Edwin Quildan, 62, receives a COVID-19 vaccine at Evergreen Primary Care Centre in London. © WHO / Blink Media - Chiara Luxardo
The World Health Organization is at the centre of the largest simultaneous global vaccine drive in history, where speed and precision are of the essence to beating the COVID-19 pandemic.
**Note: This interview reflects the context and facts available at the time of the interview, conducted on 25 January 2021**
Managing the undertaking of a lifetime
With lives, resources, and patience on the line, the global COVID-19 vaccine distribution process is the performance of a lifetime with no opportunity — or time — for rehearsals. The conductor at the centre of it all is the World Health Organization (WHO), serving as medical encyclopedia, regulator, and policymaker all at the same time.
“This vaccine introduction program is unlike any ever before in any country around the world,” said Dr Katherine O'Brien, WHO’s Director of the Department of Immunization, Vaccines and Biologicals. “There is no program like this in its speed, its dimension, its worldwide, simultaneous nature.”
A few months into the pandemic, WHO developed a target product profile guide, outlining the minimum attributes that a safe, effective vaccine candidate would need to have. Currently, more than 200 vaccine candidates are being developed and tested around the world, but not all of them meet WHO’s science-driven prerequisites for controlling the pandemic. In addition to the target profile, the vaccine candidates — tested in different labs and evaluated by varying regulators around the world — have to meet rigorous safety requirements to receive WHO’s final stamp of approval, vouching for their efficacy, safety, and quality.
“I can’t overemphasize the importance of that: we have to uphold the absolute highest international standards,” said O’Brien. “The trade-off between benefit and risk has to be so clear and driven by data, in terms of benefit because vaccines, by their nature, are given to healthy people.”
A General Practitioner holds a vial of the Oxford/AstraZeneca COVID-19 vaccine. © WHO / Blink Media - Chiara Luxardo
Even after clinical trials, the vaccines are monitored on an ongoing basis to ensure they keep meeting safety standards and people aren’t experiencing significant side effects. The scientific community keeps a careful eye on each vaccine, monitoring their progression for any red flags or any issues that may not have surfaced previously.
O’Brien explains: “With the car you drive, you would expect that the car manufacturer has a department of safety that is continuously monitoring the cars that it has produced, and is continuously improving the safety of its car. The same is true for vaccines.”
In addition to signing off on vaccines, WHO helps guide countries through the complicated process of distribution amid a global shortage of doses. Much of this requires a deep consideration of ethical issues: Which segments of society should get vaccinated first? Does a country have the responsibility to vaccinate vulnerable non-citizens within its borders such as refugees?
“It’s not very efficient or a good use of people's time for 194+ countries to all be starting from a blank piece of paper,” said O’Brien. “So WHO provides guidelines and recommendations on all the elements that have to be thought about and the decisions that have to be made.”
To advise this work, WHO relies on its Strategic Advisory Group of Experts on Immunization (SAGE), which is comprised of international physicians, academics, and global health experts. Different country contexts may necessitate varying approaches, but SAGE encourages all plans to be guided by six values: human well-being, global equity, reciprocity, equal respect, national equity and legitimacy. While its guidance does not legally bind countries, it is an important starting point as everyone grapples with these questions at the same time.
From start to finish, vaccine development and distribution operations are precise, meticulous, and allow very little margin for error. Scrupulous planning is the key to securing public trust, explains O’Brien. No detail is too small for health experts who have to consider everything from how many households need to be served to the exact timing that vaccines have to be placed in coolers for transportation.
“These are the things that really instill the confidence of families and communities,” said O’Brien. “When something new is being offered, that it's being offered on time at the time and place where they expected it. And with a quality of service that instills confidence.”
Getting from vaccine hesitancy to vaccination
Even while WHO diligently works to ensure that vaccines are safe and effective for public use, many people are hesitant for a variety of reasons including worries about side effects; the unprecedented speed with which the vaccines have come online; and confusion due to an ever-shifting information landscape, much of it filled with conspiracy theories and misinformation.
In other cases, people are worried about getting the vaccine because of mistrust. Existing vaccine hesitancy is fueled by mistrust in medical institutions and compounded by ongoing structural inequalities in health access, education, and wealth, leading to poor health outcomes.
To address inequities such as these across countries globally, international organizations are working on restoring trust in science and health institutions. The United Nations, for example, enlisted the public’s help in its Verified initiative, encouraging them to pause before circulating unconfirmed information. It also released a communications guide with tips on how to help communities overcome vaccine hesitancy, and how to cultivate their trust in the process.
“We really have to make sure that the rollouts go smoothly in a way that continues to build confidence in the vaccines, given all the misinformation, conspiracy theories, and just completely inaccurate information about these products,” said O’Brien. “We don't want to do anything that would undermine the confidence that people have and the hope they have in these vaccines which have been shown to be safe and highly effective.”
