COVID-19 Vaccine Review – Pre-Orders, Approvals, and Prioritizations

With a number of nations in the process of delivering vaccines to high priority recipients, the focus is now shifting to the timelines.

Key considerations for governments as well as the global financial markets include:

• Preorders: Vaccine costs means that some governments are unable to order enough vaccine doses until cheaper options are available. This means that only a small percentage of some populations will receive vaccines, leaving the remainder exposed.
• Vaccine availability: This not only includes dose production capacities but allocation by country.
• Vaccine approval: While a number of nations have approved COVID-19 vaccines, the large majority have yet to do so.
• Prioritization: As has been the case in the UK and the U.S, government agencies will need to prioritize vaccine recipients. There need to be enough doses to vaccinate the most vulnerable. Any shortfall will raise doubts over whether the pandemic can be brought under control.

Pre-orders

A number of countries were swift in pre-ordering COVID-19 vaccines from pharmas. Governments had placed orders well in advance of any clinical trial results.

In viewing pre-order numbers, richer nations pre-ordered from multiple pharmas. Governments also ordered in excess of total populations in some cases. The excess orders were likely made to ensure sufficient doses, with the availability of vaccines likely to be staggered.

BioNTech/Pfizer Inc. was the first to receive emergency approval, with Moderna Inc. and AstraZeneca next in line.

Looking at pre-orders across the most adversely affected nations, the numbers are quite telling:

• The U.S: 700 million doses.
  • Pfizer Inc.: 100 million.
  • Moderna Inc.: 100 million.
  • AstraZeneca: 500 million.
• The EU: 700 million doses.
  • Pfizer Inc.: 300 million.
  • AstraZeneca: 400 million.
• India: 500 million doses.
  • AstraZeneca: 500 million doses.
• Japan: 290 million doses.
  • Pfizer Inc.: 120 million.
  • Moderna Inc.: 50 million.
  • AstraZeneca: 120 million.
• The UK: 145 million doses.
  • Pfizer Inc.: 40 million.
  • Moderna Inc.: 5 million.
  • AstraZeneca: 100 million.
• Brazil: 100 million doses.
  • AstraZeneca: 100 million.
• Indonesia: 100 million doses.
  • AstraZeneca: 100 million.
• China: 100 million doses.
  • Pfizer Inc.: 100 million.
• Canada: 96 million doses.
  • Pfizer Inc.: 20 million.
  • Moderna Inc.: 56 million.
  • AstraZeneca: 20 million.
• Australia: 43.8 million doses.
  • Pfizer Inc.: 10 million.
  • AstraZeneca: 33.8 million.

While the number of pre-orders is on the higher side, it is worth noting, however, that more than 1 dose is required for effective inoculation.

This means that, for the U.S, there are sufficient doses to vaccinate the entire population. This is not the case for many of the above countries, however.

Vaccine and Population Coverage

Assuming that each nation eventually receives all pre-ordered vaccines from the three leading pharmas, vaccine coverage is as follows:

Canada: 127.7% coverage.

Japan: 114.6% coverage.

The UK: 108.7% coverage.

The U.S: 106.6% coverage.

All other governments have pre-ordered vaccine doses that fall short of total population numbers.

Australia (87.6%) and the EU (78.2%) currently fall short but will likely be in a position to bridge the gap as more vaccines become available.

Other nations, however, will likely be in for a long wait. For poorer nations, a cost-effective, single-dose vaccine is needed. As importantly, will be storage requirements for the vaccines. Poorer nations, for instance, may not be able to store and distribute the BioNTech/Pfizer Inc. vaccine.

Amongst the most adversely affected COVID-19 nations, two nations stand out in terms of population coverage.

These are Brazil, which has pre-ordered doses to vaccinate 23.9% of the population, and India. The Indian government has pre-ordered enough doses to vaccinate just 18.5% of the population.

From the numbers alone, a clear divide exists across the globe and, more importantly, suggests that the pandemic will remain for some time to come.

The Latest COVID-19 Numbers

Mindful of the above vaccine to population coverage figures, it is worth noting the latest COVID-19 cases.

At the time of writing, the total number of COVID-19 cases stood at 74,526,806, of which 52,363,010 have recovered. Total COVID-19 related deaths currently stand at 1,655,044.

By Country:

• The United States: 17,392,618 has reported cases, which accounts for almost a quarter of all cases worldwide. Total deaths stand at 314,577, accounting for almost one-fifth of total deaths. Total population: 331.0m.
• India: 9,951,072 reported cases, with 144,487 related deaths. Total population: 1,380.0m.
• Indonesia: 636,154 reported cases, with 19,248 related deaths. Total population: 273.5m.
• Brazil: 7,042,695 reported cases, with 183,822 related deaths. Total population: 212.6m.
• Japan: 184,042 reported cases, with 2,688 related deaths. Total population: 126.5m.
• The UK: 1,913,277 reported cases, with 65,520 related deaths. Total population: 67.9m.
• Canada: 481,630 reported cases, with 13,799 related deaths. Total population: 37.7m.
• Australia: 28,081 reported cases, with 908 related deaths. Total population: 25.5m.

