## Accelerating Vaccinations ## Source details **Canonical URL:** [Accelerating Vaccinations](https://www.imf.org/-/media/files/publications/fandd/article/2021/december/kremer.pdf) ## Other formats - [Markdown version](/-/media/files/publications/fandd/article/2021/december/kremer.pdf.md) - [Structured JSON version](/-/media/files/publications/fandd/article/2021/december/kremer.pdf.json) --- ### Context and economic cost - Less than half of the world’s population and only 8 percent of people in Africa have received a shot. - Each month in 2020 and early 2021 COVID-19 killed about 300,000 people. - COVID-19 is expected to reduce global GDP by $12 trillion in 2020 and 2021, which works out to roughly $500 billion a month. - More comprehensive estimates of harm, including losses from interrupted investments in health and education, are many times larger. ### Vaccine development challenges and timelines - Development is risky and time-consuming; the chance of success for any particular vaccine candidate is usually low. - Early in the pandemic, it was estimated that 15 to 20 candidates would be needed to yield roughly an 80 percent chance of at least one success. - Until 2020, vaccines took years to develop and longer still to produce on a large scale. - As late as October 2020 many experts thought we would wait until late 2021 for a vaccine to be approved and estimated that the world would produce just 115 million doses by the end of the year. - Finished production facilities are generally highly specialized and require regulatory approval; it takes time to repurpose facilities (about six months during COVID-19). ### Manufacturing capacity needs and constraints - It makes sense to install and maintain enough capacity to vaccinate the world with each of several vaccine candidates, because we cannot know in advance which will succeed. - Production was constrained by a shortage of capacity available to repurpose and by shortages of generic inputs such as glass vials, lipid particles, and bioreactor bags. - Installing standby production capacity and stockpiling inputs in advance would address these constraints. - Installing standby capacity could be designed to allow repurposing across different vaccine candidates; procurement criteria should include ease of repurposing in addition to cost. - Such capacity would cost billions of dollars, but expected returns would be high given the IMF’s estimate of COVID-19’s economic cost. ### Social versus private value of capacity - The social value of additional capacity is much greater than the private value to companies. - Estimated marginal social value of existing COVID-19 vaccine capacity in early 2021 was $500 to $1,000 per course, compared with $6 to $40 per course in current contracts. - Governments should offer incentives to install extra capacity and stockpile inputs (examples: Operation Warp Speed in the United States and the Vaccine Taskforce in the United Kingdom). - Operation Warp Speed had spent just $13 billion as of December 2020. - The US economy was estimated to lose $26 billion a day in 2020 and 2021; Operation Warp Speed would pay for itself if it cut the duration of the pandemic by just 12 hours. - Standby capacity could also serve current needs and be designed for repurposing; doing it cheaply in advance would be penny-wise and pound-foolish. ### Vaccine nationalism, trade, and global coordination - Stockpiling inputs and installing capacity in advance will help reduce the risk of vaccine nationalism—export bans and hoarding of critical supplies. - During COVID-19, the United States and India restricted exports of vaccines or inputs in 2020 and 2021; some EU countries restricted exports of surgical masks even to other EU members; the United States was accused of seizing shipments bound for its allies. - Price controls create shortages, and shortages create strong incentives for governments to prioritize domestic delivery over exports. - Vaccinating the world in a few months would significantly weaken incentives for hoarding and export restrictions; even if countries vaccinate their own populations first, delays for the rest of the world would be much shorter. - Freeing up trade is essential because different regions specialize in different vaccine platforms and supply chains are global. - Pooled investments through multilateral organizations can help manage ignorance about which region will be hardest hit; agreeing in advance to prioritize supplies for the hardest-hit countries and populations increases security for all. ### Supply capacity: national and multilateral investments - National and multilateral investments in supply chain and vaccine capacity and stockpiles should be welcomed. - Investments by one country increase global supply but could temporarily raise prices for others if input supply cannot adjust quickly. - In the long run, it should be possible to build as much capacity as needed without a substantial increase in per-unit price. - Countries not affected by a given outbreak might make their capacity available to others during emergencies. - Many countries did not expect to have fully vaccinated the majority of their populations until at least early 2022; strategic advance investment can avoid such delays. ### Financing research and dose optimization - Commercial investment in certain areas of research and development of vaccines against potential pandemic pathogens is far too low relative to social needs; public funding is a priority. - Research on options for using existing vaccine supplies more efficiently—“dose stretching”—is an urgent need. - Traditional R&D optimizes individual-level efficacy vs side effects; during shortages, the public-health tradeoff may favor lower doses, increased intervals between doses, or mix-and-match strategies. - Data from early clinical trials suggest half or even quarter doses of some vaccines could be highly effective, particularly against severe disease and death. - Using lower doses could have expanded vaccine supply by up to 1.5 billion doses a month in the second half of 2021 and potentially reduced side effects and vaccine hesitancy. - As of late 2021, despite shortages and promising data, no clinical trials of efficacy and very few further studies of immune response to fractional doses had been conducted. - The costs of further testing to optimize dosage are much lower than the expected public health and economic benefits. - Studies to ascertain optimal dosing regimens and evaluate mix-and-match dosing should take place in parallel with standard clinical trials. - The optimal dosing regimen may change as new variants emerge and the demographics of the unvaccinated population shift; booster shots are one example. - Much of the evidence from such research is a global public good, creating a role for global institutions to invest in high-social-value research (example: Coalition for Epidemic Preparedness Innovations call for proposals on fractional dosing for booster shots). ### Regulatory and procedural reforms for future pandemics - Current research and regulatory processes were not designed for pandemics; potential updates include: - Establishing scientific and ethical infrastructure to rapidly assess whether human challenge trials are appropriate. - Releasing preliminary data from early clinical trials to inform manufacturing capacity allocation decisions. - Establishing international licensing standards. - Expediting the emergency use authorization process. *Source: FINANCE & DEVELOPMENT, December 2021 (kremer).* --- _Source: https://www.imf.org/-/media/files/publications/fandd/article/2021/december/kremer.pdf_