Is immunity just a mirage, on the far horizon?

Our stalled vaccination rollout has stripped the gloss from our successful virus suppression in 2020.

What a difference a few tiny wayward blood clots can make! Our preferred COVID-19 vaccine – the one we are making here – is effectively to be sidelined for everyone under 50, and our hopes for national immunity this year have been dashed.

Australia’s ability to deal with the vaccine setback is greatly strengthened by its achievement in keeping the coronavirus at bay, but the gloss from that triumph has been stripped away. As I write this, the wheels appear to have fallen off the national rollout.

The pandemic has taught the world pharmaceutical community a great deal about the virus over the year since governments began working out their vaccine orders. Even so, the UK-Swedish supplier AstraZeneca remains a valuable option despite its rare blood-clotting complications, discovered only since its mass rollout.

Even better was the Pfizer-BioNTech vaccine, a US-European collaborative effort. Like AstraZeneca, large numbers of doses can be produced quickly. But its biggest selling point is its use of recently-developed messenger RNA technology, a feature shared with vaccines from Moderna (US) and CureVac (Germany).

An mRNA vaccine uses a synthesised copy of natural ribonucleic acid (RNA) to induce immunity cells to identify and destroy the invading virus. It promises more rapid adaptability to new virus variants than more established technologies used in most vaccines now on offer.

A year ago, AstraZeneca and Pfizer were logical and defensible choices, but some things could have been done with more forethought. Pfizer, for instance, requires its vaccine to be stored at minus 79C, which should have raised questions about its suitability for places lacking that capacity in regional Australia and in undeveloped Pacific countries.

Putting our eggs in just two baskets (or three if you include Novavax, which if authorised is unlikely to land on our shores until late this year) was a risk that the US and the UK, with many more suppliers on their order list, effectively avoided.

The AstraZeneca blood-clotting issue has been badly handled. While expressing a preference for 50 as the minimum age for the jab, Australian authorities have not set a hard-and-fast rule. GPs and others administering it will probably decline to inject anyone under 50, which will further curtail the rollout.

The virus’s mutation rate makes rapid vaccination essential if we are to avoid many years of pandemic disruption. The UK, Canada and the US are way behind us in social suppression of the virus, but they’ve turned the tables in vaccines administered: 39 million first doses in the UK, 8 million in Canada and 183 million in the US. For us, just one million first jabs.

After the hugely successful effort in 2020 to suppress the vaccine, 2021 looks like being Australia’s year of lost opportunity. 

A crucial challenge for global suppression is the speed at which vaccines can be delivered into the arms of the people of poor countries. Rich countries like Australia, New Zealand, Japan, Canada, the US, the EU and Britain hold just a seventh of the world’s people, but they have secured over half of the world’s current supply of vaccines.

Last year India and South Africa, seeking a rapid global vaccine rollout, proposed a temporary tweak to intellectual property rights that would allow ramped-up manufacture of cheaper generic versions of vaccines for rapid distribution to poorer countries.

That proposal has been supported by over 70 per cent of members of the World Trade Organisation, which would determine this one-off waiver of IP rights. Without the waiver, that big majority of countries won’t have enough vaccine coverage to secure immunity for enough of their population to render them safe for travel. 

Australia, which can afford to negotiate directly with pharmaceutical companies, is not one of those countries. Instead it is arguing for voluntary, non-enforceable agreements between would-be vaccine manufacturers and developers. It’s a halfway house that benefits no-one except the big pharmaceutical companies.

This is despite the fact that while all developers except (to its credit) AstraZeneca aim to profit from developing their vaccines, every one of them has received public grants, which by one reckoning add up to over $12 billion. Yet another instance of the pandemic driving private profit at public cost.

With viral variants proliferating, no-one is safe until everyone is safe. As a group of public health experts pointed out in The Conversation last week, that requires not just vaccines, but also a continuing global suppression effort, which is what we’re really good at. Australia may yet have something of value to offer a flagging world.

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