The world is in the midst of a COVID-19 pandemic. As WHO and partners work together on the response — tracking the pandemic, advising on critical interventions, distributing vital medical supplies to those in need— they are racing to find a vaccine.

Vaccines save millions of lives each year. Vaccines work by training and preparing the body’s natural defences — the immune system— to recognize and fight off the viruses and bacteria they target.  If the body is exposed to those disease-causing germs later, the body is immediately ready to destroy them, preventing illness.

Immunization currently prevents 2-3 million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza and measles. There are now vaccines to prevent more than 20 life-threatening diseases, and work is ongoing at unprecedented speed to also make COVID-19 a vaccine-preventable disease.

There are currently more than 100 COVID-19 vaccine candidates under development, with a number of these in the human trial phase. WHO is working in collaboration with scientists, business, and global health organizations through the ACT Accelerator to speed up the pandemic response. When a safe and effective vaccine is found, COVAX (led by WHO, GAVI and  CEPI) will facilitate the equitable access and distribution of these vaccines to protect people in all countries. People most at risk will be prioritized.

At this point in the Covid-19 pandemic, three vaccine research and development groups—BioNTech and Pfizer; Moderna; and AstraZeneca and the University of Oxford—have released promising preliminary data about their Covid-19 vaccine candidates. So far, all of these candidates have been safe in trials, and prevented Covid-19 in anywhere between 70% and 95% of trail subjects. Moderna and AstraZeneca plan on submitting their data to regulators for emergency use authorization imminently; Pfizer and BioNTech already have.

This is good news for the end of the pandemic—but particularly for those countries that have already pre-ordered millions of doses of these three vaccine candidates. According to a tally from the Duke Global Health Innovation Center, individual countries and the European Union have already ordered 2.8 billion doses of these potential vaccines. (Many countries have also pre-ordered vaccines from other companies, but these aren’t yet in late-stage clinical trials.)

Should all three of these candidates gain regulatory clearance, four countries—Canada, Japan, the UK, and the US—could vaccinate more than 100% of their entire populations based on the number of these three vaccines they’ve already pre-ordered. (Each vaccine requires two doses to generate protection from Covid-19.)

The scramble to pre-order vaccines helped spur their rapid development. Essentially, these orders allowed vaccine developers to take on the financial risk of clinical trials without knowing whether the candidate will work. In normal times, vaccine development can take up to a decade because companies are only able to pay for clinical trials once they have enough data to be confident it will be successful.

But it also creates a very real possibility that the vaccines will be unequally distributed. The Duke research group classifies as high or upper middle income the five countries and the EU that could potentially vaccinate more than their populations. According to mathematical models, if wealthy countries buy up all of the first available vaccines, the pandemic will actually kill more people than if these vaccines are distributed evenly across the globe.

Gavi, the Vaccine Alliance—an international consortium that includes the WHO and the Gates Foundation—has created the Covid-19 Vaccines Global Access Facility, or Covax, whose goal is to help distribute the rest of these vaccines across the globe. So far, they’ve received more than $2 billion in funding from countries, individuals, and philanthropic groups; they estimate that they’ll need an additional $5 billion to cover the rest of the world. Covax has so far pre-ordered 300 million doses of the AstraZeneca/University of Oxford vaccine and 200 million from Sanofi and GlaxoSmithKline (which is still in early stages of clinical testing), but those won’t be enough to cover the populations of the 92 countries that may need help buying them.

Correction (Nov. 25): An earlier version of this story showed twice the rate of vaccine coverage for countries in the second chart due to an error in data interpretation. We have updated the chart, and updated the story to reflect that only four countries, not six, currently have pre-ordered enough vaccines to vaccinate their entire countries.

Data is collected from World Economic Forum and World Health Organization



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