On June 19, Fulbright School of Public Policy and Management (FSPPM) organized a webinar titled "Expanding the Access to Covid-19 Vaccines and the Responsibilities of the State". Leading experts gave in-depth analysis from epidemiological, legal, economic, and public policy perspectives on Vietnam's vaccination strategy in the context of the fourth wave of Covid outbreaks that requires the Vietnamese government to have a new approach to the pandemic. Among other things, they discussed the need for Vietnam to map out a long-term vaccination and immunization plan.
It is very likely that certain developed countries in the world will continue to discharge the Covid vaccines they do not use, making the supply of vaccines more abundant to countries struggling to have the access to Covid-19 vaccines. While Vietnam is ready to pay for about 120 to 150 million doses of Covid vaccines, the problem is how the country would simplify red tape to receive the vaccines and roll out a comprehensive vaccination program.
Red tape in case of emergency
Prof. Pham Duy Nghia, Director of Master in Public Policy Program at FSPPM, gave an example of bureaucratic red tape when Vietnam Vaccine Joint Stock Company (VNVC) imported around 300,000 doses of AstraZeneca vaccine on May 25, but the batch stayed in the warehouse for 20 days before being sent to cities and provinces affected by Covid-19.
"VNVC paid in advance for the vaccine, so the government would have to pay back the money to the company. But the problem is that the Ministry of Health must get the approval from other ministries before spending money. That procedure is even more complicated for authorities of provinces and cities. If local authorities want to spend the local budget on Covid vaccines, according to Article 26 of the Law on Bidding and Public Procurement regarding procurement in case of emergencies, they must get the approval from the Prime Minister. Although the Vietnamese government has not declared the Covid-19 situation as an emergency, the administration should act promptly as if it is in an emergency if it wants to disburse public money for urgent procurement. Whether a company like VNVC could bring vaccines to Vietnam and how it could do so depend a lot on the support of the administrative system," Prof. Nghia said.
Dr. Nguyen Thu Anh, Director of Woolcock Institute of Medical Research Vietnam, commented that the Vietnamese government's goal of vaccinating 70 percent of the population from now until the end of 2021 is extremely hard to reach, even when there are abundant supplies of vaccines. Calculating based on global data, at the highest speed, Vietnam can vaccinate 500,000 people per day across the country. It is with the condition that Vietnamese people support the vaccination. In case of complications, the pace of the rollout would slow due to people's worries.
According to Dr. Thu Anh, we should not calculate the vaccination rate based on the doses used per day, but we should anticipate that the number of vaccinated people would drop when vaccination reaches a certain rate. Instead of aiming to vaccinate 70 percent of the population, Vietnam should give priority to provinces, cities, areas, or businesses with the highest risks of coronavirus outbreaks. The risk should not be calculated based on the infected cases, but on the likelihood that people are exposed to the virus due to business activities and daily activities. At the same time, Vietnam should focus on border areas. "If we can control the outbreaks in Bac Giang, Bac Ninh but we fail to closely monitor border areas or immigration quarantine zones, there is high risk for the virus to spread into the country," she said.
Dr. Thu Anh also noted that we should treat Covid-19 patients based on the level of seriousness. Top priority should be given to people with a high risk of death to reduce the pressure on the healthcare system, so the healthcare workers could spend time on elderly patients and patients with underlying health problems.
Domestic vaccine development strategy
At the webinar, experts agreed that there are many lessons Vietnam has learned from the Covid-19 prevention campaign, including the strategy of approaching Covid-19 vaccines. While the Covid-19 variants will stay for a long time in the world and similar pandemics may occur in the future, Vietnam should invest in a methodical and long-term domestic vaccine plan, Dr. Thu Anh recommended.
Vietnam must master the technologies for the research, development, and production of the Covid vaccine, she said. To do so, Vietnam should invest in human resources, facilities, and associated supply chain so that we can quickly produce a new type of vaccine as soon as it is introduced. Also, the main goal is to invest in scientific research to develop new types of vaccines, according to Dr. Thu Anh.
"We should choose new technologies when deciding to invest. For example, mRNA vaccines are highly effective, can be developed in a very short time, and require a short time to expand production scale, while adapting very quickly to new variants of SARS-CoV-2. Vietnam should focus on similar technologies or other technologies that countries around the world are developing." – Dr. Thu Anh stressed.
She also said that Vietnam should invest in research to develop single-dose vaccines that can treat many diseases. Some countries in the world have now begun to test these types of vaccines or vaccines that can treat cancer.
