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Could a ‘vaccine tax’ help?

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How do we deal with global vaccine inequity? Stefan Wermuth/Bloomberg via Getty Images
  • People in wealthier countries are far more likely to be vaccinated against COVID-19.
  • Some countries have committed funds to help resolve global vaccine inequity, but others have not.
  • A new paper proposes a solution: a sliding-scale tax to be built into the price of vaccines and collected by manufacturers.

As of December 9, 2021, more than 8.1 billion vaccine doses have been administered worldwide. However, most of those have gone to people who live in the world’s high income countries.

As of December 8, 2021, 64.94{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the population of those countries have received at least one vaccine dose. In low income countries, this figure is just 8.35{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

In addition to the logistical challenge of getting vaccines to those who need them, the cost of purchasing them in the first place is the most significant barrier to addressing vaccine inequity.

To get a sufficient number of people vaccinated, experts estimate that poorer countries would have to increase their healthcare spending by 56.6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, while wealthier countries would only need to increase theirs by 0.8{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

In a LinkedIn plea urging corporate boards and investors to do more to persuade their companies to address vaccine inequity, Dr. Peter Singer — special advisor to the director-general of the World Health Organization (WHO) — puts it starkly:

“Every week, around 50,000 people die of COVID-19. Presumably, most were unvaccinated and didn’t have to die. Without speedy vaccination of the world, millions more will die.”

Dr. Singer adds that doing better is not “just about stopping COVID-19, it’s about keeping everyone safe from the next variant and the next pandemic.”

“It’s also about addressing the underlying structural injustices that perpetuate inequity.”

A new paper by Dr. Andreas Brøgger Albertsen, Ph.D. — of Aarhus University in Denmark — proposes a means of more equitably distributing the cost of the world’s vaccines among governments.

Dr. Albertsen suggests that a progressive vaccine “tax” could be included in the cost of vaccines based on a purchasing nation’s ability to pay.

He notes in his paper that the tax would provide a more workable solution than vaccine equity strategies often discuss. One of the most common of these ideas is that wealthier countries could divert foreign aid funds to vaccinations.

Dr. Albertsen cites two problems with this approach. First, “using [existing] foreign aid to provide vaccines would effectively reduce the amount of assistance given for non-vaccine purposes.” Second, if only some countries increase foreign aid, the financial burden of vaccine equity will be neither evenly nor fairly shared.

The paper appears in the BMJ Journal of Medical Ethics.

By mid-2022, the WHO hopes to have 70{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the world vaccinated. This is the percentage of coverage that experts initially estimated would be required to overcome SARS-CoV-2.

In January 2021, WHO director Tedros Adhanom Ghebreyesus explained the consequence of vaccine inequity.

“I need to be blunt,” he said. “[T]he world is on the brink of a catastrophic moral failure — and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries.”

To facilitate its goal, the WHO — in partnership with GAVI, the vaccine alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and UNICEF — has established the COVID-19 Vaccines Global Access, or “COVAX,” initiative.

It is the vaccine arm of the ACT-Accelerator, which is a “groundbreaking global collaboration to accelerate the development, production, and equitable access to COVID-19 tests, treatments, and vaccines.”

The vaccine tax is fairly simple, explains Dr. Albertsen.

“For every vaccine bought,” he says, “a fraction of the price paid for the vaccine is set aside to create a fairer vaccine distribution. Under the vaccine tax scheme, the selling firm is responsible for transferring the money raised in this way to COVAX.”

“COVAX could stipulate that it will only buy vaccines from companies complying with the tax,” Dr. Albertsen told Medical News Today. “This would provide an incentive for the vaccine producers to introduce and adhere to the vaccine tax scheme and not necessarily make it more expensive for COVAX to obtain vaccines.”

Dr. Albertsen says that the amount of the tax — the percentage of a vaccine’s purchase price — must be based on a country’s ability to pay for vaccinating its population.

“It could also be considered fair to exempt low income countries from the tax,” says Dr. Albertsen.

In some countries, the word “tax” has a political meaning that could hamper the proposal’s acceptance. MNT asked Dr. Albertsen if it would be just as accurate to use a less charged term, such as “surcharge” or “fee.”

He replied: “You are completely correct. The other terms you mentioned could have been used instead. What I hoped to achieve by using ‘tax’ was to quickly signal that this would be something that buyers had to pay (i.e., non-optional) once the system is fully implemented.”

Dr. Albertsen asserts that vaccine companies may be incentivized to accept his plan due to assurances of continuing purchases by a tax-committed COVAX.

He also suggests that the steadiness of vaccine demand will reassure manufacturers. He writes in his paper, “The companies hold a strong bargaining position in terms of making the buyers cover this expense.”

