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Few people care who made the flu shot or childhood immunizations against a range of deadly diseases. Covid changed that, making vaccine manufacturers into household names and asking for choices.
Doses remain scarce for now, amid a global scenario tour inflamed by a dispute between European Union and British pharmaceutical AstraZeneca Plc. Most of the more than 90 million people who have had a chance consider themselves lucky enough to have any protection against the pandemic. But vaccines are proliferating, with positive test data from Johnson & Johnson and Novavax Inc. putting its next candidates in line for approval.
Health officials will have to figure out how to distribute all of these different vaccines. European Medicines Agency approved the AstraZeneca vaccine on Friday for all adults, but the trial’s limited data on its effectiveness in the elderly has led some countries to impose restrictions. Germany said it should only be used for children under 65, while Italy has warned against administering it to those over 55.
Many people who are increasing efficacy rates, dosing schedules or side effects want to decide for themselves. If the options are an injection from a western pharmaceutical company that has been examined by an independent regulator or from a Russian or Chinese laboratory with less transparency, the desire is even greater.
“We demand that the government give people freedom of choice,” said Gergely Arato, a member of the opposition Democratic Coalition party in Hungary.
Sputnik V Covid-19 vaccines.
Photographer: Andrey Rudakov / Bloomberg
Hungary broke with other EU members to approve Russia’s Sputnik V and a vaccine from China Sinopharm Group Ltd. alongside three shots released by Europe’s drug regulator – from Pfizer Inc., Moderna Inc. and AstraZeneca. Although Prime Minister Viktor Orban is technically offering a choice, his promotion of Chinese and Russian vaccines is putting at risk “people’s willingness to be vaccinated,” Arato told a news conference this month.
In the United States, where the only two applications authorized so far – Pfizer and Moderna – use similar technology and have demonstrated virtually identical test results, the choice may matter less for now. Elsewhere, however, some health officials have begun to address people’s concerns about vaccine differences.
Dubai, Hong Kong
In Dubai, residents over 60 or with pre-existing conditions can access the injection developed by Pfizer BioNTech SE, or Sinopharm’s.
In Hong Kong, authorities asked for sufficient doses of vaccines from Pfizer-BioNTech, Sinovac Biotech Ltd. and AstraZeneca – together with plans to secure a fourth option – to cover the 7.5 million residents.
The Pfizer vaccine will be available at community vaccination stations, with Sinovac and Astra options offered at hospitals and private clinics, and people will be able to choose what they want to receive. This is important in Hong Kong, where some people are afraid to get a vaccine made in China.
“If residents don’t want to get a particular vaccine, they can choose to have the vaccines at a different time and place,” said Chief Executive Carrie Lam in December.
Supplies are so tight in most parts of the world that the choice remains impossible. People who get vaccines often have no idea what they will receive until they walk through the door of a vaccination center or doctor’s office. But that could change if vaccines from companies like J&J, Novavax and CureVac NV will start operating in the coming weeks, and as pharmaceutical giants like Sanofi and Novartis AG lend its weight to the production effort.
EU approval
Even if they don’t offer a choice, health officials need to decide who gets what. At the The Cleveland Clinic, Cassandra Calabrese, has been telling patients to get any vaccine offered to them, although some have asked her which one she would recommend. “Things can be different as more are approved,” she said by email.
Bottles of the Pfizer-BioNTech Covid-19 vaccine.
Photographer: Oliver Bunic / Bloomberg
The European Union, criticized for its slow launch of the Pfizer-BioNTech and Moderna vaccines, expanded its offerings on Friday, approving the injection of AstraZeneca. In a sign of the growing wave of people wanting to choose, approval came after days of heated debate over the effectiveness of the injection, with Germany’s immunization committee recommending against its use in the elderly.
In the UK, where infections and fatalities are much higher than in Hong Kong, health officials are prioritizing the rapid inoculation of as many people as possible. The second dose of two vaccines is being delayed in an effort to get the first injections in as many arms as possible. Other countries are considering similar measures.
The distribution is based on “supply and logistics, such as availability of very cold freezers,” said a spokesman for the UK Department of Health by email. Pfizer-BioNTech and Moderna vaccines should be kept frozen for long-term storage, while refrigeration is sufficient for the AstraZeneca vaccine.
Efficacy rates
Although the UK has drawn up a list of priorities for vaccine recipients – starting with older and vulnerable people – it does not distribute the different vaccines based on the person’s profile, the agency added. Therefore, an 80-year-old patient can receive an injection of AstraZeneca, while another person of the same age and health condition can receive an injection of Pfizer.
Some Britons are expressing a preference based on patriotism, rather than what they may have read about different rates of effectiveness or side effects. It doesn’t matter that the American company’s vaccine was 95% effective in large trials, compared to an average of 70% for the injection of AstraZeneca.
“They are saying they want to wait for the Brit,” said Jimmy Whitworth, a professor of public health at the London School of Hygiene and Tropical Medicine, in a telephone interview. “I think it’s a purely nationalistic point of view.”
– With the help of Veronika Gulyas, Jinshan Hong and Adveith Nair
(Updates with German and Italian guidelines in the third paragraph)