The government has signed its first binding agreement to secure a Covid-19 vaccine. But what exactly is the vaccine, who’s likely to get it and when? Siouxsie Wiles talks us through it.  

This week the New Zealand government announced it has signed its first binding agreement to secure a Covid-19 vaccine. If everything goes according to plan, it’ll provide vaccines for 750,000 people. Here’s what that announcement means.

It’s been just 10 months since we first started hearing about a new virus circulating in China. Since then, our worlds have been turned upside down, and the race has been on to develop a vaccine. According to the Guardian’s Covid vaccine tracker, more than 170 research teams around the world are working on this and 11 vaccine candidates are currently undergoing phase three human trials. These trials are testing for both safety and to see whether the vaccines might actually work, at least in the short term. Check out the handy guide Toby Morris and I put together showing the different kinds of vaccines currently under development.

Here in New Zealand, our Covid-19 Vaccine Strategy Task Force has been working hard to ensure we and our Pacific neighbours get access to safe and effective vaccines as soon as possible. They’ve already signed us up to Covax, a global collaboration that aims to produce two billion vaccine doses and distribute them globally and fairly to every participating country next year. Covax works by pooling money from different countries to support the development of a portfolio of vaccines and purchase them at scale. Some of the money is also being used to invest upfront in manufacturing so any vaccines are ready to be distributed as soon as they are licensed. With Covax, both the risks and the benefits of developing and producing vaccines are shared across countries and we get access to the nine vaccine candidates in their portfolio, three of which are currently in phase three trials.

Pfizer’s BNT162 vaccine

But as well as supporting Covax, the task force is also negotiating with individual pharmaceutical companies to access vaccines not in Covax’s portfolio. And this announcement is the first of those, signed with Pfizer and BioNTech. Under the agreement, it’s possible we could start receiving doses of Pfizer’s BNT162 vaccine early next year. This would make it one of the earliest vaccines available, if it completes all clinical trials within the companies’ proposed timelines and is then approved by Medsafe.

BNT162 belongs in the genetic vaccine candidate basket. The idea behind this approach to making a vaccine is to just use the genetic material that codes for the parts of the microbe that trigger our immune system. By introducing the genetic material into our body, our cells will read the code and make the protein for our immune system to see. There are two strategies for developing a genetic vaccine: the first is to use DNA, and the second to use RNA. If DNA is used, the cell makes RNA from that DNA and then protein from the RNA. Using RNA skips the DNA-to-RNA step. BNT162 is an RNA vaccine.

The advantages of genetic vaccines are that they’re really quick to develop and really easy to scale up and manufacture. The main downside is that no vaccines developed using this technology have yet been approved for use in humans. Some have been approved for veterinary use though.

Who gets the vaccine?

If a vaccine is going to be available by early next year, the next big question is who will get it? The Ministry of Health has said it’s working on a strategy to decide and the current government has made it clear the vaccine won’t be mandatory.

I recently rewatched the movie Contagion. If you haven’t watched it and can stomach a movie about a pandemic scarily similar to Covid-19, I’d highly recommend it. It’s interesting watching what they got right (conspiracy theorists peddling fake cures) and what they got wrong (some countries welcoming the virus with open arms). Given it’s a movie, it ends with a vaccine being developed. Once it becomes available, the United States allocates it via a lottery. As batches are made, authorities randomly pick a day and month, and anyone born on that date gets the vaccine.

It’s an interesting strategy and is certainly fair, though not particularly equitable. Another strategy would be to vaccinate those who are more likely to have a severe infection, or to die. For Covid-19, this would mean people over the age of 60, men, smokers, and those with underlying medical conditions like diabetes, diabetes, hypertension, COPD, coronary artery disease, and chronic kidney disease. Whether it’s possible to vaccinate these groups will depend on the vaccine trials showing it’s safe to do so.

Perhaps a better strategy, if we are to keep intercepting the virus at our border, would be to ensure that all those working at our borders and in managed isolation and quarantine are vaccinated. We could supplement this with anyone working in our health system, in our aged care facilities, and other essential workers. If we had any doses left, we could vaccinate those who need to travel overseas for work to ensure they don’t bring the virus back with them. A vaccine becoming available could also mean a change to our border policy. For example, those visitors who were able to show evidence of being vaccinated and having mounted an immune response could be allowed entry into New Zealand without going through managed isolation.

Whatever it decides, the government has put aside over $66 million to ensure it’s able to launch an immunisation programme as soon as a vaccine is available. Now we just need to cross our fingers and wait for the trial results.