Dr. Shyam P Lohani

Almost 30.7 per cent of people worldwide have received at least one dose of a COVID-19 vaccine, and only 16 per cent is fully vaccinated. A total of 4.59 billion doses have been administered globally, and every day some 36.63 million doses are administered. At current rates, billions of people around the world might not have access to their first dose until next year. The total number of people who received COVID-19 vaccines in Nepal stands at 15. 68 per cent, out of which 9.91 per cent received full vaccination while 5.77 per cent only got partially vaccinated as of August 13 (OurWorldInData, 2021).
Vaccines are an important part of containing the spread of COVID-19. This is because they offer protection to an individual either by reducing his/her risk of infection or the severity of the symptoms. Even though a couple of vaccines are already being administered in countries around the world, more options on the market are essential to vaccinate the billions of people needed to reach herd immunity. Demand for vaccines has far exceeded supply and there are growing concerns that many of the developing economies will be left behind.
The end of the pandemic is still a long way as many of the first-generation vaccines (Pfizer BioNTech, Moderna) warrant ultra-cold chain technology which is expensive. The technology of the ultra-cold chain and associated cost causes significant hurdles to global vaccination campaigns, especially in low- and middle-income countries (LMICs). Furthermore, we still do not know how long vaccines will provide immunity.

New variants
The rise of new variants poses concern over further mutations with high vaccine breakthrough potential and low efficacy against new variants. The continuous emergence of new variants and vaccine breakthrough cases, thus, lead to negative implications for the health and wellbeing of populations, but they also create further economic consequences and disrupt regular vaccine campaigns.
Several developed economies have purchased enough doses to vaccinate their populations several times over. For example, Canada could fully vaccinate its population five times in the event that all the vaccines it has purchased are authorised for use. The use of several vaccines in the same countries has led to more people quickly getting protected, but it can also create challenges. It has posed challenges in keeping track of the type of vaccine received by its citizen, differing logistics, and storage requirements. Furthermore, different safety and effectiveness profile of each vaccine has created confusion for promoting the importance of getting the jab to the population.
There are reports of supply chain interruptions, failures to meet expected delivery quantities in time. This has led to immense global disparities in vaccine access. There is increased discussion on global vaccine equity on the moral and economic grounds but there is also the scientific argument that leaving much of the global population unvaccinated could increase the chances of the development of new variants. Moreover, the more variants that arise due to a large number of susceptible populations, the more likely it is that people will have high vaccine escape potential.
The COVAX facility was founded with the goal of hastening COVID-19 vaccine development, manufacturing, and ensuring equitable access to all countries. COVAX targets to assure at least two billion COVID-19 vaccine doses by the end of 2021 of which more than 60 per cent of those planning to distribute to 92 low-income countries. Since only a few countries have enough vaccines at their disposal for their entire adult populations, many countries are faced with the tough task of determining and defining priority groups for vaccination.
Throughout the pandemic, we have seen misinformation spreading from political leaders and celebrities, which is also fueling the infodemic. However, social media are attempting to fact-check and demote misleading posts on their platforms in order to combat the problem. However, several reports highlight that these efforts have not been entirely successful, and misleading information is still spreading throughout the world.

Vaccine mandates
There are concerns around the potential implementation of vaccine mandates and vaccine passports. Private companies may require evidence of prior COVID-19 vaccination before customers can utilise their services. Several countries and even airlines have mandated vaccine passports. Governments should seriously consider all the ethical dimensions when making decisions around vaccine mandates or passports for travel, and employment. The implementation of such requirements should take into account the individuals who cannot be immunised for various reasons.
Many first-generation vaccines require two doses spaced apart at set intervals which present logistical challenges, especially in places with weak record-keeping systems. Furthermore, we still do not know how long immunity from COVID-19 vaccines will last, and whether vaccine types can be mixed and matched. However, emerging evidence suggests that just one dose of these two-dose vaccines may offer protection against COVID-19 infection.
Luckily, a vaccine is not the only weapon against the COVID-19 pandemic. By now, we have witnessed non-pharmaceutical interventions such as social distancing, mask-wearing, and avoiding large crowds can contain the spread of infection. There is also several therapeutics to reduce the mortality rate among patients with severe COVID and admitted to healthcare centres. The rapid development of currently approved vaccines is praiseworthy; however, they are just one approach to our fight against COVID-19 than a replacement of public health measures and therapeutics.
Lastly, all countries need to vaccinate as much of their populations as quickly as possible to tackle the current pandemic, but they will also need to maintain high rates of immunisation against COVID-19 in the years ahead to counteract the upcoming waves. After all, no one is safe until everyone is safe.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)