Moving the Needle On Vaccine Market’s Systemic Issues

International | Oct 18 2021

As the world prepares to re-open for international travel, countries need to find common ground on vaccine passport approvals.

-Global vaccine market set to boom in value this decade
-Covid mRNA vaccines build hope for vaccines for other serious diseases
-Public health authorities to deal with vaccine confidence

By Ed Kennedy

The covid pandemic has elevated the subject of vaccines as a public health issue and redefined the vaccine market, which is forecast to grow to roughly US$57bn in 2050, up from US$37bn in 2019.

The industry’s growth and progress over time have yielded great benefits, helping eradicate diseases like smallpox (which last appeared in Australia in 1938) and nearly eradicating polio (which the country has been free of since 2000).

The development of covid vaccines by using messenger ribonucleic acid (mRNA) technology offers new hope in the quest to eradicate many serious diseases.

Yet the success of vaccine developers and the global market more widely will never be reliant on businesses within the industry alone.

As the (mis)management of covid vaccination programs and border policies show, the great optimism surrounding new vaccines now must also be tempered by the reality that public health authorities – though a tough job they certainly have – will unfortunately undermine confidence in vaccines generally when decisive and clear leadership is lacking.

The turbulent rollout of many national public vaccination programs, and the current policies surrounding international travel for fully vaccinated individuals, are illustrative of this.

mRNA is Marvellous but Covid programs Muddy the Waters

It is widely understood the pandemic has spurred demand for covid vaccines, and that this demand has redefined the global vaccine landscape.

But in the post-pandemic era, history may come to show the greatest legacy of the covid pandemic was the foundation it laid for mRNA vaccines of the future.

It’s held before the pandemic, no mRNA vaccine had been approved by a single country on Earth. Yet now with covid, it’s well-placed to be at the forefront of a medical revolution.

While pharma companies have been researching mRNA for years (it was first being discovered in the early 1960s) the pandemic brought it into widespread global use, and there’s now the hope that the mRNA technology could come to improve upon (and ultimately replace) pre-existing vaccines, while also being a key driver in the development of new ones.

The reason for this is the greater speed and lower cost in which a mRNA vaccine can be devised and deployed.

MRNA vaccine candidates against the flu, malaria, Zika, Nipah, hepatitis, cancer and more, are in the works.

Even if just one of these comes into being and obtains global use, it’d be a revolutionary achievement.

But though the quest to develop new vaccines is entering a very promising era, the reality is – setting aside outliers who are trafficking in clearly discredited fake news and myths –  the upheaval and uncertain timelines many nations have had surrounding their public vaccination programs could generate in any reasonable person some frustration and concern surrounding the public authorities who administrate the rollout of vaccines. 

The Grey and Illegal Markets for Covid Vaccines

When it comes to covid vaccines, some nations who’ve encountered vaccine shortages from their primary source(s) have been able to make up the difference by sourcing them from elsewhere legitimately.

Yet just as the failure of many governments to secure vaccines from legitimate suppliers has been widely publicised, the global market as a whole has also been awash with supplies of dubious origin, being offered for sale by questionable vendors (with doubt often surrounding whether they’ve actually got the vaccines at all, or are simply seeking a payment without a product).

A central factor of the grey market and its illegal counterpart is a simple case of supply and demand.

Where shortages persist, questionable activity will arise. It can do so in unexpected ways, and in surprising locales.

For instance, although the European Union (EU) was held to be the largest producer of vaccines prior to the pandemic, an underwhelming rollout of the covid vaccine program cause multiple member states to lose faith in the joint purchasing strategy devised among the EU, sparking a frenzy of activity as nations sought to source vaccines outside official channels.

Sourcing vaccines in the grey or illegal market may appear tempting for its ability to offer a quick fix, but the nature of doing business with dubious suppliers, and worse the acquisition and use of any fake vaccines that are circulating (such as the counterfeit Pfizer doses that the US company said was found in Poland and believed to be an anti-wrinkle treatment!) is counter-productive. 

