for example, priming the immune system using viral genes (see Science section). Such
vaccines are easier to manufacture at scale.
The second slice of good news is that, all being well, by the end of 2021 enough vaccines
should be available in sufficient quantities to mean that the spread of covid-19 can be
slowed substantially. Vaccines may also protect infected people by making their
symptoms less severe. Covid-19 will not suddenly disappear, but it will start to fade into
the background.
In between those layers of good news, however, will be plenty of bad. The wave of
winter cases in the northern hemisphere has been severe. And certifying, making,
distributing and administering billions of doses of competing vaccines is sure to present
problems.
Time saves lives, so regulators are rightly in a hurry to approve vaccines. But Russia and
China have given the green light to medicines that are yet to pass through large phase-
III trials. Their products fail to work or cause complications. Vaccines that receive
emergency authorisation in the West will need watching too, because they may work
differently in different groups, or provide only transient benefits. Expect lots of sniping
about regulators cutting corners and lots of theories—many conspiratorial—about why
vaccines should be avoided.
Production of several vaccines has started. Pfizer says it will have 50m doses ready by
the end of 2020. Even so, scaling up vaccine production will be a mammoth task. The
Serum Institute, the world’s largest manufacturer, has warned that there will not be
enough doses to inoculate the entire world until 2024 or beyond. Shortages of medical
glass, and of the “cold chains” that are needed to keep some vaccines, including Pfizer’s,
at -70ºC or even colder, could cause delays. So could a shortage of people trained to
administer vaccines. Given that the pandemic cost the world about 8% of GDP in 2020, a
reluctance to invest in such things for fear of wasting money would be wantonly short-
sighted.
This may hurt
There could be fights among countries. China and Russia are already using vaccine
supply as the inoculated arm of their soft power (see China section). America and
Britain may try to lock in supplies for their own citizens. Many lives are at stake.
Modelling by Northeastern University in Boston suggests that if 50 rich countries
receive the first 2bn doses of a vaccine that is 80% effective, it will prevent 33% of
deaths from covid-19, whereas if the vaccine is distributed according to countries’
population, the share of those saved almost doubles. Such insights are the inspiration
behind COVAX, an initiative to ensure equal access.
There may be fights within countries, too. If limited supplies are to save as many as
possible, health workers must be vaccinated first, followed by the most vulnerable. In
health care, as in other areas, they often find themselves at the back of the queue.
Paradoxically, once the supply is adequate, the problem will switch to rejection by anti-
vaxxers and by sceptics worried about rushed certification. Polls have found that a
quarter of adults globally would refuse a vaccine. The hope is that, if the vaccines are