Global governance for COVID-19 vaccines

Recipient-Reported Reactogenicity of Different SARS-CoV-2 Vaccination Regimens among Healthcare Professionals and Police Staff in Germany

The rapid availability of effective vaccines against SARS-CoV-2 was key during the COVID-19 pandemic. However, vaccine hesitancy and relatively low vaccine coverage rates among the general population and particularly vulnerable populations such as healthcare staff reduced the potential benefits of these vaccines. During the early phase of the pandemic, fear of vaccine-related adverse events was common among individuals who refused vaccination. Between March and May 2021, we comparatively assessed the self-reported reactogenicity of different SARS-CoV-2 prime-boost regimens using mRNA-based (BNT162b2 and mRNA-1273) and vector-based vaccines (ChAdOx1 nCoV-19) in (a) healthcare workers (HCW), and (b) police staff from southwest Germany. The majority of participants (71.8%; 1564/2176) received a homologous vaccination. Among HCW, 75.0% were female, whereas 70.0% of police staff were male. The most frequently reported reactions following the first vaccine administration were pain at the injection site (77.94%; 1696/2176), tiredness (51.75%; 1126/2176), and headache (40.44%; 880/2176), which were more commonly reported by HCW as compared to police staff. In homologous, mRNA-based and heterologous vaccination schedules, more reactions were reported after the second vaccine dose. We conclude that the frequency and intensity of self-perceived vaccine reactogenicity may differ between specific population groups and might be mitigated by tailored communication strategies.

Attributes of national governance for an effective response to public health emergencies: Lessons from the response to the COVID-19 pandemic

Background

The Coronavirus Disease 2019 (COVID-19) pandemic takes variable shapes and forms in different regions and countries. This variability is explained by several factors, including the governance of the epidemic. We aimed to identify the key attributes of governance in response to the COVID-19 pandemic and gain lessons for an effective response to public health emergencies.

Methods

We employed a mixed-methods design. We mapped the attributes of governance from well-established governance frameworks. A negative binomial regression was conducted to identify the effect of the established governance measures on the epidemiology of the COVID-19 pandemic. We used publicly available data on COVID-19 cases and deaths in countries around the world. Document review was conducted to identify the key approaches and attributes of governance during the pre-vaccine era of the response to the COVID-19 pandemic. We conducted a thematic analysis to identify key attributes for effective governance.

Results

The established governance measures, including generation of intelligence, strategic direction, regulation, partnership, accountability, transparency, rule of law, control of corruption, responsiveness, effectiveness, efficiency, equity, ethics, and inclusiveness, are necessary but not sufficient to effectively respond to and contain the COVID-19 pandemic. Additional attributes of national governance were identified: 1) agile, adaptive, and transformative governance; 2) collective (collaborative, inclusive, cooperative, accountable, and transparent) governance; 3) multi-level governance; 4) smart and ethical governance: sensible, pragmatic, evidence-based, political, learner, and ethical.

Conclusions

The current governance frameworks and their attributes are not adequate to contain the COVID-19 pandemic. We argue that countries need agile, adaptable, and transformational, collaborative, multi-level, smart and ethical governance to effectively respond to emerging and re-emerging public health threats. In addition, an effective response to public health emergencies depends not only on national governance but also on global governance. Hence, global health governance should be urgently renewed through a paradigm shift towards universal health coverage and health security to all populations and in all countries. This requires enhanced and consistent global health diplomacy based on knowledge, solidarity, and negotiation.

Vaccine and inclusion

In majoritarian democracies, popular policies may not be inclusive, and inclusive policies may not be popular. This dilemma raises the crucial question of when it is possible to design a policy that is both inclusive and popular. We address this question in the context of vaccine allocation in a polarized economy facing a pandemic. In such an economy, individuals are organized around distinct networks and groups and have in-group preferences. We provide a complete characterization of the set of inclusive and popular vaccine allocations. The findings imply that the number of vaccine doses necessary to generate an inclusive and popular vaccine allocation is greater than the one necessary to obtain an allocation that is only popular. The analysis further reveals that it is always possible to design the decision-making rule of the economy to implement an inclusive and popular vaccine allocation. Under such a rule, the composition of any group endowed with the veto power should necessarily reflect the diversity of the society.

The provision of COVID-19 vaccines developed in China to other countries: A cross-sectional online survey on the views of the Chinese public

BACKGROUND

COVID-19 vaccines are in short supply globally. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public's attitude in China towards the global distribution of COVID-19 vaccines could inform global and national decisions, policies and debates.