Finally, Vietnam should install a surveillance system for early detection of new diseases, not only for the surveillance of cases but also for DNA sequencing of bacteria or viruses, laying the foundation for the scientific research and development of new vaccines, as Dr. Thu Anh has shared.
"The development of a new vaccine can go nowhere and the failure rate is pretty high; therefore, Vietnam should have a large public investment program, encouraging the private sector to join and get the access to public investment resources to develop vaccines" – she emphasized.
On the other hand, Vietnam needs to improve the capacity of the healthcare system to roll out vaccination on a large scale with different scenarios of diseases, she added.
Explaining the issues raised by Dr. Thu Anh from a legal perspective, Prof. Pham Duy Nghia said it is a challenge for Vietnam to manage all by itself to ensure health safety for the population of nearly 100 million people. In that context, the legal system, as well as the state governance, must adapt accordingly. Favorable conditions and incentives must be given to private vaccine research centers so that they can operate with their own mechanism. Above all, these private research centers should be allowed to bid for ideas and the government will fund their projects, even when the government's investment into these projects fails.
"As an example, BioNTech and CureVac are both German vaccine research centers. The country has invested 300 million euros in CureVac but recently announced the test had failed. In other words, vaccine research is not always successful. But the research of new variants can only be possible thanks to previous studies. There is very close cooperation between Oxford and AstraZeneca, between Pfizer and BioNTech, etc. The power of cooperation is the reason for the success of vaccine development in a short time" – he said.
"The State's mission is to ensure a law on the management, investment, use of vaccines and the prevention of bad effects caused by vaccination. It should be a priority," he said.
Prof. Pham Duy Nghia also believes that it is necessary to redefine the role of the government in entrepreneurship – the government sponsors new innovations rather than leaving that to private businesses.
"The State invests in a private research center, but if the vaccine is developed, the patent belongs to the private center. The State grants the right to take advantage of the private center's intellectual property, but in return, the private center must commit to selling the vaccine, even to poor countries, at low prices. That is the reason why the contracts to sell vaccines are not made public. These contracts have a lot of complicated binding regulations between the investor and the developer of vaccines. In this case, the developer of vaccines is a private company but carries out a public mission. This characteristic must be demonstrated in the upcoming law on the management, research, and development of vaccines, and the new law should encourage investment in private vaccine centers, changing the traditional way of State governance," Prof. Pham Duy Nghia said.
Improve financial backup plan
According to Mr. Nguyen Xuan Thanh, FSPPM Lecturer and member of Prime Minister's economic consultant team, in principle, the funds for research and development of Covid-19 vaccines as well as the purchase, distribution, and vaccination must come from the State's budget. These tasks are also the responsibilities of the State. People pay taxes so that when there is an emergency like Covid-19, the State must roll out a low-cost and free vaccination program for them.
In Vietnam, the recent establishment of the Covid-19 Vaccine Fund reflects the consensus between the State, the people, and businesses, when the people and businesses donate money to the fund for the State to implement a nationwide vaccination program and do other things. There are many private companies that are ready to use their own money to buy vaccines for their employees too. According to Mr. Nguyen Xuan Thanh, the State should be aware that it still bears the main responsibility to buy vaccines for the people.
While most countries in the world, no matter rich or poor, have implemented policies to spend more money to support people and businesses during the pandemic, in Vietnam, people and businesses are willing to donate money to the State. In 2020, although Vietnam had to cope with three waves of Covid-19 outbreaks, the budget revenue was still higher than that in 2019, and even exceeded the revenue estimated for 2020 by 9.1 percent.
Another example of Vietnam's bizarre budget-saving policies in the context of the pandemic cited by Mr. Thanh is the fact that the Ministry of Finance spent 200 million dollars to be prepared to buy vaccines in 2020 on other categories as soon as COVAX announced it was offering 38.9 million doses of Covid-19 vaccines for free.
"The Covid-19 pandemic has helped the central and local governments to cut off a lot of meeting costs. It can completely be a backup fund for an emergency like Covid-19. In order to cope with crises such as natural disasters and pandemics, financial resources must always be ready to be used when something happens," Mr. Thanh said.
According to Mr. Thanh, public investment is not necessarily the establishment of state-owned enterprises or the establishment of projects to receive money from the State's budget for implementation. Public investment can be investments in pharmaceutical firms, private research centers, or universities. In the world, most vaccine manufacturers are private enterprises. Russian and Chinese state-owned vaccine manufacturers also operate under the mechanisms of the market. Therefore, public investment should be understood as sponsoring private innovations and taking the risks of failure.
- Xuan Linh-Thuy Hang