Lex Midweek Letter: arms out for boosters, thumbs up for mRNA

Dear readers,

The Covid-19 vaccination drive is often described as a race. On Tuesday it was compared to a camping trip. Anyone who has put up a small tent on a mountainside knows it makes sense to attach guy ropes ahead of — rather than during — a storm, said Professor Jonathan Van-Tam, a senior UK medical official fond of colourful metaphors.

The decision to offer the over-50s and other eligible Britons an additional dose of the BioNTech/Pfizer jab or a half dose of the Moderna vaccine will guard against the squalls of waning immunity. It is also yet another vote of confidence in the new generation of shots that use messenger RNA to teach the body to make a protein that triggers an immune response.

A trial of seven boosters, carried out at the University of Southampton, found that the mRNA jabs were the best tolerated and effective. The Oxford/AstraZeneca jab will only be used by those who cannot have the mRNA vaccines for medical reasons.

The need for supplementary jabs may not stop there. Britain’s vaccines minister Nadhim Zahawi says patients could get routine annual Covid jabs at the same time as their flu vaccinations. Moderna’s co-founder Noubar Afeyan has also talked about annual Covid boosters becoming a reality.

A need for regular boosters is a sign that, despite the vaccines’ remarkable success, they are not likely to vanquish the virus. The Delta coronavirus variant is roughly twice as infectious as the original strain that was first detected in Wuhan. That has pushed herd immunity out of reach because not enough people can be jabbed or infected to slow transmission of the virus to the point it fizzles out. Rather, the UK appears to be moving towards the “endemic equilibrium”, where cases fluctuate at a relatively stable level. Immunity will decline over time, but waves of boosters and infections will replenish it.

If confirmed, booster mandates would create a large and sustained market for Covid vaccines. Annual jabs would increase the size of the Covid vaccine market across seven major markets — the US, Germany, France, Italy, Spain, UK and Japan — from $13.6bn in 2021 to $19.5bn in 2026, according to GlobalData.

Some companies’ bottom lines would significantly benefit. Pfizer, which shares profits on sales of the Covid shot with BioNTech, reports its pre-tax Covid vaccine profit margins are “in the high 20 per cent range”. The approval of rival vaccines might eventually depress prices but, for now, they are rising. The EU paid €19.50 per shot, up from €15.50, in its most recent deal. One report noted that the UK paid £1bn for the 35m doses it ordered for next year’s autumn booster campaign.

Vaccine costs have not aroused much controversy. They pale by comparison with the economic benefits of keeping the economy open. More contentious is the principle of providing booster jabs. Scientists such as Sarah Gilbert, who developed the AstraZeneca jab, and the international authors of a recent paper in The Lancet are unconvinced. Pascal Soriot, AstraZeneca’s chief executive, recently warned that rushing the decision could impose a potential “unnecessary burden” on the NHS.

The more supplies are requisitioned by rich countries, the longer poorer countries have to wait — increasing the death toll and the risk of new variants. The World Health Organization recently called for a moratorium on booster shots until at least the end of the year, to enable every country to vaccinate at least 40 per cent of its population.

An end to the jabs shortage can be foreseen, says Pfizer boss Albert Bourla. He predicts there will be enough shots for all those willing to be vaccinated by the end of 2022. Even by the end of this year, developed countries will have 1.1bn of surplus jabs, according to Airfinity, a life sciences analytics company. That is a legacy of having spread their bets to guard against failure. Top of the league table is Canada with 8.8 doses per person, followed by the UK which ordered seven.

The UK’s stockpile will not be as big as expected, though. Shares in France’s Valneva fell more than a third on Monday after the British government ended a vaccine supply deal for 100m doses. The reason was not fully explained. UK health secretary Sajid Javid said it was clear its vaccine would not have been approved for use in the UK.

Valneva insisted it would press on with development. It is not alone in hoping that the vaccine race will turn out to be a marathon, not a sprint. More than two dozen trials have started this year, according to Evaluate Vantage. Those first out of the blocks have a big lead, but there could still be room for more contenders.

Enjoy the rest of the week,

Vanessa Houlder
Lex writer