Saturday, December 17, 2022

Economics of pandemic vaccination in Oxford Review of Economic Policy

Vaccine development and distribution during the Covid pandemic has had some notable successes and some significant shortcomings. 

Here's the latest issue of the Oxford Review of Economic Policy, which has collected articles by economists concerning some of those successes and failures and their lessons for future pandemics.

Volume 38, Issue 4, Winter 2022

Economics of Pandemic Vaccination

ARTICLES

Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 719–741, https://doi.org/10.1093/oxrep/grac036
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 742–770, https://doi.org/10.1093/oxrep/grac037
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 771–796, https://doi.org/10.1093/oxrep/grac026
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 797–817, https://doi.org/10.1093/oxrep/grac029
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 818–832, https://doi.org/10.1093/oxrep/grac028
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 833–850, https://doi.org/10.1093/oxrep/grac032
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 851–875, https://doi.org/10.1093/oxrep/grac035
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 876–886, https://doi.org/10.1093/oxrep/grac031
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 887–911, https://doi.org/10.1093/oxrep/grac033
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 912–923, https://doi.org/10.1093/oxrep/grac027
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 924–940, https://doi.org/10.1093/oxrep/grac034
Oxford Review of Economic Policy, Volume 38, Issue 4, Winter 2022, Pages 941–974, https://doi.org/10.1093/oxrep/grac038

Friday, December 16, 2022

Covid vaccine coverage in middle and lower income countries, and preparations for future pandemics

 Vaccine rollout to lower and middle income countries left something to be desired.  Some of that has to do with initial distribution when vaccines were scarce, and some has to do with vaccine hesitancy in poor as well as rich countries.  Here are two related views in Science and Nature.

The global plan for COVID-19 vaccine fairness fell short. Will next time be different?  BY GRETCHEN VOGEL, Science, 13 DEC 2022 

"On 8 December, the board of Gavi, the Vaccine Alliance—a key partner in the project—voted “in principle” to phase out much of its support for COVID-19 vaccines in middle-income countries starting in 2024, and to incorporate COVID-19 vaccinations into its regular vaccine programs for the poorest countries—if they still want them.

"The decision isn’t final, but critics of COVAX—many from poorer countries—would not mourn its demise. The effort has delivered some 1.84 billion vaccine doses to 146 countries, but many, if not most, arrived too late to have a big impact. “COVAX was completely useless for developing countries,” says Claudia Patricia Vaca González, an expert on access to medicines at the National University of Colombia, Bogotá. “It was a failure and we should admit it,” says Christian Happi, a molecular biologist at Redeemer’s University in Ede, Nigeria.

"Others have a more positive take. “Gavi and COVAX were in my mind transformational and inspirational in their aims,” says Lawrence Gostin, an expert on global health law at Georgetown University. “It got a lot of shots in a lot of arms.” Still, “I totally understand Gavi’s reasoning,” Gostin adds. Demand for COVID-19 vaccines dropped sharply after the pandemic ebbed, and Gavi wants to refocus on campaigns that have lagged during the crisis, including vaccination against the cancer-causing human papillomavirus, and ensuring no child fails to receive routine childhood vaccinations.

...

"Making vaccines where they are needed is the way forward, says Gostin, who thinks it’s unrealistic to expect wealthy countries not to put their own populations first. “Vaccine nationalism is a fact of life.” Vaca González agrees. She says COVAX’s basic premise—buying vaccines developed in wealthy countries from large pharmaceutical firms—was flawed from the start: “That was the original sin of COVAX.”

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Even after COVID, the world’s vaccine strategy is failing. Without a global, publicly funded strategy, the market will fail to deliver vaccines to stop pandemics before they surge. By Seth Berkley, Nature, 13 December 2022.

"Despite rallying to produce billions of doses of vaccines in the face of COVID-19, when it comes to developing vaccines to prevent a disease in the first place, the world is still asleep at the wheel. There is still no incentive for markets to deliver vaccines that can prevent outbreaks, even when the technology is available. If we can’t even have vaccines ready for known severe threats such as Ebola, then what hope is there for future unknown pandemic threats?

...

"The World Health Organization keeps a list of nine priority pathogens with pandemic potential, including severe acute respiratory syndrome (SARS) and Ebola, as well as ‘disease X’, which represents a possible, as-yet-undiscovered pathogen. All nine deserve a full effort: development of several candidate vaccines through the animal-model and early clinical testing stages; vialed and quality-tested vaccines that are ready for immediate testing in an outbreak; and stockpiling of enough doses to control the disease if the vaccine is shown to be efficacious. For disease X, a set of viral vectors and messenger RNA delivery systems should be ready to carry the sequences of whichever antigens prove effective against the disease, and the manufacturing and clinical trials should be worked through as far as possible. By doing much of the preclinical and clinical work in advance, we can have doses as close to ready as possible when we need them.

...

"A key first step is the establishment of an adequate, publicly subsidized market. This will enable a coordinated global strategy with the support of G20 governments to drive the research, development and flexible small-scale manufacturing needed to produce vaccines to prevent epidemics, even if, as we hope, they will not be needed."

Thursday, December 15, 2022

Preparing for a drug-resistant bacteria pandemic---vaccines and challenge trials

 Axel Ockenfels recently alerted me that "The German National Academy of Sciences Leopoldina has established a working group to analyze the economic causes of the problem of global increase in pathogens resistant to antimicrobial agents, and develop better incentives for developing antibiotics and possible solutions. "

I sent him some quick thoughts, as follows:

"one direction that seems potentially worth exploring is vaccines for bacteria pathogens.  Most of our vaccines are antiviral, but there are some vaccines against bacterial infection, even though we mostly deal with bacteria through post-infection antibiotics.  But antibiotic discovery has lots of problems, both economic and technical. And it appears that vaccine technology has advanced a lot, given the speed with which Covid vaccines were developed.  So I wonder if it wouldn’t make sense to start now to develop vaccines against some of the bacteria that we think might be candidates for developing antibody resistance, so that when those variants show up, we’ll be able to protect lots of people from getting infected by vaccinating them. 

 And challenge trials would be very useful for that, since pre-pandemic it’s hard to do conventional trials of a vaccine against a disease that most people don’t get. Challenge trials wouldn’t necessarily be very hazardous if the relevant bacteria aren’t yet highly antibiotic resistant, since the diseases would be curable… (The assumption here is that a vaccine against say, conventional tetanus, would also be protective against antibiotic-resistant tetanus, which might be true since the evolutionary pressure to evade a new vaccine is likely very different from the long evolutionary path that leads to resistance to an existing antibiotic..)"

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Earlier posts, on antibiotics here, and vaccine challenge trials.