concentrated in 10 countries, and “groups affected by conflicts and insecurity are particularly at risk of being left behind.” He did not deny that: “vaccine fairness is the most severe moral test currently facing human society.”
According to data provided by an article in the British Medical Journal (BMJ), currently rich countries have obtained at least half of the new coronavirus vaccines from the world’s leading 13 vaccine manufacturers. Low- and middle-income countries can only use the remaining small part. Although these countries have more than 85% of the world’s population, they only have less than half of the world’s new coronavirus vaccine. The article predicts that even if these 13 vaccine manufacturers produce at their maximum production capacity, by 2022, at least one-fifth of the world’s population will not be vaccinated.
The unfair distribution of new coronavirus vaccines highlights the growing global inequality. A picture of inequality is also shown to the world. Children in many poor countries are not vaccinated. Two newly developed vaccines for children are against “forgotten killer” pneumococcal disease (Streptococcus pneumoniae can cause pneumonia, meningitis and other infections) and rotavirus. However, in low-income countries with poor sanitation, the risk of dying from pneumococcal disease and rotavirus infection in children under 5 is much higher than in high-income countries. Due to the lack or even lack of health service infrastructure in these countries, these vaccines are just unaffordable and unavailable.
The “African meningitis belt” is heartbreaking evidence. Although a purified, heat-stable freeze-dried meningococcal vaccine has long been available, epidemic meningitis is still cyclically raging in the African region from Senegal in the west to Ethiopia in the east. The rate is as high as 10% to 50%.
Vaccine production capacity
The production process of vaccines is complex, involving upstream and downstream industrial chains, and there are many subjects. Even if the United States publishes vaccine patents, it is difficult for relevant countries to obtain vaccine production capacity in the short term. The industrial chain of the new coronavirus vaccine involves multiple fields, featuring wide coverage, multiple processes, and large businesses.
The upstream of the new coronavirus vaccine industry chain is the packaging and raw materials of the vaccine, mainly involving medicinal glass bottles, prefilled syringes, bottle caps, and pharmaceutical excipients. Midstream is for vaccine research and development and production, mainly involving related vaccine research and development and production enterprises. The downstream is the terminal use of vaccines and the treatment of vaccines, mainly involving the treatment of syringes and medical waste. In addition, the circulation of the new coronavirus vaccine runs through the entire process of the industrial chain, mainly involving cold chain equipment, cold chain transportation, cold chain circulation, and cold chain logistics. The gap between the supply and demand of raw materials for the new coronavirus vaccine is also severely imbalanced.
The global demand for the new coronavirus vaccine will exceed 10 billion doses, which will require about 200,000 pallet shipments, about 15 million refrigerated container shipments, and about 15,000 flights. Tinglong Dai, a professor of medical operations management at Johns Hopkins University, even stated that the supply chain of the new coronavirus vaccine will be one of the most complicated (medical logistics) supply chains in history. Some new coronavirus vaccines require temperatures as low as minus 80°C to minus 20°C. The logistics infrastructure in areas covering about 3 billion people is not yet developed, and the cold chain equipment required for vaccine transportation is also lacking.
In short, although the development of vaccines has made great progress, the best hope for ending the new crown epidemic is vaccination, but the above-mentioned problems are also hurdles that lie in front of global health governance. The solution of the problem still needs to be carried out in multilateral and diversified and in-depth cooperation.