Rohingya refugee, 22-year-old Siraj is a Community Health Worker in Cox’s Bazar, Bangladesh. He is sharing key health information while addressing fears, misinformation and rumours. © WHO Bangladesh/Tatiana Almeida
Sometimes, the messenger matters more than the message. As part of its ongoing information dissemination efforts and infodemic response, WHO relies on community leaders and local groups to take the vaccine information it provides and tailor it to their respective contexts. These efforts build on previous decades of similar approaches that WHO has used to roll out vaccines to prevent polio, measles, and other diseases. The right messenger has an intimate understanding of the local community, culture, and approach that would resonate and make the difference in whether or not someone decides to take an available vaccine.
For a public-facing Organization like WHO, part of this trust-building exercise means reiterating its commitment and action on securing global vaccination for everyone, everywhere, regardless of a country’s ability to pay.
No end to the pandemic without equitable distribution
While it is indeed good news that there are already several effective vaccines on the market, the bad news is that this won’t necessarily end the pandemic unless the actual distribution is more equitable between high-income and low- and middle-income countries. Even within countries, there have been reports that not everyone has been incorporated into national vaccination plans, with refugees, stateless people, and asylum seekers at risk of being left behind.
WHO Director-General, Dr Tedros Adhanom Ghebreyesus. © WHO / Christopher Black
Global leaders from WHO Director-General Dr Tedros Adhanom Ghebreyesus to United Nations Secretary-General António Guterres have repeatedly sounded the alarm about the dangers of vaccine nationalism. In a recent op-ed, Dr Tedros wrote that rich countries, while comprising only 16% of the world’s population, have already purchased 60% of available vaccine supplies. Painting a grim picture, he continued: “Vaccine nationalism combined with a restrictive approach to vaccine production is in fact more likely to prolong the pandemic—which would be tantamount to medical malpractice on a global scale.”
Meanwhile, COVAX, an initiative co-led by WHO, Gavi, and the Coalition for Epidemic Preparedness Innovations, is the only mechanism currently in place to deliver vaccines equitably to low- and middle-income countries. COVAX is on track to deliver on its goals. Thanks to secured avenues of supply through manufacturer deals and dose-sharing, clarity on global and regional supply forecasts, balanced demand and readiness as well as additional much-needed funding, the world now has its clearest pathway yet to ending the acute stage of this pandemic, globally.
The beginning of 2021 is crucial – in addition to needing to secure more doses and more funding, complexities that lie ahead, such as regulatory approvals, readiness and capacity, supply chain, delivery and logistics, are all now urgent challenges to be resolved if we are to successfully deliver the vaccines COVAX is striving to secure. Complicating the matter further, COVAX partners have to take into account supply shortages, regulatory approvals, and logistical hurdles such as whether countries have the infrastructure for cold supply chains (a challenge for many countries and particularly low-income settings). Supply issues are apparent for all countries which is why WHO is calling on more technologies transfer sharing intellectual property to facilitate the process.
Lucy Momenyo, 63, Lead Practice Nurse, checks a fridge containing doses of the Oxford/AstraZeneca COVID-19 vaccine. © WHO / Blink Media - Chiara Luxardo
“The cold chain planning is a critical element because vaccines have to be deployed with attention to the temperature that they have to be maintained at in order retain their potency,” said O’Brien. “You can't make a mistake on that.”
The calls for global solidarity for equitable vaccine delivery have frequently centred on moral appeals, but are increasingly urging countries to look at the economic rationale and public health ramifications if low-income communities are not able to get vaccinated at the same time as those who can afford it.
“If the virus is allowed to spread like wildfire in the Global South, it will inevitably mutate — it is mutating — becoming more transmissible, more deadly and, eventually, more resistant to vaccines, ready to come back to hound the Global North,” cautioned UN Secretary-General Guterres.
Recent studies have also calculated the economic cost that countries could incur should they continue to pursue an uncoordinated approach to vaccine distribution, the world risks global GDP losses in 2021 alone of as much as US$ 9.2 trillion with half of that cost being incurred by high income countries, if they focus only on vaccinating their own populations: compared with US$38 billion to fully fund the Access to COVID-19 Tools (ACT) Accelerator, the WHO-led initiative to provide equitable access to COVID-19 tests, treatments, and vaccines.
A patient receives the Oxford/AstraZeneca COVID-19 vaccine. © WHO / Blink Media - Chiara Luxardo
In the meantime, while global vaccination efforts are largely prioritizing the elderly and essential workers at the moment, experts are urging the rest of society to remain vigilant and adhere to safety precautions to keep the virus at bay.
“Just because we're starting a vaccine program is absolutely not the time to take our foot off the pedal for all of the other interventions we have in the toolbox to crush the transmission of this pandemic,” said O’Brien. “We are all going to have to be patient in this, because this is not a flip of a switch.
Read more about WHO’s response to COVID-19 across the world.
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WHO thanks all governments, organizations and individuals contributing to the COVID-19 response around the world, and in particular those who have provided fully flexible contributions, to ensure a comprehensive fight against the disease.
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