Obstacles to Vaccination

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The world has been hungry for good news ever since the first known case of COVID-19. The end of 2020 marked a very difficult year with some welcome news. Vaccines have been approved and large clinical trials of four candidate vaccines have shown significant promise, with three efficiencies surpassing 90% and an unpredictably high rate, according to the results released so far. While politicians have over and over failed people, scientists have restored some faith. The vaccine rollout didn’t work the way it was anticipated, despite the vast announcements in the US. The primary objective was to vaccinate approximately 20 million people by the end of December 2020, while a mere 1.2 million people were vaccinated. There is a long path forward, and just as the logistics problem is seen to be unexpected by the US, UK and elsewhere, we in Pakistan should realize that our rollout would encounter significant roadblocks. From vaccine hesitancy to lack of faith in science, there are other issues that we should also plan for. While it seems like the finish line is in sight, there is still a lot of challenging terrain to cross. The delivery of vaccines presents another challenging obstacle and is followed by questions like how much it will cost and who will pay for it. AstraZeneca and Oxford have promised to supply all of their vaccines at the cost price during the pandemic and to retain this price for low- and middle-income countries after the pandemic when, in the event of potential outbreaks, a vaccine will still be needed. But neither company, as Nature went to press, had dedicated itself to holding prices down until the current pandemic is over.
A number of rich countries have already pre-ordered around four billion doses of vaccines and have options for another five billion at current prices. COVAX, a global coalition that aims to ensure sufficient supply of vaccines for low and middle-income countries, has been able to secure vaccines for just around 250 million people, way far from what is needed. The poorest countries will be much less willing to pay than they are now, as prices start to rise. It would be morally unethical not to make the vaccine available for these nations. It would also be short-sighted because as experts say, an outbreak anywhere is an outbreak everywhere. For its 212.2 million people, Pakistan has decided to buy 1.2 million doses only. While the date for the beginning of vaccination in Pakistan has not been announced, three things should be done to ensure a reasonably smooth process and that all Pakistanis are vaccinated fairly in due course. The responsibility for results lies on us all.
Honesty and accountability by the authorities are first and foremost. Pakistan does not have a strong health system and issues related to procurement, logistics, storage and deployment should be expected. Vaccines would require cold chain and well-functioning transport, an ethically acceptable priority list, and a system that works not just on the first day, but until the last citizen is vaccinated, honesty and transparency can help establish contingency plans that can save lives and resources.
Second, we must encounter and educate the misleading perception about vaccination and tackle theories of conspiracy. This includes an all-out effort from all facets of society. This is neither a partisan nor an ethnic issue. It’s not a war between conservative and liberal ideology. Although we may differ on a lot, all political parties should fight against vaccines being a foreign plot, a strategy to rewire the Muslim brain, or what so ever nonsense is out there. The part of community leaders, mainly religious leaders, can’t be overstated either. Although there are those who like to believe in bizarre stories, many are neither against science nor dismissive of effective public health initiatives. In fact, the government needs these religious community leaders on the country’s side. A two-pronged approach will go a long way, one of education and awareness; and the other one that encourages political and military leaders, religious scholars and tribal elders from all sectors and ethnicities for taking the vaccine. It may not be a thorough solution, but it may bring us closer to achieving a high vaccination rate objective. Maybe we all need to realize that the vaccine works only if we are alive.

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