The FDA is also expected to approve the vaccine for emergency use in the United States this week. By mid-January next year, it is estimated that about 24 million Americans will be vaccinated. The optimistic projection is that by May of next year, about 70% of the U.S. population will be immunized with the vaccine, thus bringing the outbreak under effective control.
It is clear that the progress of vaccine development in Western countries has benefited from their severe epidemics. Among them, the United States, as the country with the highest number of newly crowned cases, has seen a large number of cases every day, and since November, the number of daily infections has exceeded 100,000. The outbreak has so far continued to spread rapidly on U.S. soil and has failed to be effectively controlled. There are expectations that the number of morbidity and mortality in the United States will peak around the middle of January next year.
On November 9, Pfizer Inc. and BioNTech, a German biotechnology company, first announced the results of the interim analysis, which showed that the vaccine efficacy rate of more than 90% (with a final trial efficacy rate of 95%). A week later, another U.S. company, Moderna, announced similar results.
The situation in China is quite different. Despite the severity of the early outbreak, China was one of the first countries to begin restoring socioeconomic order by quickly controlling the spread of the virus. This course of development poses new challenges to China’s current thinking about fighting the epidemic, including vaccine development, production and distribution.
Although China’s vaccine development progressed well in the first and second phases, when it reached the phase III clinical stage, it had to be taken abroad because there were too few domestic cases. However, among the countries with the highest number of cases, the United States and India are having difficulty reaching effective cooperation because of the current state of relations with China. Brazil is the third most serious country in the world in terms of the severity of the epidemic, but only the state of São Paulo actually cooperates with China Kexing, and the open and secret fight between the governor of the state and the federal president affects the normal development of cooperation between the two sides. An important test country for the Chinese vaccine is the United Arab Emirates, but only 1,000 people a day are infected in that country. These factors add to the multifaceted variables, and the cumulative number of infections in subjects will take longer to accumulate to meet the minimum requirements for interim data analysis.
In fact, prior to November, the overall need for the vaccine was not very urgent because there were few cases within China. The so-called “immunity gap” (the expected difference in herd immunity between Western countries, where herd immunity is achieved through the natural process of infection, and China, where most people are not exposed to the virus and lack immunity) to China caused by the lack of active vaccination in countries like the U.K. also did not develop. But if a vaccine is developed and mass vaccinated in the West first, the immunity gap for China may actually become a reality.
To avoid this, China would need a nationwide mass vaccination with the new crown vaccine in a relatively short period of time. According to the National Health Commission officials, the annual production capacity of the domestic New Crown vaccine could reach 610 million doses by the end of this year and more than 1 billion doses next year. At this production scale, even if all of them are used for domestic vaccination, each person will need two doses, and 805 million people will be able to receive the vaccine by the end of next year, accounting for only 58 percent of the entire population. Although China has also joined the Global Vaccine Mechanism COVAX, the latter can only provide vaccines to 1% of China’s population, adding up to less than 60%. At this rate, even if the inactivated or adenovirus vector vaccine produced in China could reach 90% vaccine efficiency (note: GCM just announced that its vaccine tested in the UAE reached 86% efficiency), it would not be possible to achieve herd immunity in the country by the end of next year. Until this goal is achieved, the current “high wall” measures to prevent imported cases must be maintained. At the same time, maintaining the current “dynamic zero” policy would not only be costly, but would also allow the naturally immunized population to remain extremely low, thus maintaining a single dependency on vaccine demand in the process of achieving herd immunity.
To address these issues, China needs to accelerate the progress of clinical trials of the new crown vaccine and ensure that the trial results are based on rigorous interim data analysis. It is important not to announce trial results without the number of infected subjects reaching a predetermined point. Secondly, for the successfully developed domestic vaccine, we should be prepared in many aspects and focus on rapidly expanding production capacity. Active importation of vaccines produced in Western countries through existing drug company cooperation channels can also be considered. Some vaccines can also be sought to be authorized and produced by domestic pharmaceutical enterprises. Thirdly, the current policy of voluntary vaccination at one’s own expense should be changed, and the new crown vaccine should be included in the first category of vaccines for management, which should be provided by the state free of charge and citizens should be obliged to receive it. At the same time, it should be noted that the focus must first be on addressing the domestic demand for vaccines, and the demand for vaccines in most developing countries should be met more through technology transfer and assistance in improving their vaccine production capacity.
So far, the world has been under the shadow of the new coronavirus for a year. The advent of vaccines, while not necessarily providing the ultimate answer to this global crisis, could be a game-changer. Policy makers need to respond to the latest changes in the situation and make timely adjustments to their epidemic prevention strategies so that they are based more on risk assessment, while actively coordinating travel restrictions with the international community to align standards and build fast-track pathways to facilitate the orderly movement of people and goods.
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