OBJECTIVE

The aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China, and how these attitudes vary across provinces and by sociodemographic characteristics.

METHODS

We conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions on their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights.

RESULTS

A total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fully fulfilling domestic needs (75.6%, 95% CI: 74.6% - 76.5%). Women (76.8%, OR = 1.18, 95% CI: 1.07 - 1.32, P = .002) and those living in rural areas (76.8%, OR = 1.13, 95% CI: 1.01 - 1.27, P = .03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1%, 95% CI: 71.0% - 73.1%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3%, 95% CI: 76.3% - 78.2%).

CONCLUSIONS

Among our survey sample, we find that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China globally. Conducting similar surveys in other countries could help align policymakers' actions on COVID-19 vaccine distribution with the preferences of their constituencies.

CLINICALTRIAL

Common Demand vs. Limited Supply—How to Serve the Global Fight against COVID-19 through Proper Supply of COVID-19 Vaccines

Vaccination plays an essential role in the fight against Coronavirus Disease 2019 (COVID-19). The currently insufficient vaccine production capacity makes it difficult to balance supply with demand, which has led to a contradiction between command demand and limited supply. According to analysis based on game theory, the attributes of COVID-19 vaccines vary with supply strategies formulated by vaccine-producing countries. This means that vaccine-receiving countries can only be motivated to prepare operable vaccine distribution plans through the supply of COVID-19 vaccines as global public goods. The rational distribution of global public goods must be guaranteed by a global supply institution system. To that end, Elinor Ostrom’s eight design principles provide a basis for designing such a global supply system. This paper proposes a nested institution solution for guaranteeing the global supply of COVID-19 vaccines based on the design principles, which include clearly defined boundaries, proportional equivalence between benefits and costs, collective-choice arrangements, monitoring, graduated sanctions, conflict-resolution mechanisms, minimal recognition of rights to organize, and nested enterprises. To win this global fight against COVID-19, COVID-19 vaccines must not only be treated as global public goods, but countries must also be urged to coordinate cooperation in global institutional design, thus ensuring that COVID-19 vaccines can truly benefit all mankind.

COVID-19 and the Challenges in World’s Largest Vaccination Drive in India

COVID-19’s second wave has placed India into a state of emergency. Since the beginning of April 2021, the country has seen an extraordinary influx of corona positive cases. Due to COVID-19, our country is in the midst of the world’s worst crisis. Many reports and articles about the lack of hospital beds, oxygen cylinders, ICU beds, ventilators, and other medical supplies were published (both print and electronic) in this second wave, exposing the flaws in our country’s healthcare system. On January 16, 2021, the Indian government launched the world’s largest vaccination effort, but we still have a long way to go in vaccinating our 1.4 billion people. India, after China, is the world’s second-most populous country, accounting for approximately 17.5 percent of the global population. This post aims to emphasize the issues that our country is currently facing, as well as possible solutions to combat this deadly illness.

Global access to COVID-19 vaccines: a scoping review of factors that may influence equitable access for low and middle-income countries

OBJECTIVE

To identify the factors contributing to equitable access to COVID-19 vaccines for low and middle-income countries (LMIC).

METHODS

We conducted a scoping review following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and a five-stage framework for scoping studies. We performed systematic searches for published peer-reviewed literature in five databases: Medline, Embase, Web of Science, Global Index Medicus and COVID-19 Evidence Epistemonikos (August 2020, updated May 2021).

RESULTS

Systematic selection according to predefined criteria resulted in the final inclusion of 45 peer-reviewed articles, with no limitations on study design or publication type. We derived four key factors that potentially influence equitable access to COVID-19 vaccines in LMICs: (1) collectively agreed global mechanisms or frameworks; (2) bilateral purchasing, contracting, and vaccine prices; (3) vaccine manufacturing that is supported by sharing know-how; and (4) countries' strength in implementing vaccination programmes.

CONCLUSIONS

This scoping review highlights the ongoing challenges for the international community in ensuring equitable access to COVID-19 vaccines for LMICs. The literature suggests that vaccine manufacturing can influence the supply of vaccines, as can the role of patent holders who can influence global governance through their role in the distribution of COVID-19 vaccines. Our findings indicate that including the principles of equitable access throughout vaccine research and development, procurement, scale-up and distribution processes can support equitable access for LMICs. Advances made with mRNA vaccines may have additional benefits in relation to expanding the manufacturing of other vaccine. Finally, the exploration and scale-up of such capacities of LMICs are likely to prove to be a valuable investment, even after the pandemic.