Beyond that, Dr. Albertsen told MNT that he feels that the world is eager to solve the vaccine-inequity dilemma.

“I believe that many people, including world leaders, can see that the current unequal distribution of vaccines is unethical.”

He added, “Some countries have, through their actions (i.e., donations to COVAX), shown a willingness to mitigate this, while others have been less forthcoming in that regard.”

Noting that “the vaccine tax does not solve all the problems with vaccine production,” Dr. Albertsen says, “it can work alongside other proposals to solve other problems and can seemingly complement them.”

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Experts tout boosters; CDC releases omicron data: COVID updates

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FDA authorizes Pfizer booster for kids ages 16-17: Live updates

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Pfizer vaccine: Protection against Omicron coronavirus variant improves with three vaccine doses

Samples from people who had two doses of the Covid-19 vaccine saw, on average, a more than 25-fold reduction in neutralization ability against the Omicron variant than the earlier virus, “indicating that two doses of BNT162b2 may not be sufficient to protect against infection with the Omicron variant,” the companies said.

The companies said two doses may still provide protection against severe disease.

“Although two doses of the vaccine may still offer protection against severe disease caused by the Omicron strain, it’s clear from these preliminary data that protection is improved with a third dose of our vaccine,” Pfizer Chairman and CEO Albert Bourla said in a statement. “Ensuring as many people as possible are fully vaccinated with the first two dose series and a booster remains the best course of action to prevent the spread of COVID-19.”

The initial lab studies used serum from blood from individuals who received two or three doses of the Pfizer/BioNTech Covid-19 vaccine. The sera was collected from subjects three weeks after their second dose, or one month after a third dose. The data released Wednesday has not been peer-reviewed or published.

“We believe that with the two doses, you still have relevant protection for severe disease, but clearly the drop is antibodies is substantial,” Dr. Mikael Dolsten, chief scientific officer at Pfizer, told CNN Chief Medical Correspondent Dr. Sanjay Gupta on Wednesday. “However, the good news this morning is that our data show convincingly when you get your boost — the third boost — the antibody levels rise 25 fold and are now similar to the originally two dose boost that protected well against ancestral strains as well as Delta.

“Go and get your third boost and you have a robust, quite impressive antibody response as well as a strengthening of the other arm of the immune system, the T cells,” Dolsten said. “That’s really the takeaway … two doses is on the weak end against this new variant, T cells may help you to be protected against severe disease, hospitalization — but it’s really time to get the third boost.”

NYC anime convention may offer 'earliest looks' at Omicron spread in US, CDC director says

President Joe Biden called the preliminary results “very, very encouraging.”

“I have some good news this morning that Pfizer’s lab report came back saying that the expectation is that the existing vaccines protect against Omicron but if you get the booster you’re really in good shape. So that’s very encouraging news,” Biden told reporters on the South Lawn Wednesday.

“That’s the lab report. There’s more studies going on but that’s very, very encouraging.”

Another study, released Tuesday by researchers in South Africa, showed the Omicron coronavirus variant partly escapes the protection offered by the Pfizer vaccine. The preprint study showed people who have been previously infected and then vaccinated are likely to be well protected, and Alex Sigal of the Africa Health Research Institute in Durban, who led the study team, told CNN that boosters are also likely to protect people.

“My impression is if you get a booster you are protected, especially against severe disease,” Sigal said.

Since reports of the Omicron variant emerged in late November, US health officials have urged people to get vaccinated and boosted. Last week, the US Centers for Disease Control and Prevention began recommending all adults get a Covid-19 vaccine booster.

Adults who have had the Pfizer or Moderna Covid-19 vaccines are eligible to get a booster six months after their second shot. Those who got the Johnson & Johnson one-shot vaccine are eligible for a booster of any authorized vaccine two months after their first dose.

About a quarter of adults who are vaccinated against Covid-19 have also received a booster dose, according to CDC data. More than 144 million adults should get a booster, based on CDC guidance, but only about 48 million adults have received one.

Pfizer and BioNTech also said Wednesday they are continuing to develop a variant-specific vaccine for Omicron and it will be available by March, if it’s needed.

“I’m not sure that we’ll need it because it’s one very likely scenario that the current booster will be enough to maintain protection, but if we need one, I’m sure we can make one and the good news is that we will have it by March,” Bourla said on NBC’s “Today” show on Wednesday.

CNN’s Deidre McPhillips, Naomi Thomas and Amanda Sealy contributed to this report.

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Does the Omicron variant increase risk of reinfection?

