Covid-19 vaccination budget must account for all possibilities

Photo: Reuters

A lot of resources are expected to be set aside in Budget 2021 to procure Covid-19 vaccines and fund related operations. In addition to the number of people targeted to be vaccinated, the number of doses per person and price per dose, another crucial element is the effectiveness of these new vaccines.

In June, the US Food and Drug Administration lowered the efficacy bar to 50% for Covid-19 vaccine candidates. Other regulatory agencies around the world have also followed suit. The former director of immunisation at the US Department of Health, David Salisbury, covered this topic well in Britain’s The Guardian newspaper, pointing out that an efficacy of 50% means only half of those receiving vaccines may be protected.

In this lowest-acceptable case scenario, we would have to acquire at least double the doses to administer to twice as many people to meet the protected population target. As explained by Salisbury, whatever the effectiveness rate ends up being, no vaccine is 100% effective. Other factors to be considered include immunity retainment and rate of virus mutation – a combination that complicates vaccine development, vaccine purchase strategy and vaccination efforts toward achieving nationwide immunity.

We are still unsure how long the acquired immunity will be retained. WION News (World is One News, an international India-based English language pay TV channel) reported in July on a study in Britain that measured antibody levels in people after they had contracted the virus. The research showed immunity levels are prone to decline in “just a few months” after recovery.

If this proves to be the case, then the acquired protection is very temporary, which means vaccine purchase must take into consideration potential supplementary doses.

Chinese authorities reportedly require vaccines to provide a minimum of six months of immunity to be approved for use in China. Should immunity last only a few months or even six months, vaccination efforts may not be so straightforward.

Assuming the initial vaccinated population are unable to retain their immunity for long, significant pressure for access to the next round of vaccines can be forecasted. The global Covax Facility vaccine allocation plan was reported to initially provide vaccines for only up to 10% of Malaysia’s population, and we don’t know yet when we can get more.

Additionally, we have to account for the possibility, however unlikely, of the virus mutation rate being faster than expected and at a magnitude that may render the vaccines useless. That would mean purchasing an entirely different version for the next batch.

There are researchers that doubt such scenarios, but nobody can say for sure at the moment. Therefore, the assessment of purchase volumes and the corresponding budget estimates have to at least consider these possibilities.

Operational estimates must account for supply chain and logistical issues, addressing anti-vaccination groups, and population uniformity.

We may be dealing with novel types of vaccines and WION News reported that many vaccine developers have emphasised the “uncertainties”, which could be interpreted as a warning that vaccines are not guaranteed to work.

Further adding to the risks is the fact that there have been no clinical trials conducted on the Malaysian population to provide any direct extrapolation on efficacy.

Of course, indemnity clauses, disclaimers, and all the legal jargon related to efficacy, safety, and other metrices would usually be present in purchase contracts and are likely to be reflected in pricing structures. Malaysian authorities must review these carefully and ensure the budget is spent wisely.

Authorities should consider studying a scenario of procuring more than one type of vaccine to cover for potential vaccine failure and deploy a multi-vaccine strategy to increase chances of successful vaccination. Understandably, potential inefficiencies and practicality have to be considered given that purchasing different types of vaccines would present significant logistical complications. Not to mention the obvious impact on government expenses.

As for ground operations, its best for authorities to consider conducting trial rollouts with smaller volumes at several test locations first, prior to conducting nationwide vaccination.

Some vaccines could be more temperature-sensitive and less resilient to physical agitation. Poorly established supply chains, cold storage and distribution chains may fail, and human error may occur due to lack of training and familiarity. It’s necessary to consider purchasing a buffer supply to account for potential handling losses.

Lastly, achieving national herd immunity is dependent not only on a high enough percentage of the population being vaccinated and retaining immunity, but it also requires uniformity. This means having sufficient number of protected people spreading evenly in the population to “surround” and protect the unvaccinated ones. According to a global survey conducted by market research company Ipsos from July 24 to Aug 7, a substantial 15% of Malaysians disagree with vaccination.

Assuming these antivaxxers are mostly concentrated in rural areas, clusters of infection could still spread within these communities. In this case we’ll get a concentration of immunised population in urban areas, surrounded by many smaller groups of non-protected population.

Science, Technology and Innovation Minister Khairy Jamaluddin has shown considerable insight on the matter in a Facebook Live session with StarBizWeek recently, indicating the possibility of billions of ringgit allocated to vaccines in Budget 2021. In a separate article Khairy also assured that the authorities will set up task forces to carry out the necessary early preparations prior to receiving vaccines.

Without the approval and successful implementation of a well-thought-out national budget, negative health and socioeconomic impacts are expected to be prolonged and worsened. Lawmakers should internalise “economics of empathy” and set aside political differences to focus on the rakyat’s pressing needs.

AMEEN KAMAL

Head of Science & Technology, Emir Research

Note: Emir Research is an independent think tank focused on strategic policy recommendations.