Addressing Different Needs: The Challenges Faced by India as the Largest Vaccine Manufacturer While Conducting the World's Biggest COVID-19 Vaccination Campaign

The COVID-19 pandemic has highlighted some of the challenges that countries face when balancing domestic and global necessities, for example with regard to vaccine needs, production and distribution. As India hosts one of the world's largest vaccine manufacturing industries and has one of the most extensive vaccination strategies, the country is particularly exposed to these challenges. This has become all the more obvious as the country experienced a second pandemic wave in the first half of 2021, which has led to a total ban on exports of COVID-19 vaccines. An analysis of the national vaccination strategy and the domestic vaccine industry through review of peer-reviewed literature, grey literature, and news reports showed the fragile balance between domestic and international needs. A numerical comparison of India's domestic COVID-19 vaccine needs, export agreements, and production capacities was conducted. It was found that at current production rates as of April 2021, meeting all of the needs and complying with all of the agreements would be impossible. Scale-ups in production, as promised by the industry, however, will enable the achievement of all targets in the long term.

China and the global search for health security: history, vaccines, and governance

China is a key player, not just an actor, in the global search for health security. Reiteration of this point is useful for International Relations studies, which often portray China as a factor to contend with, especially given the background of the country as the first to report the outbreak of the COVID-19 pandemic. This paper adopts an analytical framework developed through a summary of routines in Chinese engagement in global health from a practitioner’s perspective: aid, interdependence, governance and knowledge. These are the core elements in a country’s pursuit of engagement with the rest of the world. After the introduction, the second section of the paper reviews contributions from China in the history of global plague control over the past century. The third section discusses structural issues affecting access to vaccines, which are essential for bringing COVID-19 under effective control. The fourth section identifies a number of challenges China is facing in global health governance. The final section offers a few concluding thoughts, reiterating the nature of interdependence in the global search for enhancement of health security.

International Collaboration to Ensure Equitable Access to Vaccines for COVID-19: The ACT-Accelerator and the COVAX Facility

Policy Points Equitable access to a COVID-19 vaccine in all countries remains a key policy objective, but experience of previous pandemics suggests access will be limited in developing countries, despite the rapid development of three successful vaccine candidates. The COVAX Facility seeks to address this important issue, but the prevalence of vaccine nationalism threatens to limit the ability of the facility to meet both its funding targets and its ambitious goals for vaccine procurement. A failure to adequately address the underlying lack of infrastructure in developing countries threatens to further limit the success of the COVAX Facility.

CONTEXT

Significant effort has been directed toward developing a COVID-19 vaccine, which is viewed as the route out of the pandemic. Much of this effort has coalesced around COVAX, the multilateral initiative aimed at accelerating the development of COVID-19 vaccines, and ensuring they are equitably available in low- and middle-income countries (LMICs). This paper represents the first significant analysis of COVAX, and the extent to which it can be said to have successfully met these aims.

METHODS

This paper draws on the publicly available policy documents made available by the COVAX initiatives, as well as position papers and public statements from governments around the world with respect to COVID-19 vaccines and equitable access. We analyze the academic literature regarding access to vaccines during the H1N1 pandemic. Finally, we consider the WHO Global Allocation System, and its principles, which are intended to guide COVAX vaccine deployment.

FINDINGS

We argue that the funding mechanism deployed by the COVAX Pillar appears to be effective at fostering at-risk investments in research and development and the production of doses in advance of confirmation of clinical efficacy, but caution that this represents a win-win situation for vaccine manufacturers, providing them with opportunity to benefit regardless of whether their vaccine candidate ever goes on to gain regulatory approval. We also argue that the success of the COVAX Facility with respect to equitable access to vaccine is likely to be limited, primarily as a result of the prevalence of vaccine nationalism, whereby countries adopt policies which heavily prioritize their own public health needs at the expense of others.

CONCLUSIONS

Current efforts through COVAX have greatly accelerated the development of vaccines against COVID-19, but these benefits are unlikely to flow to LMICs, largely due to the threat of vaccine nationalism.

