As European COVID-19 vaccine campaigns got underway with celebratory first jabs into the arms of citizens in half a dozen countries, some seasoned observers were still wondering if the pace of vaccine roll-outs will move fast enough to outpace the continuing high levels of infection and fatality – now being fuelled by a new mutant SARS-CoV-2 virus strain taking hold on the continent.   

Among the 27 countries of the European Union, Germany, Greece, France, Italy, Spain and Poland were among the first to begin administering shots on Sunday – after receiving the first dispatches of the EU’s order for  some 200 million doses of the Pfizer vaccine, which has been delivered region-wide.  However, some countries were already behind, with the Netherlands not due to start vaccinating until 8 January.

European leaders ranging from Italy’s Prime Minister Giuseppe Conte and Spain’s Pedro Sánchez, to European Commission president Ursula Van der Leyen have heralded the recent moves, expressing hope that the vaccines will be transformational for the continent, which has suffered some of the world’s highest infection and death tolls in the year since the pandemic began. 

“Today, we start turning the page on a difficult year,” von der Leyen, the European Commission president wrote in a Twitter post on Saturday. “The  #EUvaccinationdays are a touching moment of unity. Vaccination is the lasting way out of the pandemic. ”

Today, we start turning the page on a difficult year. The #COVID19 vaccine has been delivered to all EU countries.

Vaccination will begin tomorrow across the EU.

The #EUvaccinationdays are a touching moment of unity. Vaccination is the lasting way out of the pandemic. pic.twitter.com/pYOj5vS2gV

— Ursula von der Leyen (@vonderleyen) December 26, 2020

Regulatory Delays Followed by Holidays Hamper Initial Rollout

While Switzerland was in fact the first country in continental Europe to administer a COVID vaccine on 23 December – the start has been largely symbolic. In the intervening period of Christmas and New Year’s holidays, only a few more vaccines have been administered in the Confederation – with more serious efforts only set to get underway in mid-January.  Further dampening enthusiasm was the death of one of the first vaccine recipients, a 91-year old woman in the Canton of Lucerne, just five days after receiving the vaccine – although Swiss authorities said that the timing had been “a coincidence.“

But the chain of events have also left some observers worried that delays seen so far could have a lasting impact on the vaccine’s rollout in Switzerland – a country where death rates have been comparatively high throughout the pandemic, and are even more so right now. 

“Israel has vaccinated over 700,000 people and what has Switzerland done so far?” asked Dr. Pierre Goloubinoff, a biologist at the University of Lausanne who has worked in both countries, including collaborations on COVID therapies, in an interview with Health Policy Watch. 

“As of 29 December, there were 6 vaccinations in Canton of Geneva and a few dozen, maximum, in Fribourg and the Valais. At this rate Switzerland will be vaccinated in 250 years.  

“The Department of Health doesn’t seem to understand that in just three weeks of delay, with 4000 new infections per day, 100 will die everyday. That means in three weeks, more than 2000 people will die unduly.”

“If we could do a vaccine blitz, and vaccine all of the high-risk population in a month, in terms of the economy it would be completely liberating,” he said.

Already high Swiss infection and death rates, compounded by the spread of a new mutant strain of the virus originating in the United Kingdom, and which is even more infectious, hold the potential to create more havoc for health systems and economies – just as countries try to regain normalcy, he warned.  

For the moment, COVID vaccines being rolled out still appear to be effective against the mutant virus strains that have surfaced recently in South Africa as well as the UK.  However extensive spread of those strains will also create new opportunities for still further mutations – which could then increase risks that vaccine efficacy could be reduced.

Vaccine Conservatism & Christmas Hamper Swiss Rollout Efforts

In comparison to Israel, a country similar in size to Switzerland, and nearly identical COVID infection rates, Switzerland’s average mortality rate throughout the pandemic has been roughly double – Goloubinoff noted in a provocative Facebook post last week which made the comparisons very directly:

 Pressing ‘Restart’ – In Slow Motion?

