Perspectives Covid-19 vaccine: best keep the ‘free’ market out of it It looks as though the world has found a vaccine to fight the pandemic, but this is a story confined to powerful countries like the U.S. and China. As a doctor contacting hundreds of patients every day, I truly hope Vietnam will get access to the vaccine as soon as possible. Only when every person in the country is vaccinated can my colleagues and I feel safe. However, making this happen is easier said than done. High quality vaccines are expensive and even "affordable" ones cannot reach everyone. China’s state-owned China National Pharmaceutical Group Corp., also known as Sinopharm, announced recently that it can provide 200 million doses of Covid-19 vaccine within this year. The company said it expects one dose of its vaccine to be 97 percent effective in producing an immune response, and that the rate would climb to close to 100 percent after the second dose. It has been reported that the price for a double shot dose of the Sinopharm vaccine could be around $145. $145. That worries me. I did a quick calculation, assuming that the pandemic has an R0 of 5. The variable R0 indicates the average number of people who will contract a disease from someone who has it. If the R0 is 2.5, then one person with the disease is expected to infect, on average, 2.5 other people. So in order to prevent the infection spread when the R0 is 5, the number of people who have to be vaccinated must be calculated by the ratio of 1:5, which means at least 80 percent of Vietnam’s population of 95 million must be vaccinated to create community immunity. That’s a whopping $11 billion price tag at $145 a two-shot dose. In the U.S., the progress of vaccine-making by pharma giants Pfizer and BioNTech is being speeded up by applying the technique of using the messenger RNA, or mRNA. Basically, the mRNA-based vaccine teaches cells how to make a protein that triggers an immune response inside our bodies. Pfizer and BioNTech announced in July an agreement under which the U.S. government will get 100 million doses of the Covid-19 vaccine candidate jointly developed by them for $39 per patient for a two-shot immunization. That vaccine must be preserved at minus 80 degrees Celsius, and so far, just a few facilities in Vietnam are equipped for such storage, including the National Institute of Hygiene and Epidemiology and the National Hospital for Tropical Diseases. Obviously, it would be impossible for Vietnam to import such a vaccine in large quantities. The U.S. government will also pay as much as $1.5 billion to buy 100 million doses of Moderna's experimental Covid-19 vaccine. This vaccine also uses the mRNA technique but it is easier to preserve. Yet at the reported $74 per person market price for two shots, Vietnam will have to spend $6 billion to buy it for 80 percent of its population. Spending $6 or $11 billion on a vaccine is a utopian project for Vietnam. In the latest development, Moderna has asked the FDA to greenlight its vaccine, the Washington Post has reported. The report cites the company as saying its two-dose vaccine regimen was 94 percent effective at preventing illness in a 30,000-person clinical trial – "a performance that exceed expectations and is on par with the best childhood vaccines." "Experts anticipate there will be enough doses to inoculate 20 million people this year between Moderna’s vaccine and a second from Pfizer and the German firm BioNTech," the report said. The U.S. and China do not participate in the Covax Facility, a global initiative that has been joined by 64 economies to bring together governments and manufacturers to ensure that eventual Covid-19 vaccines reach those in greatest need, whoever they are and wherever they live. Therefore these two nations are not obliged to share their vaccines with others. In September, U.S. senator Thom Tillis introduced the America First Vaccine Act to ensure that Americans will be the first to receive any Covid-19 vaccine developed by an American company once it is passed. "Specifically, the legislation will prevent a manufacturer of a vaccine that was developed with the support of federal funding from distributing a vaccine outside of the U.S. until it is certified that domestic need for the vaccine has already been met or is in the best interest of American public health," he said. Vaccine nationalism is not new. During the 2009 H1N1 pandemic, countries able to produce vaccines had refused to export their products until they could ensure domestic demand was met. Now, in the time of Covid-19, the world is reverting to old solutions applied decades ago. In October, the EU and the U.K. had sat down with manufacturers to buy 3.8-5 billion doses of Covid-19 vaccine. International NGO Oxfam said in September that wealthy nations representing just 13 percent of the world’s population have already cornered more than half (51 percent) of the promised doses of leading Covid-19 vaccine candidates. What worries me now is that when high-quality vaccines made by Pfizer, Modema and Sinopharm go through different commercial channels, they will become extremely expensive as they get to Vietnam. With the fear of getting the disease looming over them, I believe there will be rich people who accept spending big sums on getting vaccinated. Apart from having to spend on masks, disinfectants and hand sanitizers, one has to be quarantined for at least 14 days in case of contact with a Covid-19 patient or, if one does get infected, the treatment could end up costing much, much more than getting vaccinated. Meanwhile, the Global Alliance for Vaccines and Immunization (Gavi)’s Covax Advance Market Commitment (AMC) has only pledged to provide each member nation, including Vietnam, enough doses to vaccinate up to 20 percent of their population. For more doses, the AMC will only fund poor countries. The rest will have to pay $4 for each dose. Vietnam is now a lower middle-income country, which means it will have to pay. The AMC operates based on the Gavi, the same initiative when the world had once applied when dealing with the Pneumococcal disease in 2005 to save hundreds of thousands of children in poor nations. Yet 15 years later, there is no insurance that Covax will allow nations like Vietnam to acquire the Covid-19 vaccine. The ability of companies to make vaccines is limited. Even at full capacity, by 2022, the world will only be able to vaccinate 61 percent of its population. Supply cannot meet market demand in the coming time and therefore, the vaccine is likely to cost a lot. This, at a time when many people have lost their jobs or have had their incomes reduced because of the pandemic. Availability’s one thing, affordability another A researcher at Vaccine and Biological Production Company No. 1 in Hanoi holds a semi-finished product of Covid-19 vaccine produced by Vietnam, July 2020. Photo by VnExpress/Giang Huy A researcher at Vaccine and Biological Production Company No. 1 in Hanoi holds a semi-finished product of Covid-19 vaccine produced by Vietnam, July 2020. Photo by VnExpress/Giang Huy. During a pandemic, the supply-demand imbalance and expensive vaccine prices could lead to a humanitarian health crisis. How do we prevent it? That’s a very difficult question to answer. I think the government has to prepare a plan right now to ensure fairness. Viruses do not choose places and people to spread, but thousands of scientific studies have indicated that the new coronavirus that causes Covid-19 often occurs in large populated cities rather than rural or mountainous areas. Elderly people with chronic diseases are also very susceptible to contagion as are the group of workers who usually come into contact with many people, like receptionists, cashiers, and medical staff. People working in closed, frozen environments and places where crowds usually gather are equally vulnerable. As for making the vaccines genuinely affordable, the government should have special policy to use the state budget to offer free vaccinations so that those who want to spend a fortune on them do not get the opportunity to do so. The vaccination policy should give priority to those at high risk of contagion.