Next-Generation COVID-19 Vaccines Should Take Efficiency of Distribution into Consideration

The dire need for safe and effective coronavirus disease (COVID-19) vaccines is met with many vaccine candidates being evaluated in pre-clinical and clinical studies. The COVID-19 vaccine candidates currently in phase 3 or phase 2/3 clinical trials as well as those that recently received emergency use authorization (EUA) from the United States Food and Drug Administration (FDA) and/or other regulatory agencies worldwide require either cold (i.e., 2–8°C) or even freezing temperatures as low as −70°C for storage and distribution. Thus, existing cold chain will struggle to support both the standard national immunization programs and COVID-19 vaccination. The requirement for cold chain is now a major challenge towards worldwide rapid mass vaccination against COVID-19. In this commentary, we stress that thermostabilizing technologies are available to enable cold chain-free vaccine storage and distribution, as well as potential needle-free vaccination. Significant efforts on thermostabilizing technologies must now be applied on next-generation COVID-19 vaccines for more cost-effective worldwide mass vaccination and COVID-19 eradication.

The immunology of SARS-CoV-2 infection, the potential antibody based treatments and vaccination strategies

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a potentially fatal agent for a new emerging viral disease (COVID-19) is of great global public health emergency. Herein, we represented potential antibody-based treatments especially monoclonal antibodies (mAbs) that may exert a potential role in treatment as well as developing vaccination strategies against COVID-19.Areas covered: We used PubMed, Google Scholar, and clinicaltrials.gov search strategies for relevant papers. We demonstrated some agents with potentially favorable efficacy as well as favorable safety. Several therapies are under assessment to evaluate their efficacy and safety for COVID19. However, the development of different strategies such as SARS-CoV-2-based vaccines and antibody therapy are urgently required beside other effective therapies such as plasma, anticoagulants, and immune as well as antiviral therapies. We encourage giving more attention to antibody-based treatments as an immediate strategy. Although there has not been any approved specific vaccine until now, developing vaccination strategies may have a protective effect against COVID-19.Expert opinion: An antiviral mAbs could be a safe and high-quality therapeutic intervention which is greatly recommended for COVID-19. Additionally, the high sequence homology between the SARS-CoV-2 and SARS/MERS viruses could shed light on developing to design a vaccine against SARS-CoV-2.

Love thy neighbour? Allocating vaccines in a world of competing obligations

Although a safe, effective, and licensed coronavirus vaccine does not yet exist, there is already controversy over how it ought to be allocated. Justice is clearly at stake, but it is unclear what justice requires in the international distribution of a scarce vaccine during a pandemic. Many are condemning 'vaccine nationalism' as an obstacle to equitable global distribution. We argue that limited national partiality in allocating vaccines will be a component of justice rather than an obstacle to it. For there are role-based and community-embedded responsibilities to take care of one's own, which constitute legitimate moral reasons for some identity-related prioritisation. Furthermore, a good form of vaccine nationalism prioritises one's own without denying or ignoring duties derived from a principle of equal worth, according to which all persons, regardless of citizenship or identity, equally deserve vaccine-induced protection from COVID-19. Rather than dismissing nationalism as a tragic obstacle, it is necessary to acknowledge that a limited form of it is valuable and expresses moral commitments. Only then can one understand our world of competing obligations, a world where cosmopolitan duties of benevolence sometimes conflict with special obligations of community membership. Once these competing obligations are recognised as such, we can begin the work of designing sound ethical frameworks for achieving justice in the global distribution of a coronavirus vaccine and developing practical strategies for avoiding, mitigating or resolving conflicts of duty.

RBD-Fc-based COVID-19 vaccine candidate induces highly potent SARS-CoV-2 neutralizing antibody response

The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed serious threats to global health and economy, thus calling for the development of safe and effective vaccines. The receptor-binding domain (RBD) in the spike protein of SARS-CoV-2 is responsible for its binding to angiotensin-converting enzyme 2 (ACE2) receptor. It contains multiple dominant neutralizing epitopes and serves as an important antigen for the development of COVID-19 vaccines. Here, we showed that immunization of mice with a candidate subunit vaccine consisting of SARS-CoV-2 RBD and Fc fragment of human IgG, as an immunopotentiator, elicited high titer of RBD-specific antibodies with robust neutralizing activity against both pseudotyped and live SARS-CoV-2 infections. The mouse antisera could also effectively neutralize infection by pseudotyped SARS-CoV-2 with several natural mutations in RBD and the IgG extracted from the mouse antisera could also show neutralization against pseudotyped SARS-CoV and SARS-related coronavirus (SARSr-CoV). Vaccination of human ACE2 transgenic mice with RBD-Fc could effectively protect mice from the SARS-CoV-2 challenge. These results suggest that SARS-CoV-2 RBD-Fc has good potential to be further developed as an effective and broad-spectrum vaccine to prevent infection of the current SARS-CoV-2 and its mutants, as well as future emerging SARSr-CoVs and re-emerging SARS-CoV.