A woman getting tested for COVID-19 at a mobile testing site at Times Square in New York City on Dec 6, 2021Share on Pinterest
A woman getting tested for COVID-19 at a mobile testing site at Times Square in New York City on December 6, 2021. Anadolu Agency/Getty Images
  • Omicron, which is the latest SARS-CoV-2 variant of concern, is spreading globally.
  • A South African study has found high rates of reinfection among those with previous confirmed SARS-CoV-2 infections since the beginning of November. This was when scientists discovered the Omicron variant there.
  • These observations suggest that Omicron can evade immunity from prior infection.

A preprint study from South Africa suggests that the Omicron variant of SARS-CoV-2 is more than three times as likely to reinfect people than previous variants.

This ability to evade immunity from prior infection may be causing its rapid spread.

For the study, which has not yet undergone peer review, researchers rapidly analyzed 2,796,982 confirmed SARS-CoV-2 cases in South Africa. All first infections had occurred at least 90 days before November 27, 2021.

The researchers identified primary infections and suspected repeat infections. They considered anyone who tested positive again more than 90 days after their first positive test to have a reinfection with SARS-CoV-2.

The team analyzed whether or not there were differences in reinfection risk during the first, second, and third waves. The second wave was dominated by the Beta variant, the third wave was dominated by the Delta variant, and experts assume that the Omicron variant has dominated reinfections since November 2021.

They judged a higher relative risk of reinfection among the population in any wave as indicating immune escape by the virus. Immune escape means that the virus can evade immunity acquired through either infection or vaccination.

Of the sample, 35,670 people (1.3{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}) had two confirmed SARS-CoV-2 infections. There were peaks of reinfection in January and July 2021, which corresponded with the peak of waves two and three in South Africa, along with a spike in reinfections in November 2021, which corresponded with the detection of the Omicron variant there.

The researchers suggest that this means that Omicron can evade prior immunity. They call for in vitro studies to test this.

They also note that although in vitro studies for the Beta and Delta variants suggested that they could evade prior immunity more effectively than the original Alpha variant, their own analysis did not show this at a population level. This is because there was no increased risk of reinfection in either the second or third waves compared with the first.

The authors suggest that scientists need to design better experiments to determine the risk of immune escape in vitro.

Dr. Chris Coleman — an assistant professor of infection immunology at the University of Nottingham in the United Kingdom — told Medical News Today: “This is a clear sign that the new variant is escaping immune responses, as this is evading the ‘natural’ response — which may be more complex than vaccine-induced response.”

These findings may have implications for public health planning. For example, if Omicron is more transmissible and can evade immunity, the potential for spread is enormous. The authors question whether or not immune escape will mean that people are less protected against severe COVID-19.

Experts have noted that most Omicron infections have, so far, led to only mild symptoms, and there have been no recorded deaths yet. However, the ability of Omicron to reinfect is worrying.

Dr. Arturo Casadevall, Ph.D. — chair of the Molecular Microbiology & Immunology Department at Johns Hopkins Bloomberg School of Public Health in Baltimore — highlighted that concern.

He said: “These results imply that Omicron has changed so much relative to the other variants that prior COVID-19 immunity is not as protective. This finding is very concerning because it implies that whatever immunity was built up by prior COVID-19 is not sufficient to protect against Omicron.”

In speaking to the Science Media Centre, Prof. Paul Hunter — a professor of medicine at the Norwich School of Medicine in the U.K. — agreed.

“Unlike previous waves that were because the variants were intrinsically more infectious, Omicron appears to […] have substantial immune escape, at least from immunity caused by a natural infection. Whether Omicron is also more infectious is possible but cannot be answered by this analysis.”

– Prof. Paul Hunter

The authors point out that their study cannot answer the question about whether or not the current vaccines will be effective against Omicron. At the time of the study, vaccination levels in South Africa were very low.

However, experts believe that — as with other variants — even if vaccines do not prevent infection, they should prevent severe COVID-19 from Omicron.

The vaccination status of those with suspected reinfections in this study was not known.

“One key question, of course, is if this [increased risk of reinfection with Omicron] also applies to vaccinated individuals and, as they say, the public health implications (e.g., is the infection milder with reinfection?).”

– Dr. Chris Coleman

Dr. Casadevall stressed: “These findings heighten the concern that the same [immune escape] may happen in those vaccinated. Omicron is showing itself to be a very dangerous new variant with the potential to set back some of the progress we have made against COVID-19.”

So, until we have more data about Omicron, experts are clear that the priority is to get as many people vaccinated as possible.

Dr. Michael Head, Ph.D. — a senior research fellow in global health at the University of Southampton in the U.K. — told the Science Media Centre: “[While] we await more data to emerge over the coming days and weeks, the message to the general public has to be — go and get all the doses you are eligible for.”

