Coronavirus (COVID-19): vaccines and vaccination campaign

When it comes to the rate of fully vaccinated persons, there are several countries where more than 80 percent of the population received the ‘full vaccine package’. Among large countries, China stands out with some 90 percent of its population fully vaccinated, while the U.S. stands at some 68 percent. When it comes to the booster shot, which was especially recommended in response to the Omicron variant, Chile was leading among larger countries. Currently, China is administering a few thousand doses per day. This is a huge diffference compared to the summer of 2021 when the daily record was reported for June 28, 2021, with 22.4 million Chinese receiving the vaccine.

Booster campaign driven by Omicron threat

At the end of November 2021, a new variant of SARS CoV-2 was reported in South Africa. Alarming news was that this variant, soon known as Omicron, showed signs of immune escaping abilities and a so far unseen spreading speed. Somewhat moderating was the fact that the variant seemed not to penetrate deep into the lungs and thus caused a significantly lower rate of severe cases and hospitalizations than Delta and other variants. Experts, however, quickly emphasized that Omicron’s extreme contagiousness and its evading of immunity could still cause trouble for hospitals and health systems. That would be especially true for Western developed countries where demographics show a much higher share of older populations which are in general more under threat from the coronavirus.
Since many people received their first two shots already five, six, or more months ago, booster shots for countering the Omicron wave have become essential over the last weeks and months. Studies showed that especially the mRNA vaccines were effective against Omicron, foremost protecting from severe cases. And indeed, although the variant is causing the highest infection numbers since the begin of the pandemic, death and hospitalization numbers are still mostly lower than one year ago.

Inequality casts a shadow on the global campaign

Although mathematics tells us that every human worldwide should have received at least one dose of a COVID-19 vaccine, the reality looks quite different. Most of all African countries, but also several countries from Latin America and Southeast Asia, remain white spots on the global vaccination map. Vaccination inequality is becoming an increasingly prominent key word. It was obvious from the very beginning that rich countries hogged as many vaccines as they could. Countries like Canada and the UK, for example, reserved doses with which they could vaccinate more than three times of their respective population. At the same time, most undeveloped countries were able to secure pre-orders covering only five to ten percent of their population. Countries like the DR Congo, Haiti, and Chad still have less than one percent of its population vaccinated.
It is, of course, also up to the biopharmaceutical companies to make their products accessible. While AstraZeneca delivered almost two thirds of its doses to lower-middle-income countries, Moderna delivered nearly 85 percent of its doses only to the richest countries. In a recent report, Moderna, Pfizer, and BioNTech are directly criticized by Amnesty International for putting profit before accessibility. These companies have already been criticized for their high vaccine price tags, especially considering the fact that Moderna’s and BioNTech’s COVID-19 research was largely funded by taxpayer money.

SARS-CoV-2 mutations pose a new threat

During late 2020 and early 2021, more infectious new variants of the novel coronavirus were discovered in the UK, South Africa, and Brazil, and are spreading in more and more countries since then. While the UK variant (B 1.1.7, now called variant "Alpha") has a significantly higher transmissibility, it doesn’t seem to affect the efficacy of current vaccines so far. But studies published in mid-March showed that B.1.1.7 is more than 50 percent deadlier than former variants. It was shown, for example, that the risk to die from COVID-19 for a 55–69-year-old male increased from 0.6 to 0.9 percent within 28 days after a positive test.
Meanwhile, the variants first discovered in South Africa (B.1.351, now called variant "Beta") and in Brazil (P.1, now called variant "Gamma") have shown potential for immune escape/evasion. For example, Moderna’s vaccine showed significantly lower efficacy rates against B.1.351. As a response, the U.S. biotech company launched a trial for a modified version to tackle the new virus variant. Almost every virus develops mutations over time and they can both weaken the virus or make it more dangerous for humans. To observe and track the new variants is of great importance regarding the success of the ongoing global vaccination campaign.
During April and May, a new variant became the focus of global attention. First discovered in India at the end of 2020, B.1.617 (now called variant "Delta") has already become the dominant variant in India and was primarily responsible for the recent surge in new cases. Cases have also been discovered in countries such as the UK, the U.S., and Germany. A subtype of this variant – B.1.617.2 – seems to be even more transmissible than the B.1.1.7 variant. Current vaccines continue to work against the new variant, although at a somewhat lower efficacy level. In the meantime, the delta variant is already seen as the major driver of the next, fourth wave of the pandemic which is expected to come in autumn.

Longing for normality

The interest in the vaccines is of course an expression of humanity’s unabated wish and hope to eventually get back to normal life by reaching some kind of herd immunity. Nothing is fueling this hope like the three most prominent/promising vaccines from Biontech/Pfizer, Moderna, and AstraZeneca/Oxford which started being approved during end-2020. Combined, these three received and agreed to pre-orders for around five billion doses worldwide.
The first COVID-19 vaccine has been approved for widespread use in the United Kingdom, and the first doses were delivered to British seniors on December 8, 2020. The United States followed, as first shots were received by Americans on December 14th. Although it was the fastest developed and launched vaccine in human history, the next obstacle awaits: How to distribute the vaccine to billions of people around the world? The largest vaccination campaign ever is also a gigantic supply and logistic challenge.

Trust is essential for a successful campaign

Not only is an effective distribution of the vaccine needed, but also enough people who are willing to get vaccinated. Vaccine hesitancy became a more prominent topic recently, and the ongoing pandemic has an intensifying effect. There are countries traditionally skeptical of vaccinations, first and foremost France, Russia, and many other countries of the former Soviet Union and former socialist bloc, as well as regions with strong anti-vaccination movements like Northern Italy. Furthermore, the mixture of a permanent crisis situation, intermittent lockdowns, and restrictions is a breeding ground for general skepticism, rejection of authorities, and conspiracy theories.


