Sciana members discuss next steps in fighting COVID-19

Members and foundation staff hear from Coalition for Epidemic Preparedness Innovation's Frederik Kristensen

The Coalition for Epidemic Preparedness Innovations (CEPI)'s Frederik Kristensen helped relaunch Sciana's webinar series following a brief hiatus.

Kristensen, who serves as deputy CEO and director for people, planning, and policy at CEPI, was on hand to talk to Sciana members and foundation staff in a webinar titled, "Delivering a COVID-19 Vaccine: What Happens When One is Approved?"
    
The webinar, which took place on October 14, also included country perspectives from Sciana members, including Sarah Anderson (UK), Nora Kronig (CH), and Matthias Wismar (DE).

It was the first Sciana webinar to occur since June 23, where members and foundation staff discussed “COVID-19 and leadership: lessons for the future?”

Ilona Kickbusch, chair of the Sciana Network, once again served as moderator for the latest discussion. She was joined by Sciana’s new programme director, Mary Helen Pombo.

Members heard the stakes could not be higher: hopes of ending the COVID-19 pandemic are pinned on developing one or more safe and broadly effective vaccines. Over 300 candidate vaccines are in development globally, and governments are deep into the process of planning the roll-out of a vaccine, following approval by regulators. Factors that will need to be taken into account nationally include who should be given the vaccine first and how to respond to the likely popular reaction, while also taking into account existing anti-vax sentiment, potentially amplified by the compressed timescale for COVID-19 vaccine testing.

These issues also have an important international dimension and are not new. CEPI, a public-private partnership, was set up in the wake of the Ebola crisis so that vaccines could be developed faster, and access to them could be made more equitable.

Work on a COVID vaccine started early - in January 2020 - and the question of equitable global access is critical, as COVID-19 risks exacerbating global poverty on a huge scale, with the IMF predicting that the pandemic could push the proportion of people living in poverty in the poorest countries to levels that were last seen a decade ago.

CEPI is directly supporting the development of nine vaccine candidates through the COVAX coalition supported by more than 180 countries. Vaccine candidates have been chosen based on the criteria of speed, scale in the production of, and equitable access. Beyond the development of a vaccine, other criteria for international collaboration are important. These include filling an R&D funding gap to develop a second-generation vaccine given in a single dose or is more temperature-stable, not least to be of more use to lower-income countries.

Work needs to be done to ensure country readiness, given that there are over 200 regulatory regimes in existence worldwide. Liability issues also need to be addressed, and to ensure that compensation for patients is a reality, but at the same time, protect manufacturers. Allocation is a potential conflict source, as governments try to balance their need to protect their own citizens against the ideals of equitable global allocation.

COVAX, launched by the World Health Organization, GAVI, and CEPI, includes a framework for the equitable allocation of any successful vaccines, and WHO is planning for vaccination programmes to cover 20% of all people in each country, including health workers and people at high risk of harm from the virus.

Work will need to be done with the public in all countries, not just meeting the criticisms of the anti-vaccine movements, but also reassurance and information aimed at people who are sceptical and concerned about the speed with which vaccines are being developed – over a period of 12-18 months when the process normally takes years. It will be vital to reassure people that the steps taken to develop a vaccine and ensure a vaccine's safety have been done in parallel, instead of the normal process that is sequential, and no corners have been cut with respect to safety.

These concerns resonated with Sciana members in all three countries. In Switzerland, a small country not part of the European Union with an open border, the government has pursued multiple channels through multiple initiatives. Bilateral agreements with the private sector have been drawn up at the same time as participation in the global collaboration of COVAX. Switzerland has forged links with other small states, such as Singapore, to strike a balance between the need for international solidarity and the reality of being a small power navigating large global coalitions and regulatory rules. Bilateral agreements are seen as pragmatic for a small country, rather than an act of national selfishness. Meanwhile, preparations are well underway to administer a vaccine and create a campaign to communicate to the public.

The UK is also supporting COVAX and is at the forefront of vaccine development, with groundbreaking research taking place in Oxford but also other research centres. At the same time, work is being done to draw up a framework for delivery. This is being guided by the need to reduce the risk of developing disease amongst the most vulnerable and is likely to mean vaccination will be prioritised for health and care workers, those over the age of 80, and people in care homes.

The UK already benefits from a well-established vaccination programme for flu, aimed at children and older people, rooted in general practice, which is well trusted by the public. A COVID-19 vaccination programme would likely be a combination of mobile units and general practice. Work has begun on public communication campaigns to explain the rationale about who will get priority, answer worries about safety and efficacy, and equips health workers to respond to fears about side-effects. Public information campaigns will need to reach all sections of the population, particularly groups from black and minority ethnic communities, who already vulnerable but may also be wary of vaccines because of the experience of discrimination in their lives.

Germany is also developing plans on distributing, storing, and administering vaccines, coordinated by the Robert Koch Institute and others. Who will get priority is a live issue, as there will not be enough vaccine in the beginning to vaccinate everyone. The machinery for coordinating a mass vaccine programme is being set up, but public consensus about the handling of the pandemic is beginning to crumble as the second wave of infections has taken off. Regional differences in lockdown rules have complicated this, and fake science is on the rise, exacerbating existing vaccine hesitancy.