When a coronavirus vaccine is ready, who gets it first?


“The 360” shows you diverse perspectives on the day’s top stories and debates.

What’s happening

Government and private companies around the world have mobilized in an effort to develop a vaccine for the coronavirus at a record pace. The Trump administration earlier this month announced a program called Operation Warp Speed in hopes of having a viable vaccine ready by the end of the year.

Creating a vaccine in a year or 18 months would be an unprecedented achievement. But some experts say the steps afterward are where the hard work really starts. Getting billions of vaccine doses to people in the far corners of the globe represents one of the biggest logistical challenges in the history of medicine.

Recent history has shown that even when an effective treatment for a dangerous disease exists, production and distribution issues can hamper the effort to help. In 2009, a limited number of an H1N1 swine flu vaccine led to “absolute desperation” for supplies, a state official said. The push to distribute a vaccine for Ebola in Africa was held back by confusion and lack of trust among the local population.

Neither of these efforts was remotely at the scale needed to successfully implement a vaccine for the coronavirus. Scientists estimate about 70 percent of the population would have to be immune for “herd immunity” to be effective. In the U.S. alone, that means more than 200 million doses would be needed, and perhaps more if the vaccine requires “booster” shots.

Why there’s debate

Creating and distributing millions or billions of vaccine doses depends on a steady supply of a long list of materials — glass vials, rubber stoppers, syringes and refrigerators, to name a few. A shortage of any one of them could derail the whole process.

Vaccine distribution will be a massive undertaking for every government, but some of the president’s critics say the Trump administration is uniquely unequipped to handle it. Shortages of tests, certain drugs and protective equipment, which have plagued the U.S. response to the virus, may be signs of future scarcities when a vaccine is ready, they argue. A former high-ranking government health official has alleged that the Trump administration lacks a “fair and equitable plan” to produce and distribute the vaccine.

When doses gradually roll off the production line, there will likely be a fight over who gets the vaccine first. Experts broadly agree that health care workers should be treated first, but there’s little consensus on which group should get vaccinated next.

Who receives the vaccine may depend significantly on which country wins the race to create one. As many as 100 vaccines are currently in some stage of production. Projects in the U.S., China and the United Kingdom currently appear to be out in front. World leaders have expressed concern that whichever nation produces a vaccine first might hoard supplies for its own citizens at the expense of the rest of the world. Financial issues like intellectual property rights and the cost of the vaccine may also limit access, some argue.

Despite all these hurdles, experts say there is some reason for optimism that the challenge can be overcome. The large number of vaccines in development may mean that more than one will prove viable at around the same time. Having multiple vaccines — each with its own unique production and distribution needs — could help prevent a single logistical snag from shutting down the process entirely.

International collaboration, rather than competition, could help ensure the vaccine gets to those who need it most, some argue. The World Health Organization is working with global leaders in an effort to foster cooperation among nations and “assure equitable access worldwide.” Many countries, including the U.S., have also created financial incentives for companies working on vaccines to make sure that concerns over loss of profit don’t stifle the development rush.

What’s next

A handful of the most promising vaccine candidates have moved into accelerated human trials, but it will likely be several months before any of them prove viable. Trump has promised to have a vaccine available to most American by the end of the year, but that pledge has been met with significant skepticism by scientists. The British government has said a mass-produced vaccine could be ready by September, though similar questions about that timeline have been raised.


Some people will inevitably have to wait for the vaccine

“No matter how well-prepared we are, there won’t immediately be enough coronavirus vaccine to immunize all Americans. Choices will have to be made about who goes to the front of the line.” — Elizabeth Weise, USA Today

Countries can work together to make sure the vaccine is distributed fairly

“The best way to ensure that vaccines and treatments are provided to all who need them, including those in the developing world, is for countries to commit to working cooperatively … to keep trade protections and intellectual property rights from becoming barriers to public health.” — Jennifer Hillman, Foreign Affairs

The U.S. is not ready for the challenge of making and distributing a vaccine

“Meeting the overwhelming demand for a successful coronavirus vaccine will require a historic amount of coordination by scientists, drugmakers and the government. The nation’s supply chain isn’t anywhere close to ready for such an effort.” — Sarah Owermohle, Politico

A wide variety of supply issues could throw the whole process off track

“It’s not necessarily that we don’t have this thing or we can’t make this thing. It’s that making this thing is logistically complex and getting it there is logistically complex and there are many many ways that that process can break down when you have people getting sick, when you have borders closing, when you have everything else happening.” — Maggie Koerth, FiveThirtyEight

A global fight over vaccine doses may erupt

“Vaccines and international politics have always been tied together. And this time will be no different. In fact, in the face of a pandemic that has decimated economies, disrupted lives and shaken politics, the political battle will probably be fiercer than ever.” — Stuart Blume, New York Times

Financial incentives could motivate pharmaceutical companies

“Vaccine makers need to be encouraged to develop coronavirus vaccines and get them widely distributed as soon as possible. Committing upfront to make doing so worth their while might kick the whole process into a higher gear.” — Scott Duke Kominers, Bloomberg

Supply shortages in the early stage of the pandemic are a bad sign for vaccine access

“If the global race over the past few weeks and months to procure coronavirus-related medical equipment is anything to go by … then the competition to acquire precious quantities of a new vaccine will be something the likes of which the world has never seen.” — Rachel Oswald, Roll Call

World leaders will face pressure to hoard vaccines for their own populations

“If and when one country has a workable product, it will likely come under immense pressure to use it at home before sharing with other parts of the world.” — Editorial, USA Today

Providing the vaccine to people in poor countries will be especially difficult

“Getting vaccines to poorer and socially unsettled parts of the world can be dangerous for health care workers. And parts of the world with less energy infrastructure challenge the so-called cold chain if a vaccine requires refrigeration. … Countries with more fragile societies also present a communications challenge. If people don’t know what’s going on, or don’t know how a vaccine works, they might refuse it.” — Adam Rogers, Wired

The government could step in to take private companies out of the process

“Instead of allowing firms to compete with one another for monopoly rights to manufacture a future COVID-19 vaccine, thereby squandering limited financial and scientific resources to ensure future potential profits, the whole sector could immediately be put to work, collaboratively, in the public interest, both developing and producing the vaccines we need.” — Dana Brown, NBC News

Vulnerable people in the U.S. will face many barriers to access

“Making the vaccine free for all would certainly be a big step toward enabling everyone in the U.S. to receive the potentially life-saving shot. But it’s only a start. Many other factors will affect how accessible even a $0 vaccine is for all Americans.” — Molly Longman, Refinery29

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Photo illustration: Yahoo News; photos: AP, Peter Varga/Shutterstock

Originally published