Vaccines for Pakistan to combat COVID-19

It was February last year when the first two cases of COVID-19 were detected in Pakistan, simultaneously in Karachi and Islamabad. Since then, a year has passed but the pathogen of the virus is still rampant in the country, like everywhere else in the world. It has disrupted social interactions, daily lives, and livelihoods of millions of people in every country!As of February 1, 2021,Pakistan has reported more than 546,420 confirmed cases of the novel coronavirus and 11,680 deaths, painting a very grim picture of sufferings,and continued disappointing struggle for controlling the virus spread, just like in other countries around the world! The newvariant strands(V.1.1.7&501Y.V2)found recently in many countries are more contagious and exhibit much higher transferable rates. The emergence of this new landscapeis causing further havoc globally as it seems that the health officials are losing theirwar against the deadly pathogenthat has killed 2.4 million people and more than 103.6 million have been diagnosed with the novel coronavirus as of the 1st day of February.
Since people are not following World Health Organization (WHO) and local health officials’ guidelines to help stop the roaring wave of the spread, the best hope is the vaccination of large-scale population in every country. Multinational pharma companies are already racing around the clock to develop vaccines that will help in decelerating the virus to reach to a level (herd immunity) that will give a sign of relief and a room for breathing to everyone from the pandemic.
Currently, there are two most commonly used vaccine technologies (platforms). Conventional, also called “inactivated” whereby vaccines work by exposing the body to a dead virus (treated with heat, chemicals, or radiations). Thus, it cannot infect cells and replicate-to trigger an immune response. The second type of technology is called “viral vector” in which a harmless virus, called “vector” is used to deliver a small part of COVID-19’s genetic material into the body’s cells which then replicates to activate the immune system which in turn triggers the production of the antibodies.
There have been several vaccine candidates (more than 37) that have gone through the stringent three distinct testing phases of human trials. After the initial (first phase) safety & dosage screening, twenty-four (24) vaccines were selected for expanded safety screening. In the last phase (third phase) twenty (20) vaccines were chosen for a large-scale efficacy test. Based on the efficacy trials data only 2 vaccines have been approved to date in the USA for administering for mass scale inoculation.
During the early period of the COVID-19global spread (spring of the last year), rush andfrenzyfor securing the PPEs by every country has been very well documented. The wealthy countries were found outbidding each other in securing the limited supplies of the PPEsfor their citizens (in some cases countries were bidding against their own states and provinces), leaving nothing for the mid & lower income nations, but to wait. Similar conditions are developingnow for procuring the vaccine supplies as some of the wealthy countries have bought out(in some cases) the entire productions of the vaccine manufacturers leaving behind nothing for the mid to lower income and poor nations to have access to. If this trend will continue and the vaccine supply is not shared equitably with the other nations, it will create a catastrophic condition and “morale meltdown.” Similar sentiments have been expressed by WHO officials and also been highlighted by several Philanthropists and other global agencies.
Based on the latest available data, and Duke University’s Global Health Innovation Center, wealthy countries have secured 4.2 billion doses under the bilateral arrangements directly from the pharma companies, while higher to middle income nations have ordered 1.1 billion doses for their citizens. Lower middle-income countries have reported 411 million doses commitments from the manufacturers and the bottom of the income bracket (poor) nations have confirmation for just 270 million doses!
Canada has announced that it will donate excess number of the doses it has secured to the poor nations. Late last year, President Xi Jinping has stated China’s commitment to offering Chinese vaccines for “global public good” through the “priority access” mechanism as well as free of charge to some deserving countries.
Pakistan is one of the countries who has conductedhuman use trials with Chinese Sinopharm vaccine and has received just now (January 31, 2021) its first ever vaccine doses of 500,000 as a donationfrom China, its “Iron Brother.”With its price tag of US$31 per dose, its total market value is about US$15.5 million (since it was free, it did not cost Pakistan anything except the fuel cost used in a R/T by Pak Airforce cargo plane). This arrangement has also been confirmed by the Chinese Ambassador to Pakistan, Nong Rong. In a public statement he said, “proud to be the first country to contribute to the vaccination plan of Pakistan.” In a tweet, Pakistan’s Foreign Minister, Shah Mahmood Qureshi, appreciated China for the donation. According to some sources, China has promised another shipment of one million doses of the same vaccine by the end of February.
The vaccineis based on the “inactivated” technology (platform) and requires 2 doses with 3-4 weeks apart. It has shown 79.34% efficacy and does not require extremely cold (like -80 degree centigrade for Pfizer) storage conditions. It can be stored in any standard refrigerator at 2 to 8 degree Celsius for 24 months, without any concerns. Most common side effects reported are headache, muscle ache and fever. This Chinese vaccine has also been approved for emergency use in addition to China, in the United Arab Emirates and Bahrain. As of now, WHO is reviewing the phase three trial data supplied by Sinopharm and anticipate giving its final decision by March.
The second vaccine approved by Pakistan’s health ministry is Oxford-AstraZeneca, a British-Swedish multinational who has licensed the vaccine from University of Oxford.This vaccine is based on “viral vector” technology (platform) and uses a weakened chimpanzee common cold virus to deliver a SARS-CoV-2 protein into human body that triggers its immune system to fight COVID-19.
The vaccine is undergoing through the data assessment (submitted by AstraZeneca) by WHO & EMA and the decision is expectedby January end for the non-COVAX countries and by March/April for the COVAX members. The vaccine has been authorized for its emergency use besides Pakistan, in Britain, Brazil, Mexico, Argentina, India, Saudi Arabia and the UAE.
AstraZeneca vaccine is based on the “vector viral” technology (platform) and requires two doses with a minimum of 4 weeks to 12 weeks apart. Its efficacy is 70.4% and like the Chinese vaccine (Sinopharm) can be stored in standard refrigerators (2-8 degree Celsius). Its most common side effects are tiredness, fever, chills, joint pain, nausea, headache, body ache. Preliminary indications are that this vaccine will cost US$3-4 per dose, a significantly lower than the other currentlyemergency use authorized vaccines.
According to a recent tweet by Pakistan’s Federal Minister for Planning, Asad Umar, the COVAX(WHO’s platform to facilitate the equitable access and distribution) has informedhim to supply Pakistanup to 17 million doses of AstraZeneca vaccine in 2021(most likely in the second half of the year). Since this vaccine is the cheapest and with the discount from COVAX, it will be the most inexpensive vaccine and thus the best choice for Pakistan.
In order to reach the herd immunity level, Pakistan has to inoculate 130-150 million of its citizens in the shortest possible time (by the end of 2021). It means, Pakistan needs to procure at least 130 million doses (for a single dose vaccine) or 260 million doses for a 2-dose vaccine; or a combination of the two types to reach to the herd immunity inoculation level. At the end, it all boils down to how much funds are available to Pakistan from the multilateral-donor agencies for combating the COVID-19 pandemic.

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