How Should a Safe and Effective COVID-19 Vaccine be Allocated? Health Economists Need to be Ready to Take the Baton
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COMMENTARY
How Should a Safe and Effective COVID‑19 Vaccine be Allocated? Health Economists Need to be Ready to Take the Baton Laurence S. J. Roope1 · John Buckell1 · Frauke Becker1 · Paolo Candio1 · Mara Violato1 · Jody L. Sindelar2 · Adrian Barnett3 · Raymond Duch4 · Philip M. Clarke1,5
© The Author(s) 2020
Recently, there have been encouraging commitments around the world to manufacture coronavirus disease 2019 (COVID19) vaccines in anticipation of results from clinical studies. Although in stark contrast to the normal process of vaccine development, this unprecedented approach seems appropriate [1]. Every extra month spent without a COVID-19 vaccine comes at a substantial cost to both global public health and the economy, making it almost impossible to overspend on the research, development and production of a vaccine [2]. The logistics of universal vaccination are extremely challenging. In the UK, AstraZeneca plans to distribute a COVID-19 vaccine developed by Oxford University [3] with the aim of producing “30 million doses of the vaccine for the UK market by September, with expectations of 100 million doses by the end of the year” [4]. In total, AstraZeneca is committed to manufacturing 2 billion doses, including a licence with the Serum Institute of India for the supply of 1 billion doses, intended mainly for low-and middle-income countries and including at least 400 million by the end of 2020 [5]. The accelerated development has been assisted by prepurchase agreements from governments in several developed countries [6]. Other pharmaceutical companies have similar plans for manufacturing and stockpiling other * Philip M. Clarke [email protected] 1
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
2
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
3
School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
4
Nuffield College, University of Oxford, Oxford, UK
5
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
vaccines currently in development [7]. While such planning is encouraging, if an effective vaccine does emerge, significant allocation challenges lie ahead. In this article, we outline these challenges and propose a framework to address them. The timing of vaccine results is subject to considerable uncertainty. Randomised controlled trials (RCTs) of vaccines need to recruit sufficient numbers of people to have statistical power to detect efficacy and potentially rare and/or delayed adverse effects. Uncertainty over future case numbers has led some RCTs to recruit participants from multiple countries [8]. Furthermore, the timing of announcements of the results of vaccine RCTs may be governed by reaching predefined stopping criteria, rather than occurring at a predetermined time. It is therefore probable that at the time the results of a successful vac
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