Global COVID immunity requires 11.2 billion doses

Bernard Arulanandam is an immunologist for the South Texas Center for Emerging Infectious Diseases and vice president for research, economic development, and knowledge enterprise at UTSA.

JANUARY 29, 2021 — Editor’s note: This op-ed by Bernard Arulanandam originally appeared in the San Antonio Express-News.

As various COVID-19 vaccines roll off the manufacturing line, the daunting logistics of mass distribution and immunization represent an unprecedented challenge.

With a global population of just less than 8 billion people and the estimated number needed to reach herd immunity between 60 and 70 percent of the population, we will need 5.6 billion vaccine doses. Given that treatment regimens will require a second dose, this will approach 11.2 billion doses globally. To put this in perspective, this is equivalent to 34 times the U.S. population.

This staggering requirement exposes vulnerabilities on several fronts, including manufacturing, supply chain, personnel, deployment and implementation. These weaknesses are further amplified in under-resourced and poorer countries that lack basic infrastructure.

“This global effort will require genuine and transparent leadership from different world bodies with a renewed urgency for cooperation.”

Vaccines are inherently complex to manufacture and more so for highly sophisticated products such as the Pfizer and Moderna vaccines that utilize mRNA technology. These modern products incorporate specialized technological innovations for production and require precursor materials from a few sources abroad that inherently produce a narrow supply chain.

Additional constraints include logistics and mapping of distribution sites, tackling cold chain requirements during delivery and administration, and systematically monitoring the delivery and dispensation of additional doses. Given that COVID-19 vaccines are in emergency-use authorization and being shipped to countries with various regulatory requirements, tracking vaccine safety and efficacy across different populations becomes paramount. This also requires constructing a unified communication channel that transcends borders and facilitates trust across racial and ethnic lines.

This pandemic has refocused the needs to diversify geographically, secure the supply chain nationally and globally, and reduce the dependence on sole countries such as China. There is a need to develop a sustained strategy with a funding source to mature innovative technologies and solutions that will bring vaccines and biologics to market faster. Finally, learning from past successes in global vaccine and treatment delivery networks akin to the GAVI vaccine alliance and the U.S. President’s Emergency Plan for AIDS Relief will provide a framework to achieve the desired vaccine coverage.

Marshaling this global effort will require genuine and transparent leadership from different world bodies with a renewed urgency for cooperation. The need to further fuel alliances across public-private partnerships is evident to end this pandemic and be much more prepared for the next.

— Bernard Arulanandam