A shot in the arm but whose?

The coronavirus has infected over 66 million people and killed more than 1.5 million worldwide, and these are only the reported cases. There are many more unreported in the developed world and especially in developing countries, which have inadequate diagnostics infrastructure.

The past few weeks have brought some rays of hope. The Pfizer-BioNTech, Moderna and AstraZeneca-Oxford University vaccines have grabbed most of the headlines because of their more than 90 percent efficacy, although the last is shrouded in controversy over sample size and methodology. Russia’s Sputnik V is beingrolled out there, but little is known about the methodology of its trials.

Light at the end of the tunnel is clearly welcome, but the UK’s fast-track approval of the Pfizer-BioNTech two-shot vaccine raises a raft of legal, logistical and ethical questions.

Vaccines should be available to all and at an affordable price, but what is affordable and how should developers be compensated for their efforts? Many vaccines were developed by wealthy pharma giants, but it is precisely their deep pockets that enabled them to fund the research, and to manufacture and stockpile vast quantities of vaccines that trials might have shown to be useless.

How to distribute the vaccines, some of which have to be stored at -70C? This will be easier in developed countries with a strong cold storage infrastructure. Even there, the ultra-low temperatures pose a problem, when many hospitals lack adequate refrigeration capacity. It becomes a million times more difficult in developing countries which are largely devoid of healthcare and logistics infrastructure.

How to implement a national vaccination scheme? Who should be vaccinated first? Even Britain’s universal National Health Service will be sorely tested by a program of this magnitude, and it will be even harder in the US, where the Centers for Disease Control issue guidelines but implementation is the responsibility of individual states. The UK is opting to vaccinate healthcare workers first, followed by care-home residents, vulnerable groups and the elderly. The UK wants to work downward by age group, which is not the only recommended course of action. Some experts think young people should be given priority immediately after the elderly because they are potentially super-spreaders.

Then there is the question of whether to make vaccination compulsory, which would encounter constitutional challenges in democracies.

As for the distribution of vaccines, there is broad consensus that everybody should have access, and manyworld leaders have made benevolent statements to that effect — but when push comes to shove, politicians instinctively want to protect their own citizens first. Ninety-five percent of doses of the Pfizer-BioNTech and Moderna vaccines have been ordered by developed countries. Forty percent of the AstraZeneca vaccine, which requires more moderate refrigeration, has been earmarked for low-income and middle-income countries

Research suggests that there is a better way for everyone. A study in March by Northeastern University in Boston indicated that if the first two billion doses of vaccines were supplied to wealthy countries and one billion to poorer countries, 33 percent of global deaths would have been averted by Sept. 1, but if the doses were to be distributed equitably 61 percent of global deaths could be prevented. This was obviously an academic exercise, but it should still convince leaders that cooperation stands a better chance of fighting the virus than “vaccine imperialism.”

These are all difficult questions, but the virus knows no boundaries, whether national, economic or social. A genuinely compassionate and effective response should be the same.

• Cornelia Meyer is a Ph.D.-level economist with 30 years of experience in investment banking and industry. She is chairperson and CEO of business consultancy Meyer Resources. Twitter: @MeyerResources