Particularly given such stories are precisely what the voices fanning the flames of fear among those yet to be vaccinated will seize upon.

Doing business with suppliers who will never actually supply the vaccines or provide fraudulent versions would bring no benefit and does little to build confidence.

Unequal Opportunities With Vaccines Will Delay Individuals Getting Vaccinated

According to Gavi, the vaccine alliance, at time of writing there are 21 vaccines in use globally.

Although this is no small number – and incidentally Gavi also contends 194 other vaccines are in the pre-clinical development stage – there can be different side effects on the cards with different vaccines, and it’s also held some varying efficacy rates in the months following the jab.

Yet until now, the desire for access to a vaccination for most has primarily been driven by health concerns and a desire to return to a (more) normal life.

That remains the key driver for the majority, but with the emergence of the vaccine passport across multiple jurisdictions that entitles the fully vaccinated to access to extra venues and activities in comparison to the unvaccinated, there’s a new incentive for those yet to get the jab to do so.

This said, it is now the international implications of the vaccine pertaining to passports that will loom large, and can be expected to have a bearing on demand.

The dynamic between the US Food and Drug Administration (FDA) and the AstraZeneca and Sputnik V vaccines is illustrative of this.

The Side Effects of the Vaccinated Traveller Requirement

The FDA is yet to approve AstraZeneca as a covid vaccine. Given the availability of Pfizer and Moderna in the US, which have already received FDA approval, the status of AstraZeneca likely isn’t a source of great anguish for most Americans.

But it has implications across the Atlantic.

While there is the expectation this particular vaccine will be added to the list of those approved (the final authority surrounding which vaccines will be recognised for entrants to the US ultimately resting with the Centre for Disease Control and Prevention) the absence of such an approval by the FDA would surely make those needing to travel to the US nervous.

Russia’s Sputnik V has not been approved by the FDA (or the World Health Organization at time of writing).

Some Russians will contend there is politics at play, but for individuals who’ve been fully vaccinated with Sputnik, entry into the US appears ruled out until further notice once new rules come into effect this November.

For those still planning to be vaccinated, it can be expected that considerations surrounding which vaccine is viewed favourably in their international destinations of choice will loom large.

For those who’ve had their first jab, they may form the view that doing a mix-and-match of different vaccines is one way around this.

Not only have numerous health authorities advised against a mix-and-match approach, but some countries have previously refused to deem a mixed-dose recipient as fully vaccinated, or do so but only with particular vaccine combinations.

Some travellers have already pursued border crossings by doing quarantine or laundering their travel status by spending time in another country between their primary destinations (Mexico was recently a popular port of call for Britons looking to get into the US) but business and travellers as a whole will require far more consistency and certainty in border arrangements before resuming international travel.

The Challenge in Finding Cures for Vaccine Market Woes

The vaccine market is on the cusp of an exciting new era.

But even if the rollout of a cure to other diseases may not come with quite the same urgency, the management of vaccination requirements for international travellers leaves much to be desired.

In turn, the variables from one country to the next is not only problematic for travellers now, but is set to drive grey and illegal market activity later.

Public health authorities need to learn from their failures in sourcing and delivering vaccines.

Just as vague (and changing) delivery dates for vaccines over the past year undermined business confidence and the capacity for people to plan their future (or to simply hang on until their working life and access to income resumes), the failure to provide clear and certain leadership for travel-entry requirements would be another blunder.

It is in the interest of all nations that are intent on swiftly reopening borders to avoid this.

There’s no suggestion that finding a shared vision is as simple as flicking a switch, but if almost 140 countries could find agreement in principle this month to set a global minimum corporate tax rate, finding common ground on vaccines would surely be worthwhile to help restore confidence to businesses reliant on international travel, and accordingly, to drive down activity in the grey and illegal vaccine markets which can undermine vaccine uptake.

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