That, he says, reflects broader shortcomings in the non-pharmaceutical approaches tried so far. But even so, the introduction of COVID vaccines should mark a moment when every country can press “restart” on their efforts to combat the virus, he observed: 

“My general prediction was that the vaccines are going to totally change the situation because they are efficient.  They decrease the risks dramatically; it makes the difference between someone like me having a 1 in 50 chance of being hospitalized and a 1 in 100 chance of dying to having a 1 in tens of thousands chance,” said Goloubinoff who is 64.  

However, even when vaccine campaigns do finally get underway in mid-January, he fears that Switzerland is not adequately geared up well for the kind of rapid blitz that is needed now. 

“Switzerland had a year to get organized, to say that we are stuck now because we were not ready, is of the stupidest reasoning,” bemoaned Goloubinoff. “We have a great infrastructure but we are not prepared for pandemic response.” 

Although Switzerland, like Israel, has procured enough vaccines in principle to immunize its entire population, the initial deliveries of the Pfizer vaccine will be in far smaller quantities – with only 357,000 doses due to be available by the end of January 2021.

And that is only enough to vaccinate about 178,500 people in the month of January – when Israel is vaccinating the same number of people in just one or two days [see related story]. 

Eventually, the Moderna vaccine should bolster vaccine availability – particularly since Moderna’s global manufacturing, Lonza, is based in the Valais town of Visp. 

However, Swissmedic has not yet approved the Moderna vaccine.  And that is despite the fact that it was approved on 18 December by the United States Food and Drug Administration with even fewer reservations than those that accompanied that of the FDA’s approval of Pfizer’s mRNA vaccine – which Swissmedic greenlighted earlier in the month.

“I suspect Swissmedic has not made a determination on Moderna because the experts were not asked by the Conseil Féderal to work on an emergency basis during their Christmas holidays,” said Goloubinoff, wryly. 

The damage of vaccine delays, whether due to holidays, supply chain gaps, or an overall lack of preparedness will be cumulative, not only in terms of mortality, but also in terms of long-term disabilities being experienced by younger people suffering from ‘Long COVID’, Goloubinoff says. 

He cited the recent experience of one of his PhD students, aged 35 who became ill with COVID this autumn and nearly died: “He’s still walking with a stick, is very, very weak, and able to carry out maybe half of the intellectual load that he was doing before.”

Official Swiss Vaccine Communications Provide No Timetables

As it stands now, the initial vaccine rollout will be extremely limited. A Swiss Mission missive, sent to UN employees in the Geneva area last week, announced that Geneva’s vaccine drive, beginning on 28 December, would include people aged 75 and older living in care homes, and some hospital staff.

“As more vaccines are delivered by the Confederation, the campaign will be expanded to people aged 65-74 years of age, as well as to people with clinically diagnosed pre-existing conditions under 65 years of age,(e.g. cardiac illness, obesity, etc.),” the notice, dated 22 December, states.  As for anyone under the age of 65, the rollout date remains undetermined.

A circular from the Canton of Vaud sets the first date for vaccinations two weeks later, on 11 January. There too, the initial phase of immunizations will be limited to people aged 75 living in care facilities, along with health care workers.

The circular also hastens to underline the complexity of the vaccine task being faced, stating: “this vaccination campaign is without precedent in terms of its logistical chalenges, which include conservation of three types of vaccines [Pfizer, Moderna and AstraZeneca] at different temperatures.  In addition, certain products have to be mixed before the injection, and then they all have to be injected in the 5-6 hours after having been placed in ambient temperature conditions. Finally, everyone who wishes to be vaccinated has to go two times, within an interval of four weeks.”

Other Health Policy Watch queries yielded no further clarity regarding vaccination schedules:  “We haven’t yet received word of when we will be receiving the vaccine,” said the head of an outpatient clinic at a hospital in the Canton of Vaud.

In response to another query, a Swiss Department of Health spokesperson also had no further details about timetables, stating only: “The vaccine doses are arriving in a staggered manner, as they do in every country. We expect to have everyone vaccinated by early summer who wants to be,” the spokesperson said.   

