BCG estimates that it may take more than a year to produce vaccines for almost 8 billion people.

By Johanna Benesty, Marin Gjaja, Dan Kahn, Josh Kellar, Ben Keneally, Rich Lesser, Jonathan Scott, and Emily Serazin

The foundational question concerning availability is how long will it take to manufacture, distribute, and administer enough doses to protect a global population of almost 8 billion people, under current production capacity.

Our best-case analysis suggests that 2 billion to 3 billion people will remain unprotected by the end of 2021, even if all ten current Phase III trial vaccines receive approval and if manufacturers ramp up distribution quickly and utilize 100% of their capacity. (See Exhibit 2.) Even if the vaccination of all 2 billion children is delayed until more safety data is available, a shortfall is almost certain.

Most of the shortfall will impact people in countries with low or midrange per capita income that can least afford an extended public health and economic crisis. That is in part because wealthy countries have pre booked billions of doses of promising vaccine candidates. For example, Canada, the European Union, Japan, the UK, and the US will have more than two-and-a-half times the supply they need if all the candidates receive approval, accounting for the fact that all but one of the vaccines require two shots. (See Exhibit 3.) China and Russia are subsidizing five homegrown vaccines, which account for half of the candidates that are in Phase III trials worldwide.

Low-income countries are dependent on the success of the COVID-19 Vaccine Global Access Facility (or the Covax Facility), a global coalition led by the World Health Organization and two public-private alliances. The Covax Facility’s mission is to distribute enough vaccines to cover 20% of the population in participating countries by the end of 2021, with rich nations subsidizing vaccinations for 92 low- and middle-income countries. It has commitments from 84 wealthy nations, including China but excluding the US.

Europe and the US will likely redistribute excess capacity to emerging markets if most of their late-stage trials are approved. But that is cold comfort to public health officials in nations in desperate need now.

Manufacturing billions of doses is rivaled in complexity by the distribution, storage, and administration challenges. Two of the leading vaccine candidates require doses to be stored at ultracold temperatures at or below –20°C. These ultracold requirements create supply chain challenges, limit where vaccines can be distributed (especially in emerging markets), and increase the risk of spoilage. Of the leading vaccine candidates, only one is being considered for a single-dose regimen; all others require a booster shot three or four weeks apart. Annual boosters may also be required.

Government advisory bodies are finalizing allocation and prioritization recommendations for the vaccines. In the best case, these decisions will be free of controversy and political pressure. The reality is that vaccines will initially be a scarce resource, and they may or may not be deployed to maximize public health. The rollout of the antiviral drug remdesivir in the US, which initially excluded states with high caseloads, should be a cautionary tale.

There are optimistic signs that stakeholders understand these dynamics. More than a dozen pharmaceutical companies along with the Bill & Melinda Gates Foundation recently pledged to ensure “global access to diagnostics, therapeutics, and vaccines.”

About the Authors

Johanna Benesty is a managing director and partner in Boston Consulting Group’s Paris office. She has helped define go-to-market strategies for vaccines and partnered with social impact organizations dedicated to improving public health.

Marin Gjaja is a managing director and senior partner in the firm’s Chicago office. He leads BCG’s global work on COVID-19 scenario planning for both the public and private sectors.

Dan Kahn is a principal in BCG’s Chicago office.

Josh Kellar is a managing director and partner in the firm’s Chicago office. He is a core member of BCG’s Health Care and Corporate Finance & Strategy practices, with expertise in advanced analytics, value-based delivery of health care, and the application of new digital technologies in health care.

Ben Keneally is a managing director and partner in BCG’s Sydney office. He is a coleader of the firm’s Health Care practice in Australia.

Rich Lesser is the president and CEO of BCG. He is based in the firm’s New York office.

Jonathan Scott is a managing director and partner in the firm’s New York office. He is a former physician who specializes in the transformation of health care organizations.

Emily Serazin is a managing director and partner in BCG’s Washington, DC, office. She is a core member of the firm’s Health Care and Social Impact practices, and she is an expert on global vaccine development.

Acknowledgments

The authors thank Kristen Brignac and Rob Kirk for their invaluable assistance in researching and writing this article.

© Boston Consulting Group 2020. All rights reserved. 10/20

This is an excerpt of the paper:
Vaccines Aren’t the End of the Fight, but the End of the Beginning”,
focusing on Vaccines Production Capacity.

Click here to download the PDF version (of the complete paper)

Edited for Brazil by:

Joaquim Cardoso do Rosário
Senior Advisor of Healthcare @ BCG — Boston Consulting Group.
São Paulo Office, Brazil.

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Joaquim Cardoso @ BCG

Senior Advisor for Health Care Strategy to BCG — Boston Consulting Group