A marathon ahead

The race between infections and injections

Photo courtesy: Reuters

The world marked a historic milestone on February 3, when the number of Covid-19 vaccinations globally surpassed the number of confirmed cases on that day. Although non-pharmaceutical interventions contributed mainly to this drop in transmissions, the rapid development of several vaccines and accelerating vaccination rates in several countries suggest that the end of the pandemic might be in sight.

The country has registered around half a million infections and about 32,000 deaths so far. The threat of a second wave of the virus has also not materialised to the extent seen in many other countries. Approximately 1,000 new cases are currently being recorded daily across the country and the daily death toll is less than 100. On the economic front, Pakistan’s GDP shrank by around 0.5 percent in 2020. While this economic and social damage is unfortunate, the situation compares favourably with regional economies and the advanced economies of Europe and North America.

Prudent government policies, federal and provincial, the long-lasting effects of childhood immunisation and the population age structure, among other factors, have are considered to have helped Pakistan escape the worst of the pandemic so far. However, there is no room for complacency until the virus is eliminated from Pakistan and the world.

The race between infections and injections is gaining momentum across the world, including Pakistan. Relatively rich and middle-income countries, especially the UK, Bahrain, the USA, Israel and the UAE are leading this drive. Globally, the pharmaceutical sector has sufficient production capacity to manufacture around 16 billion doses, enough to inoculate the entire world population. However, the complexity of vaccine manufacturing chains and challenges in scaling up production mean that even the advanced economies will struggle, at least in the short run, to secure enough supplies for their citizens.

Most countries are using one of the top ten leading vaccines and have adopted different routes to gain access. Many advanced economies were pro-active by and “pre-purchased” several vaccines with multiple suppliers, effectively financing their research and development. Large developing countries, such as India and Argentina, leveraged their vaccine manufacturing capacity and so obtained some early supplies. In Mexico, a billionaire philanthropist, Carlos Slim, donated $150 million towards the purchase of vaccines for Latin American countries. Some states, such as Brazil and Indonesia, participated in Phase 2 and Phase 3 trials, while others have launched a rollout irrespective of the potential side effects of locally developed or imported vaccines.

Pakistan has launched a vaccination drive with the donation of around half a million doses from China. Another tranche of around 17 million vials is expected mid-year from Covax, a global alliance set up to provide access to vaccines in developing and least-developed countries. The support from Covax will cover around 3 percent of Pakistan’s population, enough to vaccinate healthcare workers and some vulnerable sections of society. However, vaccinating this large county of 220 million people will be an enormous task.

Pakistan needs to focus on strengthening its healthcare system by increasing the level of spending on healthcare to above the current level of 3.2 percent of GDP, and closer to the global average of 9.8 percent.

Achieving general immunity requires vaccinating around 60-70 percent of the population. Added to that difficulty is the uncertainty around the real-world efficacy of vaccines compared to clinical conditions and the mutation of the virus into more contagious variants, for which some vaccines may be less effective.

National and international actions can ensure swift and successful mass vaccination. National preparedness, besides securing sufficient doses, requires efficient logistics networks and services, reliable cold chains and arrangements to capture and secure data. Establishing clear priorities and transparency in the vaccination process is equally important. The National Command and Operation Centre (NCOC) can ensure highly vulnerable groups, especially the elderly, healthcare professionals and educational workers are accorded preference for inoculation.

Structural issues create additional challenges. Target populations may live in remote areas of Pakistan, lack access to healthcare services and be underserved by transport infrastructure and logistics services. Similarly, it can be difficult to reach vulnerable populations or internally displaced persons who are often highly mobile. Vaccine hesitancy is also gaining momentum in some communities. It is imperative to build trust by emphasising the scientific basis of the treatment and transparency in the identification of potential vaccines and the sequencing of rollout programmes, with emphasis on ensuring equitable distribution. National authorities and healthcare providers should develop strong oversight mechanisms for quality assurance to prevent falsification and the procurement of substandard and unsafe vaccines, and to guard against black market or illegal sales and distribution.

On the multilateral front, several developing countries have proposed relaxing some provisions of the WTO TRIPS Agreement to facilitate production of generic drugs and vaccines to tackle Covid-19. Pakistan is supporting this initiative to help ensure equitable access for developing countries. The WTO’s incoming director general, Ngozi Okonjo-Iweala, has expressed support for declaring the vaccine as a public good. The race to secure Covid-19 vaccines has prompted vaccine nationalism, with some countries hoarding, stockpiling or restricting exports to ensure their citizens benefit first. This is contributing to a generally skewed rollout of vaccines in favour of high-income countries. The Covax initiative will go some way to address this issue by supporting equitable global access but needs international support to raise necessary finances.

Given that Covid anywhere is Covid everywhere, and no one is safe until everyone is vaccinated, Pakistan’s support for these global initiatives is imperative. An uncoordinated global approach to vaccine distribution could delay the broad-based economic recovery in this highly integrated and mutually dependent world. Moreover, Covid could widen income inequalities and hinder the achievement of the Sustainable Development Goals in the remaining implementation period (up to 2030).

In the long-term, Pakistan needs to focus on strengthening its healthcare system by increasing the level of spending on healthcare to above the current level of 3.2 percent of GDP, and closer to the global average of 9.8 percent. This is not the first pandemic the country is facing nor will it be the last.

The authors are economists at the Commonwealth Secretariat in London. The views expressed above are those of the authors and do not necessarily reflect the official position of the Secretariat

Coronavirus vaccine: A marathon ahead