Double-edged news

In news that is calculated to buoy markets globally, a major pharmaceutical manufacturer has said that its Covid-19 vaccine candidate has 90 per cent efficacy and has shown no major side effects in Phase-III trials. This is the BNT162b2 vaccine from Pfizer, which was being developed by the small German company BioNTech. So far, little is known beyond the press release from the pharma major, and most experts have cautioned against prejudging the detailed medical data to follow. And, of course, the final decision will be taken by regulators, first in Europe, then in the United States, and subsequently elsewhere in the world. Nevertheless, this is a landmark moment: The first credible news of a successful Phase-III trial for a vaccine that would address the disease, which has devastated the global economy and killed so many people. It is a tribute to the private sector pharmaceutical industry that so many vaccine candidates are in the pipeline and that the first success has been achieved in what is, by the standards of vaccine development, an unbelievably short length of time.

It is important to note that this good cheer should not necessarily be felt in India, however. BNT162b2 is based on the novel messenger RNA (mRNA) technology. While this means it could be speedily developed, it also has relatively fragile efficacy. Previous statements from the developers have suggested that it needs to be stored at super-low temperatures — of minus 70 degrees Celsius or lower. Once it has been thawed out after transportation at this super-low temperature, it needs to be kept refrigerated at just above zero degree Celsius for at most 24 hours — after which it loses efficacy and winds up being a placebo. The distribution challenge for countries like India should be obvious. It is difficult enough to send out regular vaccines. But this one, in addition, requires super-low temperatures; has complex inventory requirements, with a maximum 24-hour shelf life; and needs a follow-up dose in exactly three weeks. Put together, this is a near-prohibitive ask for the Indian distribution system. The developed world, however, could manage it. Certainly, Europe has already contracted for 300 million doses of the vaccine. The danger is of a two-speed recovery from the pandemic, in which countries that have the cold chain infrastructure to distribute mRNA vaccines emerge swiftly, and those in the developing world like India that do not have such facilities have to deal with the pandemic for much longer. Worse, the availability of this relatively effective vaccine in the developed world would reduce the profitability, and thus the incentives, for other vaccine candidates to proceed with their trials — even if such vaccine candidates might be far better suited for Indian conditions.

This means that the vaccine state of play for India has changed dramatically. The government must quickly determine whether an mRNA vaccine such as Pfizer’s (or Moderna’s, which is much more expensive but slightly easier to store) is basically infeasible for India or whether a sustained investment over the next six months in a cold chain could be made. This determination must be made in the next few weeks. If this vaccine is infeasible, the government must double support for the other, more easily transported vaccine candidates, or risk India being locked into the pandemic for even longer than expected.


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