While easier to consider for the above nations, vaccine allocation across the EU is a more complicated matter.

Some nations are more adversely impacted than others, these being France, Germany, Italy, and Spain. It is therefore more likely that these nations would receive a greater allocation than the likes of Estonia, which has only reported 19,271 cases.

For France, Germany, Italy, and Spain, the total number of reported cases stands at 7,487,259, with 198,935 related deaths. Combined population: 256.3m.

Other Adversely Affected Nations

• Russia: 2,734,454 reported cases, with 48,564 related deaths. Total population: 145.9m. Unlike most other nations, however, Russia has developed its own Sputnik V vaccine. Vaccinations have commenced countrywide and Sputnik V is likely to be made available to other nations. Countries such as India are reportedly considering sizeable orders.
• Turkey: 1,928,165 reported cases, with 17,121 related deaths. Total population: 84.3m.
• Argentina: 1,517,046 reported cases, with 41,365 related deaths. Total population: 45.2m.
• China: 86,777 reported cases, with 4,634 related deaths. Total population: 1,439.3m.

When considering the total number of reported cases and deaths and effective containment measures, there is a reason for some nations to hold back from 100% population coverage.

Australia, amongst a number of other nations, were effective in preventing a far higher number of cases. Vaccinations in major cities, as opposed to rural areas, would likely deliver adequate protection against the virus.

For countries, such as Brazil and India, however, the COVID-19 numbers suggest that far greater coverage is needed.

A lack of vaccine coverage should therefore be a concern until cheaper alternatives are available.

Other Pharmas / Vaccines

A number of other pharmas are in the midst of clinical trials, with vaccines likely to be available early next year.

These include Johnson & Johnson, which has been playing catch up in the last few months. From Russia and China, there are also two vaccines that are drawing international interest:

Sputnik V: The Gamaleya Research Centre, which has developed the Sputnik V vaccine has announced up to 2-years of immunity against COVID-19. This is far greater than those of BioNTech/Pfizer Inc. and Modena Inc. that are likely to offer up to five months of immunization. Additionally, the vaccine has a reported efficacy rate of 91.4%.

While countries such as the U.S may refrain from ordering Russia’s Sputnik V, Brazil, India, and other adversely affected countries will likely benefit.

Sinopharm: China produced, there are reports that as many as 1 billion doses of China’s vaccine will be available next year. China is not solely reliant upon domestic vaccines and has pre-ordered the WHO-backed COVAX and 100 million Pfizer Inc. doses. The UAE is currently administering the Sinopharm vaccine.

Vaccine Approvals

The next step in the fight to end the COVID-19 pandemic is for government agencies to approve vaccines.

To date, Bahrain, Saudi Arabia, Singapore, the UK, and the U.S have approved the BioNTech/Pfizer Inc. vaccine. As previously mentioned, other vaccines are already being administered, though more approvals are needed.

Later today, the FDA is also set to review the Moderna Inc. EUA, with emergency approval anticipated following the review findings earlier in the week.

The EU has also had to bring forward its review timelines, with the EMA set to review the Pfizer Inc. vaccine on 21^st December. This had been originally diarized for mid-January.

In the UK, AstraZeneca is also expecting emergency approval. As was the case with the Pfizer Inc. vaccine, other nations will likely follow. An MHRA emergency approval could be given this week or next.

For India, completion of the Sputnik V clinical trials will then allow the review process to begin.

Vaccine Prioritization

As pharmas begin to deliver vaccines across the world, government agencies have had to prioritize vaccine recipients.

The general trend has been to prioritize the most vulnerable. These include front line workers, such as 1^st respondents and care home facility workers, and elderly patients.

A number of key agencies have announced the following priorities:

UK: The Joint Committee on Vaccination and Immunisation (“JCVI”): The UK’s “JCVI” announced that the first priorities should be the prevention of COVID-19 mortality and the protection of health and social care staff and systems.

U.S: The CDC’s phase sequence leaves adults with high-risk medical conditions and the over 65s in phase 1c.

In phase 1a are healthcare personnel and LTCF residents, with phase 1b including essential workers.

The EU: The European Centre for Disease Prevention and Control provided guidance on prioritization earlier this month. As was the case with the U.S and the UK, healthcare workers, the elderly, and persons with certain comorbidities form the priority groups. Due to likely shortage, however, groups will likely become smaller.

Supply Chain and Production Targets

As more nations approve the COVID-19 vaccines, the pressure will mount on pharmas to produce more doses to meet demand.

Beyond AstraZeneca and Johnson & Johnson, more vaccine options are going to be needed to bring an end to the pandemic.

Key through the remainder of this year and the 1^st quarter of next year, however, will be the vaccination of high priority groups.

Success in vaccinating the most at risk in a timely manner will then bring forward the timelines to vaccinate general populations.

We can expect further priorities to be issued, which will likely be dependent upon the vaccination process in the coming months.

Countries may have pre-ordered sufficient doses for total population coverage. These counties will need to receive these orders, however, to bring the virus under control.

Assuming that there are no adverse effects from vaccines becoming available, the focus will remain on production, distribution, and new vaccines to market.

Once mass inoculation is in process, an end to the pandemic will be in sight.