Vaccinating 70%, an unjustifiable optimism

LondonBeyond the phenomenal political mess between the European Commission and AstraZeneca, the truth is that the excuses shared by the CEO of the pharmaceutical company, Pascal Soriot, in an interview published in four European media on Tuesday, are perfectly possible. This is what Salvador Macip, a doctor and researcher at the University of Leicester and the UOC, assures to the ARA. "That the production of the vaccine would have ups and downs was to be expected. At the beginning the supply went very well because companies have been accumulating doses even before the vaccine was approved. But now we are already streaming, and production has a biological component, as Soriot explains, which is not accurate. What he says can happen. Now, whether this is the reason for the decrease in doses or whether there are other political motives behind it is difficult to know. In any case, the excuse is plausible". However, it could also be that there is an excess of ambition or optimism.

In any case, Soriot has spoken of bad "luck" in the production plants in Belgium and Holland, where the biological component of the vaccine that has to reach the final manufacture is made. What is he talking about, in particular? In general, vaccines have several elements: the so-called active components, which stimulate the immune system (killed virus, virus protein or genetic material of a virus); adjuvants, which enhance the immune system response; stabilizers, which extend shelf life; antibiotics, which prevent bacterial contamination during manufacturing; and preservatives, which prevent contamination during distribution (such as when a multi-dose vial is opened).

Each vaccine also has a unique manufacturing process, but some steps are quite similar. For example, propagation of active components, by growing them in animal, plant, fungal or bacterial cells ("cell culture") or by growing them through chemical reactions; purification, to extract the active components; formulation, to mix the vaccine components in a way that optimises them to ensure that an effective immune response is produced, can be taken up by the human body, can be produced on a large scale and remains stable; filling and finishing the vials; labelling and final packaging for, at the last end of each batch, sampling and testing to check the microbiological integrity of the product.

The great challenge of immunization against covid is that it is either global or it is useless; and that the world has to produce at least 5.5 billion vaccines a year, twice as many if you think of the two doses. And it is an impossible challenge to achieve because there is no industrial capacity to do it in less than a year.

Europe, lagging behind

As for the pace of vaccination in Europe, the differences between the UK and the EU are striking. In the past seven days, the British health system has managed to vaccinate 2.6 million people with a first dose. In total, since the the start of the campaign, 10.76% of the population has been at least partially immunised. In Spain, by contrast, only 2.76%. However, this is the highest percentage in the EU.

In any case, the gap between the figures has put AstraZeneca in the spotlight in the last few hours, particularly for failing to deliver on its promises to deliver vaccines. The EU is also under scrutiny for managing the creation of a vaccine portfolio for the 27 countries, shrouded in secrecy.

So what has gone wrong in the EU? Beyond Soriot's excuses and AstraZeneca's lack of foresight, perhaps we should also ask whether the prospects - 70% of the Spanish adult population vaccinated before or at the end of the summer, between 15 and 20 million people - were not very optimistic. "I would say it was based on a mathematical calculation that everything would work perfectly, when this campaign has never been done before", Rafael Vilasanjuan, director of global policy and development at lCS Global in Barcelona, and a member of the steering committee of Covax, the World Health Organization's programme for equitable distribution of the vaccine, tells the ARA.

However, there have also been problems stemming from the lack of vaccine production capacity in Europe, particularly in relation to the UK, compounded by the delay in the development of the vaccine by Sanofi and the Institut Pasteur in Paris.

AstraZeneca, in any case, has caught its fingers with promises about which its most important partner, the Serum Institute of India, "already warned them", as Vilasanjuan recalls. Soriot's company assured that it would produce up to one billion doses this year, a much more than ambitious goal - which is quite impossible. In addition to this contract, it has signed others with the Spanish company Mabxience, which will manufacture the antigen at its plant in Garin (Argentina) and, thanks to an agreement with the foundation of tycoon Carlos Slim, will take part of the final process to Mexico to manufacture 150 million vials. It also licensed the product to R-Pharm in Russia for this country and its neighbours (also the Middle East and the Balkans), and to Shenzhen Kan gtai in China (200 million), and Fiocruz in Brazil (100 million). A policy of expansion based on having a vaccine available for everyone, including poor countries, which, perhaps now, it is not in a position to fulfil.