Governments cannot let the most vulnerable be the least protected again.

Boston Consulting Article by Johanna Benesty, Marin Gjaja, Dan Kahn, Josh Kellar, Ben Keneally, Rich Lesser, Jonathan Scott, and Emily Serazin 

The pivotal Phase III trials of COVID-19 vaccine candidates are nearing the first results, and hopes are rising that the end of the worst pandemic in a century may be approaching. These understandable hopes must be tempered by the complexities of defeating this virus. Countries are still only months into a very long fight.

Even with a highly successful vaccine rollout—the bull case—the public will still be wearing masks, maintaining distance, and avoiding crowds for many months after regulatory authorization. In fact, the public will likely be taking these precautions into the second half of 2021 or longer. Testing, tracing, and continuing efforts to reduce the severity of the disease with therapeutics will also remain crucial. If the rollout is less successful—the base and bear cases—such interventions could stay in place for 15 more months or longer. (See “The Bull, Base, and Bear Cases.”)

The rollout needs to happen both efficiently and equitably. We will have failed if vaccines disproportionately flow to wealthy nations and individuals at the expense of nations with low or midrange per capita income and marginalized communities. Governments cannot repeat the mistakes made during the early days of the pandemic, when the most vulnerable were the least protected from the virus. Countries, regions, and states still have time to get this right through science, hard work, and vigilance.

For public health officials, who have been on the frontlines all year, the work enters the next crucial phase. In countries that have contained the virus, winning the health endgame will cement trust and legitimacy, creating a platform on which to build economic recovery. For countries that have struggled with their public health response, this phase is the opportunity to flip the script and restore faith in the government.

Where the world stands

The response to the coronavirus is proceeding in three phases—flatten, fight, and future. The world is still in the early stages of the fight phase, which began when nations restarted activity to end the flatten (or lockdown) phase. Rolling out vaccines and improving therapeutics will help us accelerate the fight, while crush-and-contain strategies and smart government policies will help manage further impact.

Ten novel COVID-19 vaccine candidates have entered Phase III clinical trials across the globe less than nine months after the sequencing of the virus genome. Many more are close behind. The US Food and Drug Administration (FDA) and the European Medicines Agency could grant emergency-use authorizations as soon as November 2020. The Chinese and Russian governments have already approved five vaccines for emergency use.

These authorizations start the clock on the hard work of rolling out vaccines to a global population in an orderly and scientific sequence that prioritizes protecting the health vulnerable and those who have a high risk of exposure. What happens in low-income nations matters for humanitarian and practical reasons. In an interconnected world of global trade and tourism, fully restoring a country’s economic, social, and public health depends on a global recovery that includes all nations.

Likewise, the rollout of vaccines requires the near-flawless execution of an interconnected chain of processes. Because of the vagaries of manufacturing vaccines, there is a saying in the scientific community that “the process is the product.” In the case of COVID-19 vaccines, this aphorism extends to every aspect of the rollout: distribution, the supply of glass vials and syringes, ultracold storage, public education and outreach, record keeping and follow-up, and safety and efficacy monitoring.

Four known vaccine “unknowns”—availability, effectiveness, safety, and uptake—will determine how swiftly this happens. More here.