2020.11.16 通往covid-19疫苗的道路可能很快，但会很颠簸

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The World in 2021
The path to a covid-19 vaccine may be quick, but it will be bumpy
Certifying, manufacturing and distributing it will not be easy



Nov 16th 2020
BY EDWARD CARR: DEPUTY EDITOR, THE ECONOMIST


FOR A WORLD that desperately needs to be vac­cinated against SARS-CoV-2, the virus that causes covid-19, 2021 will be a frustration sandwich—two thick slices of good news, wrapped around a layer of conflict, delay and disappointment. Policymakers should try to make that filling palatable. Many thousands of lives will depend on their efforts.

The first slice of good news is that the next six months will see lots more new vaccines to complement the successful candidate from Pfizer-BioNTech. That is a testament to the power of scientific collaboration. Vaccines used to take 10-20 years to create, but today there are more than 320 projects, including dozens in advanced clinical trials. What’s more, this work is yielding valuable advances in vaccine research, as teams attack the virus from different angles. Some vaccines take the old-fashioned route of using an attenuated virus. Others, like the Pfizer vaccine, are breaking new ground by, for example, priming the immune system using viral genes (see article). 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 may 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 article). 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 more than 90% effective, as Pfizer’s seems to be, governments will be able to persuade most people to turn up for a jab.

All this amounts to a daunting agenda for governments. They must communicate clearly about the scientific rationale for approvals and the criteria for distribution. They must invest in supply chains and training, knowing that some spending will be wasted. And they will need to explain to their citizens how the whole world gains if countries work together to distribute vaccines fairly.

Edward Carr: deputy editor, The Economist ■

Correction: Due to an editing error, the word "may" was omitted from the sentence about Chinese and Russian vaccines, wrongly implying that they do not work or cause complications. This was corrected on December 23rd 2020.




2021年的世界
通往covid-19疫苗的道路可能很快，但会很颠簸
认证、制造和分发疫苗并不容易



2020年11月16日
作者：爱德华-卡尔：《经济学家》副主编


对于一个迫切需要接种SARS-CoV-2（导致covid-19的病毒）疫苗的世界来说，2021年将是一个沮丧的三明治--两片厚厚的好消息，包裹着一层冲突、拖延和失望。政策制定者应该努力使这种馅料变得可口。数以千计的生命将取决于他们的努力。

第一片好消息是，未来六个月将看到更多的新疫苗来补充辉瑞-生物技术公司的成功候选疫苗。这证明了科学合作的力量。疫苗曾经需要10-20年的时间来创造，但今天有超过320个项目，包括几十个高级临床试验。更重要的是，这项工作在疫苗研究方面取得了宝贵的进展，因为各团队从不同角度攻击病毒。一些疫苗采用了老式的路线，即使用减活的病毒。其他的，如辉瑞公司的疫苗，则是通过使用病毒基因来激发免疫系统，从而取得了新的突破（见文章）。这种疫苗更容易大规模生产。


第二条好消息是，如果一切顺利，到2021年底，应该有足够数量的疫苗可以使用，这意味着covid-19的传播可以被大大减缓。疫苗还可能通过使症状不那么严重来保护受感染的人。Covid-19不会突然消失，但它将开始逐渐消失在背景中。

然而，在这些层层叠叠的好消息之间，将有很多坏消息。北半球的冬季病例浪潮一直很严重。而认证、制造、分发和管理数十亿剂量的竞争性疫苗，肯定会带来问题。



时间可以拯救生命，因此监管机构理所当然地急于批准疫苗。但俄罗斯和中国已经为尚未通过大规模第三阶段试验的药品开了绿灯。他们的产品可能会失效或引起并发症。在西方获得紧急授权的疫苗也需要关注，因为它们对不同群体的作用可能不同，或者只提供短暂的好处。预计会有很多关于监管机构偷工减料的冷嘲热讽，以及很多关于为什么应该避免使用疫苗的理论--很多是阴谋论。

几种疫苗的生产已经开始。辉瑞公司说它将在2020年底前准备好5000万剂疫苗。即便如此，扩大疫苗生产规模将是一项艰巨的任务。世界上最大的制造商--血清研究所警告说，在2024年或以后，将没有足够的剂量来接种整个世界。医疗玻璃和 "冷链 "的短缺可能会造成延误，而 "冷链 "是将一些疫苗（包括辉瑞公司的疫苗）保持在零下70度甚至更低的温度所必需的。接受过疫苗管理培训的人员也可能出现短缺。鉴于该大流行病在2020年给世界带来了约8%的国内生产总值，如果因为担心浪费钱而不愿在这些方面进行投资，将是肆意的短视行为。


这可能会伤害
国家之间可能会有争斗。中国和俄罗斯已经在利用疫苗供应作为其软实力的接种武器（见文章）。美国和英国可能试图为自己的公民锁定供应。许多人的生命处于危险之中。波士顿东北大学建立的模型表明，如果50个富国收到首批20亿剂80%有效的疫苗，它将防止33%的covid-19死亡，而如果疫苗按国家人口分配，获救者的比例几乎翻倍。这样的洞察力是COVAX背后的灵感，这是一项确保平等获得的倡议。

国家内部也可能会有争执。如果要让有限的供应量尽可能多地挽救生命，就必须首先为卫生工作者接种疫苗，其次是最脆弱的人群。在卫生保健领域，就像在其他领域一样，他们经常发现自己排在队伍的后面。

矛盾的是，一旦供应充足，问题就会转为反免疫者和担心仓促认证的怀疑论者的拒绝。民意调查发现，全球有四分之一的成年人会拒绝接种疫苗。希望的是，如果疫苗有90%以上的效力，就像辉瑞公司的疫苗那样，政府将能够说服大多数人去接种疫苗。

所有这些对政府来说都是一项艰巨的任务。他们必须就批准的科学依据和分配的标准进行明确的沟通。他们必须对供应链和培训进行投资，因为他们知道有些开支会被浪费掉。他们还需要向其公民解释，如果各国共同合作，公平分配疫苗，整个世界都会受益。

爱德华-卡尔：《经济学人》副主编。

更正一下。由于编辑错误，关于中国和俄罗斯疫苗的句子中省略了 "可能 "一词，错误地暗示它们不起作用或导致并发症。这一点已在2020年12月23日得到纠正。