The world’s attention has been focused on the development and fair distribution of COVID-19 vaccines. However, financial contributions to the COVAX initiative, a global coordinated effort to promote the development of COVID-19 vaccines and ensure fair allocation of the vaccines, has been unsuccessful to reach its target amount.

Last week, the WHO made a last-ditch effort to encourage countries to participate in the COVAX initiative. But its success seems unlikely, given that only two days are left (31 August 2020) to the deadline for submitting expressions of interest. As of 24 August, only 10 countries of the G20 submitted their intent to participate in the initiative. Many lament this poor international cooperation. The root of this disappointment may be the belief that once we develop vaccines and allocate them fairly across the globe, we can end the pandemic. However, are the development and equal distribution of vaccines everything that are needed to overcome COVID-19? Perhaps not. We might face another set of challenges, after we develop and distribute vaccines.

1. Who is responsible for overseeing and regulating the distribution of vaccines?:      In the initial stage, COVAX is planning to vaccinate 20 per cent of the most vulnerable population (including health workers and the elderly) in every member state. However, it is unclear who has responsibility for overseeing whether distributed doses are delivered to the target population. Corruption in the process of allocating vaccines can happen in both richer and poorer countries, because many more people are in need of vaccines.

In particular, it is important to oversee the distribution of vaccines in developing countries, because if there is injustice in the distribution of vaccines in these countries, it may increase a pessimistic view among the donor countries in helping poorer countries with free access to vaccines or a chance to buy them at a lower price. Hence, the outcome of global vaccine cooperation in this pandemic may influence the decision of countries when a similar need for global vaccine cooperation may arise in the future.

However, it is unclear who will take the responsibility to ensure the fair and appropriate distribution of doses to the target population. As we have witnessed in this pandemic, the WHO has not been given enough authority to regulate the behaviours of its member states. GAVI, a co-convener of the vaccine pillar of the WHO’s Access Tool, provides COVAX Facility with administrative work, but it is unclear whether GAVI has the responsibility to oversee the allocation of vaccines in each country.

2. Do we have ideas to address hesitancy toward COVID-19 vaccines?:      Perhaps, there are two types of scepticism in relation to COVID-19 vaccines. On the one hand, people have lower trust in vaccines itself, and believe that vaccines cause rather harmful effects on health. This type of vaccine scepticism has been a major barrier for vaccination of children in many countries. For example, in Pakistan, there is a wide range of public resistance to polio vaccine, despite proving the effectiveness and safety of the vaccine. People who share this kind of vaccine hesitency may be more likely to reluctant to be vaccinated, even if they have access to COVID-19 vaccines.

On the other hand, there are concerns regarding the safety of COVID-19 vaccines. According to the survey conducted by King's College London, only 53 per cent of Britain's population are willing to have a COVID-19 vaccine. The survey found that there are broad concerns among the UK population about the safety of COVID-19 vaccines. At least, for now, I share their opinion. I have asked myself a question: if I was told tomorrow morning that COVID-19 vaccine has been developed and I was chosen to be vaccinated, would I be willing to take a shot? Maybe not (again, at least, for now). I may hesitate, due to concerns regarding the safety of the vaccine.

It seems that people distrust the safety of COVID-19 vaccines because of their unprecedented nature and the hastiness in their development. It typically takes 10 years to confirm the safety and efficacy of a vaccine. However, in less than a year since the pandemic began, as of 27 August, 44 vaccine candidates have already entered clinical trials, and 4 of them have been under Phase III trial. These fast-tracked vaccine developments may increase the possibilities that their side effects may not have been examined in a detailed manner. Or, the safety issues of vaccines would be ignored for political reasons, as can be seen in the event where the Russian government approved a vaccine without completing Phase III trial, arguably, to becme the first country to devlope a COVID-19 vaccine.

It has widely been understood that we cannot end the pandemic, unless everyone is safe. However, could we blame people who hesitate to take a vaccine for safety reasons? Or, do governments have a right to force these people to be vaccinated, to protect others? These are difficult questions. Vaccine scepticism and hesitancy could be serious barriers in responding to the pandemic. Addressing them is as important as the development and fair allocation of vaccines.

The leaves of the tree outside my window, which was bare in March when the lockdown started, has begun to fall. Time has passed, but we still have many challenges to address, and the end of the pandemic is still far away.