That remains in stark contrast to countries like Israel, which are vaccinating everyone 60 and older right now – and soon to move onto teachers and younger people with chronic health conditions. Among the 700,000 people vaccinated so far, there has been one widely reported death in a man aged 70 suffering from multiple health conditions. However, as one prominent Israeli health expert pointed out, among people aged 60 and over, some 700 a week die on average in any case from causes unrelated to COVID.

In the United States Lack of Public Health Infrastructure Inhibits Vaccine Delivery 

On the other side of the Atlantic, frustrations about a slow pace of vaccine rollout also are surfacing in the United States, the Boston-based, Stat News reported this week.

Although the Trump administration has shipped more than 11 million doses of the Pfizer and Moderna vaccines to locales around the country, only 2.1 million people have received their shots since the drive began on 14 December, according to the US Centres for Disease Control (CDC).  

“We are below where we want to be,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was quoted as saying on CNN. “Not being responsible myself for the rollout, I can’t personally guarantee that we’re going to catch up. I hope we do.”

In the case of the US, the biggest stumbling block appears  to be the lack of budget and coherent public health infrastructure for administering the vaccines – after they are received. 

While outgoing President Donald Trump aggressively invested in, and pushed for Operation Warp Speed’s vaccine R&D – he left the critical field operation underfunded. State and local public health officials have waited for months for  more than $US 8 billion that they said would be needed to develop the infrastructure needed to administer vaccines, while the Trump administration provided only $US 340 million. The coronavirus stimulus package passed by the Congress shortly before Christmas and signed by the US president on Sunday, finally allocated the full amount that had been requested.  

Along with a shortage of funds, the US health system is fragmented between a host of public and private health insurance providers – which make a single coherent campaign of the kind being launched in other countries, such as the UK, Europe, Israel, Bahrain, even more challenging. 

“There appears to be no investment or plan in the last mile,” tweeted Ashish Jha, dean of the Brown University School of Public Health. “No effort from Feds to help states launch a real vaccination infrastructure. Did the Feds not know vaccines were coming? Shouldn’t planning around vaccination sites, etc not have happened in October or November?”

United Kingdom Approves AstraZeneca/Oxford Vaccine – Good News For Low- and Middle-Income Countries

There was was good news in the United Kingdom, however, where the adenovirus-based COVID vaccine jointly developed by AstraZeneca and the University of Oxford, became the third to receive regulatory approval by a globally recognized agency, on Tuesday, 30 December.

Approval of the AstraZeneca vaccine by the Medicines and Healthcare products Regulatory Agency (MHRA) will allow the UK to redouble its aggressive vaccine efforts – while it directly faces the threat of the SARS-CoV2 virus variant on home turf.

On Tuesday, 53,135 new Covid cases were recorded in the UK – the highest single day rise since mass testing began, BBC reported. The UK has ordered 100 million doses of the AstraZeneca vaccine – enough to vaccinate 50 million people – or roughly 75% of its population.  

That is in addition to the Pfizer vaccine, which the UK’s National Health Service was the first to rollout already beginning on 8 December.   With ample supplies now available, the NHS aims to open vaccine campaigns to a much wider swathe of the general public, ramping up the pace of vaccinations to as many as two million people a week.

The UK regulatory approval of the AstraZeneca vaccine also marks an important milestone for low- and middle-income countries – as the vaccine’s modest cold-chain requirements permit storage in a conventional refrigerator making it easier to administer in resource-constrained settings.

Some 3 billion doses of the AstraZeneca vaccine are due to be manufactured in 2021 including  in India and Brazil – with some supplies also being procured and distributed even more widely through the WHO co-sponsored COVAX facility. 

Even so, while vaccine hoarding, vaccine nationalism and inequitable distribution of vaccines remain huge global issues to be surmounted – the problems already being experienced by high income countries seemingly awash in vaccines, may be seen as warning signal to other nations that are only just now starting to plan their vaccine campaigns. 

And the message is this: once you have secured an adequate vaccine supply – that is still only the beginning of the journey.

Image Credits: Euoropean Commission , Our World In Data .