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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Antibody levels might help speed up approval

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New research suggests that antibody levels generated by vaccines could be an accurate way of measuring effectiveness. Image credit: Michaela Handrek-Rehle/Bloomberg via Getty Images.
  • Health authorities only approve the use of COVID-19 vaccines that have gone through rigorous clinical trials.
  • Scientists assess whether a vaccine is effective by checking whether participants in a trial develop the infection after having the vaccine.
  • In the present study, researchers find that a person’s antibody response could serve a correlate of effectiveness, instead of whether people develop the infection.
  • Using this proposed measure could speed up the regulatory approval of future vaccines.

In a new study, scientists have found that antibody levels can help indicate the effectiveness of the Moderna COVID-19 vaccine.

The research, published in the journal Science, may be the first step toward speeding up the regulatory approval process for future vaccines.

In theory, scientists could use antibody levels to identify vaccine effectiveness, rather than clinical trials to investigate how many vaccinated people develop severe COVID-19.

The speed with which scientists have developed vaccines for SARS-CoV-2, the virus that causes COVID-19, is unprecedented.

Previously, vaccine development typically took 10–15 years. By contrast, the Pfizer-BioNTech vaccine received emergency regulatory approval from the Food and Drug Administration (FDA) on December 11, 2020, less than a year after scientists first identified the virus.

However, researchers are still eager to reduce the time it takes to develop future vaccines.

Scientists may do this by identifying biomarkers that can stand in for the results of clinical trials. If these biomarkers can accurately predict how effective the vaccine is, it may obviate the need to see how many people develop the infection in a clinical trial.

Speaking to Medical News Today, Prof. Florian Kern, chair in immunology at the Brighton and Sussex Medical School, in the United Kingdom, said, “If it were possible to define a laboratory endpoint — in this case an immunological marker — that can tell us if someone is protected or not, it would be easier to measure the protective effect of a vaccine quickly and compare this effect to that of other vaccines.” Prof. Kern was not involved in the new study.

In the study, the researchers wanted to see whether antibodies produced in response to the Moderna COVID-19 vaccine could accurately predict whether the vaccine was effective.

They did this by analyzing data from the phase 3 trials of the vaccine. The researchers were looking at the level of binding and neutralizing antibodies produced and at certain properties of these antibodies.

The team focused on these biomarkers assessed at the point of the second vaccination and 4 weeks afterward.

The researchers found a clear link between higher levels of antibodies and greater protection against symptomatic COVID-19 .

Participants with antibody levels in the top 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} had a 10 times lower risk of symptomatic COVID-19 compared with participants who had undetectable or negative antibody values. This was the case no matter which antibody biomarker the researchers focused on.

MNT spoke with Dr. Peter Gilbert, a professor in the Vaccine and Infectious Disease Division of Fred Hutchinson Cancer Research Center, in Seattle, and the corresponding author of the study.

Summarizing the findings, Dr. Gilbert explained, “Four separate tests used to measure antibody levels in the blood showed that the higher a vaccine recipient’s antibody response, the less likely [they were] to experience symptomatic COVID-19.”

“The same measurements also indicated that higher antibody responses correlated with higher estimated vaccine efficacy against symptomatic COVID-19.”

“The findings are based on data from the phase 3 COVE trial, which enrolled more than 30,000 adult volunteers and established 94.1{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} estimated vaccine efficacy against COVID-19 for the mRNA-1273 vaccine,” Dr. Gilbert added.

He also noted that the findings may help accelerate the approval process for future vaccines.

“Correlates of protection are surrogate markers of efficacy that can be used to reliably predict whether a vaccine will be protective, which can accelerate regulatory authorization and approval of vaccine candidates.”

“Rather than conducting large-scale clinical trials to establish vaccine efficacy, which can require tens of thousands of volunteers and can take months to years to complete, data collected from blood samples from smaller cohorts of vaccinated individuals can be evaluated using a particular test that would indicate whether a vaccine is likely to have clinical benefit in that population.”

– Dr. Peter Gilbert, corresponding author of the new study

The study authors caution that their investigation had a short follow-up period and included a relatively small number of COVID-19 cases. Also, the group did not consider the effects of booster vaccines or different variants of the virus, as these had not emerged when the trial was conducted. The trial had sampled a large and ethnically diverse number of participants for its immunogenicity measurements.

“While it may seem like an obvious finding that that more antibodies equates to higher levels of protection against COVID-19, this detailed analysis advances evidence toward establishing a correlate of protection that could be used to accelerate regulatory processes for variant-specific formulations of mRNA COVID-19 vaccines, as well as authorization of prototype mRNA COVID-19 vaccines in children,” said Dr. Gilbert.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.