Additionally, the enormous speed with which the laboratories developed and produced the vaccines as well as the quickened process of approval raise concerns among many people, questioning whether they have been thoroughly tested (while other major factors like technology advancements, combined forces in R&D, and extraordinary funding from many countries are often overlooked). Accordingly, in many countries the group of hesitant people who ‘first want to wait and see’ was significant – for example, almost 40 percent of all surveyed in the United States at the begin of the vaccination campaign, although this percentage decreased to four percent as of January/February 2022.

The only true game-changer

As soon as the deadly potential of the new coronavirus became obvious, finding a safe and effective vaccine was the global health priority. Other than potentially dangerous herd immunity by natural infection, for many experts it is the only true game-changer in this pandemic. Being the first company to produce a vaccine against the new disease is a matter of prestige and, even more so, a matter of potentially high profits. Not only the established big pharma companies, but also small innovative biotech firms are competing to create a vaccine against the new coronavirus. Several such companies have increased their market capitalization as a result of being involved in research on SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2 - the virus that causes the COVID-19 disease).

Good news in November 2020

On November 9th, Pfizer and BioNTech announced that their vaccine BNT162b2 was 90 percent effective in protecting from COVID-19. After more evidence from the trials came in, the efficacy rate was corrected to even 95 percent. Thus, the American-German cooperation was the first project with preliminary evidence from phase III in clinical trials.

This would facilitate the production of the first 50 million doses of the vaccine until year-end, and then another 1.3 billion doses during 2021. Only a week after the announcement of BioNTech/Pfizer, U.S. biotech company Moderna also reported that phase III trials of its vaccine showed an outstanding 95 percent efficacy. Both vaccines are using mRNA technology and would be the first vaccines of this kind ever brought to market. As of early December, applications for (emergency) approval have already been submitted in the U.S. and in Europe. On December 2nd, the United Kingdom became the first country to announce the approval of the BioNTech/Pfizer vaccine for widespread use among its population.

Progress and setbacks for AstraZeneca's vaccine

AstraZeneca added to the positive news on November 23. The company reported that its vaccine – developed in partnership with Oxford University – showed a 62-90 percent efficacy in phase III. Although the efficacy is significantly lower, the vaccine could be the favorite for widespread usage around the world. While the vaccines developed by Moderna and especially Pfizer need an ultracold supply chain that has yet to be established, AstraZeneca’s vaccine can be stored at normal refrigerator temperature. Therefore, it would be far more attractive for remote areas and poorer countries. However, the big range in efficacy and the fact that patients with a lower dose showed the most protection, exposed dosing errors in the trial. There were further setbacks to hit the late-stage clinical trials of the AstraZeneca/Oxford project. One patient developed severe neurological symptoms, while another volunteer died in Brazil. The trial continued, however, because the deceased patient was believed to be part of the placebo group.

Finally, on December 30, the British authorities gave green light for the vaccine. But the next turn of events came at the end of January when it became clear that the British-Swedish company will not be able to deliver the huge amounts of vaccine that were pre-ordered by many countries around the world within the agreed time frame. The announcement of reduced deliveries led to a heated dispute especially between the European Union and the drug manufacturer. In February, further throwbacks came along. Due to lack of data on the efficacy among seniors, several countries approved the vaccine only for adults younger than 65 years. And in South Africa, the use of the AstraZeneca vaccine was stopped after it showed a too low efficacy against the new mutation of the virus.

Early frontrunners in the race for a vaccine

From the very beginning of COVID-19 vaccine research, Moderna's mRNA-1273 probably was the most mentioned vaccine in development. It has been developed by Moderna Inc. in partnership with the National Institute of Allergy and Infectious Diseases (NIAID). Considering how slow drug development can be, the new vaccine was ready in record time, far quicker than drugs manufactured during previous pandemics. This was made possible mostly by significant scientific advances in recent years.

The mRNA-1273 vaccine was the first vaccine worldwide given to healthy humans. The urgent situation means that regulators have started to grant emergency approvals for diagnostics, vaccines, and treatments. After Moderna, CanSino Biologics from China was the second company which started running clinical tests in healthy volunteers. The trio of top frontrunners was completed by a team at the Oxford University partnered by AstraZeneca.

A surprise from Russia

On August 11th, Russia’s president Putin announced that his country was the first to have a vaccine ready to be administered to COVID-19 patients. As a way of showing total confidence in the vaccine called "Sputnik V", he informed the media that one of his daughters had already received a dose. Scientists from outside Russia have reacted with skepticism. Not only was clinical trial phase II performed with only 76 participants, but phase III results were skipped completely. Phase III began only in September with approximately 40,000 volunteers, according to Russian sources. But as of November, the first results of the late-stage trial showed that the Sputnik V vaccine had a high efficacy, ranging from 92-95 percent. While several countries around the world have pre-ordered the vaccine, Western countries remained skeptical, stating a lack of peer-reviewed evidence from the trials in Russia so far. These concerns have been removed to a certain extent by an analysis published in The Lancet on February 2, confirming Sputnik V's high efficacy of nearly 92 percent. Since then, an increasing number of Western pharmaceutical companies and countries are in talks with the Russian site about producing and using Sputnik V. A big issue for Western countries is, however, that Russia might want to gain political leverage and influence through the vaccine.