Text size
Vincenzo Pinto / AFP / Getty Images
Mass vaccination offers hope of a return to pre-pandemic normality. But the distribution process also has some potentially unpleasant side effects: vaccination without a careful plan could inadvertently make the world even more uneven than it was a year ago. The two initial candidate vaccines, Pfizer-BioNTech and Moderna, can have particularly problematic consequences for inequality. But the candidate who may have looked like a runner-up in the Oxford-
AstraZeneca,
has great potential to end as the most essential vaccine to end the pandemic.
Governments are taking steps to prioritize vulnerable people, but two groups stand out as potentially facing the consequences of unfair vaccine implantation programs: those living in rural areas and those in developing or underdeveloped countries.
Two factors stand out. First, vaccines that have been authorized so far have different “supply characteristics” in terms of their cold chain requirements and shelf life. The Pfizer-BioNTech vaccine, the first to be 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 3.5 days once thawed. Less rigorous, the Modern vaccine requires storage at freezer temperature and has a shelf life of up to 30 days after thawing. The Oxford-AstraZeneca vaccine, approved yesterday in the United Kingdom, can be stored and transported at normal refrigerator temperature (35-46 F) as flu vaccines, with a shelf life of more than six months.
Second, different geographic regions have different “demand characteristics”. Urban cities concentrated high demand, while rural areas dispersed low demand. The launch of the Pfizer-BioNTech vaccine in the UK is focused on major hospitals and primary care clinics that face sufficient demand to administer at least 975 doses within the 3.5-day shelf life. In the United States, some rural hospitals cannot offer jabs because they do not have the necessary specialized freezers or do not have enough staff. This is not just an American problem: three territories in Canada were unable to receive supplies during the initial deployment because they also lacked freezers.
If advanced nations face such difficulties, imagine how disadvantaged rural communities around the world will do. Especially in developing countries, rural areas are at risk of falling even further behind urban areas in the recovery of Covid. But that fate is not inevitable.
The Oxford-AstraZeneca vaccine could protect billions of people worldwide, allowing equitable and accessible access. While the developer is conducting a study to increase its effectiveness by combining it with the Sputnik V vaccine developed by Russia, the true potency of the Oxford-AstraZeneca vaccine lies in its ability to overcome the distribution challenges faced by its counterparts.
The first way that the Oxford-AstraZeneca vaccine can promote efficiency and equity in mass vaccination is by allowing public health officials to distribute the right vaccine to the right geographies to reduce waste. Rich countries have ordered millions of doses of multiple vaccines in development. Australia alone has ordered more than 140 million doses for a population of just 26 million people. The key is not only to ensure sufficient doses, but to strategically allocate different types of vaccines to reduce waste, taking into account the characteristics of supply and demand.
Considering these two factors, together with the availability of cold chain infrastructure and ultra-cold storage, it is more efficient to deploy the Pfizer-BioNTech vaccine in denser cities, allocate the Modern vaccine to cover areas of high and medium density, and use the vaccine Oxford-AstraZeneca to cover rural areas. By doing so, we can reduce the risk of wasting the first two vaccines in rural areas, a critical factor when each dose can potentially save a person’s life.
Second, we can be inspired by the world of chocolate. Since many developing countries lack a sophisticated cold chain distribution network, it has often been a challenge for many food manufacturers to sell to these emerging markets. Typical chocolate products melt at 86-90 F. To reach consumer markets in developing countries with hot climates, such as India, confectioner Cadbury has developed a temperature-tolerant chocolate formula that can withstand temperatures as high as 104 F to minimize deterioration. The Oxford-AstraZeneca vaccine is the equivalent of Cadbury’s hot climate chocolate. Its mild temperature storage and handling requirements make it much more promising to reach these regions. The Serum Institute of India, supported by the Gates Foundation, says it has already manufactured 40 to 50 million doses of the Oxford-AstraZeneca vaccine.
The Oxford-AstraZeneca vaccine can be administered as conventional vaccines for other diseases, for which many low-income countries have developed transferable experience over the years. To further address staff shortages and the risks of human error in regions where qualified health workers are limited, it can be administered using pre-filled, ready-to-administer injection devices that require little training. These single-dose syringes minimize potential human error and simplify administration. They have seen many success stories in developing regions, including mass vaccination against childhood hepatitis B in rural parts of Indonesia.
The Covid pandemic has hit us all, but not equally. Closing the border has cut off the supply of seasonal agricultural workers in some rural areas, the OECD reported, leaving producers without labor and reducing the earnings of these low-income workers. There are many more examples. The global recovery depends on successful mass vaccination. The last thing we want is to allow unequal access to vaccines to further aggravate our pre-existing systemic geographical inequality.
At the end of the day, developing effective vaccines for Covid is not the end of the game. Mass vaccination in all corners of the world does. Oxford-AstraZeneca seems to be the vaccine that can make this happen.
Ho-Yin Mak is an associate professor of business science at the Saïd Business School at the University of Oxford. Christopher S. Tang is a distinguished university professor and Edward W. Carter chair in business administration at UCLA Anderson School of Management.