♦ Updated daily ｜Taiwan’s Covid-19 Outbreak

For the past month, Taiwan’s 23 million people have been on an emotional roller coaster hinging on two daily statistics.

One of them is the number of COVID-19 deaths. There were 508 COVID-19 deaths in June, an average of 19 deaths every day, exceeding accidental deaths, the sixth-leading cause of death in Taiwan.

The second one is the number of vaccine doses delivered. The 3.74 million doses donated by the U.S. and Japan have gradually found their way into people’s arms, allowing many senior citizens to finally join the ranks of the vaccinated. Still, the supply is too thinly spread.

Accordingly, Yen Po-wen, chief executive officer of the Tzu Chi Foundation, having just put in an order for five million doses of the Pfizer-BioNTech vaccine, relates that Tzu Chi’s goal is to allow junior high school and high school students to be vaccinated without taking from public funding for adult vaccinations.

(Source: Chien-Tong Wang)

The reason for the selection of Pfizer-BioNTech is that it is currently the only vaccine that has passed clinical trials around the world, and can also be given to everyone from age 12 and up.

Yen relates that the Delta variant currently making its way through Taiwan is highly infectious among young people, prompting fears that “once students return to school after the summer vacation, community spread is likely.”

That people are scared, angry, and even taking things into their own hands, is due to a frustrating reality.

The government ordered around 20 million doses of vaccines from AstraZeneca, Moderna, and Covax, yet only around one million doses have been received to date.

What is the hold up?

Given the mild degree of the pandemic at first in Taiwan, the government did not take a proactive enough attitude, placing orders too late and spending too little. Still, most countries around the world have faced similar situations to Taiwan in recent months as they wait for vaccines to arrive.

Bottleneck #1: Vaccine newbies lead development, hit production snags

The fluctuations of one statistic are revealing. According to March Vaccine Supply Report projections from the IFPMA and CEPI, if all goes smoothly, global vaccine production could exceed 14 billion doses. However, those agencies lowered their projections in May to just 11 billion doses.

An unexpected gap developed over a two-month period due to various reasons, including raw material shortages to the supply chain, insufficient production equipment, and an excessive production quality failure rate.

At the root of all these issues lies a gigantic scientific achievement.

AstraZeneca, Pfizer-BioNTech, and Moderna took just 11 months to bring their respective COVID-19 vaccines to market, potentially saving hundreds of millions of lives.

“Never in human history have vaccines been developed so quickly. Even the flu vaccine took a full 18 years to develop,” wrote Rafael Vilasanjuan, a Spanish public health expert and board member of the GAVI Vaccine Alliance, in a paper.

The problem is that all three of these companies are new to the vaccine industry.

BioNTech and Moderna are startups, and while AstraZeneca is a major pharmaceutical maker, the company obtained the vaccine technology through Oxford University and had never made its own vaccine before.

(Source: Shutterstock)

Jerome Kim, director general of the International Vaccine Institute (IVI) and a member of the WHO’s Product Development for Vaccines Advisory Committee (PDVAC), relates that the first to take up development of COVID-19 vaccines were not conventional vaccine producers like Sanofi or Merck, but R&D-oriented companies. Accordingly, this has posed considerable challenges to reaching full volume production.

Jerome Kim, director general of the International Vaccine Institute (IVI) and a member of the WHO’s Product Development for Vaccines Advisory Committee (PDVAC). (Source: International Vaccine Institute)

Raw materials are an even more difficult issue. In the past, influenza vaccines accounted for the largest volume of global annual vaccine production, at around three to five billion doses per year. However, the demand for COVID-19 vaccines is three to four times that.

The supply chain was unable to keep up right from the start, as every type of key raw material experienced shortages, including the specialized glass vials and plastic bags used to contain vaccines, as well as biological raw materials.

Moreover, there are also some brand new challenges. The Pfizer-BioNTech and Moderna vaccines utilize completely new mRNA technology. However, as mRNA is quite fragile, it must be packaged in a layer of lipid nanoparticles (LNP) before being injected into a human body.

A year ago these lipids, tremendously difficult to manufacture, were produced by the gram over the course of an entire year, whereas now the LNP demand for Pfizer-BioNTech’s vaccines alone is in the tons.

Bottleneck #2: World’s biggest plant in India at under 20 percent

Taiwan’s vaccine drought is largely related to AstraZeneca. Of 20 million doses sourced outside Taiwan, AstraZeneca accounts for half. Yet only 120,000 doses have been delivered to date.

The problem emerged with AstraZeneca's biggest contract manufacturer, the Serum Institute of India, which is also the world’s largest vaccine maker.

According to a Bloomberg report, the Serum Institute promised to supply 400 million doses late last year, only to be fraught with issues. By early 2021 it had only delivered  70 million doses.

Next, due to the seriousness of the pandemic in India, the government there has instituted a direct ban on vaccine exports. It is generally forecast that the interdiction could remain in place through the end of the year.

The United States is the world’s second-largest vaccine manufacturing country. According to statistics from the Wall Street Journal, through May the U.S. had manufactured 330 million COVID-19 vaccine doses. However, due to the severity of the pandemic domestically, it has kept nearly all of the supply for its own use.

This gave China the upper hand in vaccine diplomacy, exporting 250 million doses over the first half of the year.

Still, as the U.S. vaccination rate among adults nears 70 percent and the country steadily leaves the pandemic behind, the situation is turning around.

In early June, a U.S. military C-17 transport plane touched down at Taipei’s Songshan Airport. Three U.S. senators emerged from the cabin.

It heralded Taiwan’s largest vaccine delivery to date, 2.5 million doses of the Moderna vaccine donated by the U.S. government.

Starting from Taiwan, the U.S. began hitting back at China, embarking on a global strategic-level vaccine diplomacy campaign.

At the June G7 summit, the United States and other major industrialized nations reached a consensus, agreeing to donate one billion vaccine doses within the next year.

Jerome Kim says that although vaccine diplomacy may not be the best way for the world to achieve herd immunity, "it can certainly help Taiwan get vaccines more quickly.”

(Source: AP)

Concurrent with the launching of vaccine diplomacy, the United States also lifted its embargoes on the export of domestic vaccine raw materials. This resolved supply chain cuts, enabling overseas pharmaceutical companies to go full speed ahead with production.

An upstart has joined the fold in the second half of the vaccine competition.

The highly anticipated Novavax, developed in the U.S., is expected to receive approval and hit the market in the third quarter of the year. The company plans for monthly production volume to reach 150 million doses.

Japan, Korea enter contract manufacturing; set to triple monthly production capacity in the second half

Including Samsung Biologics (producing for Moderna), SK Biopharmaceuticals (producing for AstraZeneca and Novavax), Takeda Pharmaceutical of Japan (producing for Moderna and Novavax), more and more companies are coming aboard for contract manufacturing to boost production capacity, the industry optimistically anticipates a surge in global vaccine supplies during the second half of the year.

IFPMA relates that as of the end of May, only 2.2 billion COVID-19 vaccines had been manufactured globally. However, the foundation projects that global production volume could reach 8.8 billion doses over the next seven months, nearly tripling the previous average monthly production volume.

With this in mind, minister of health and welfare Chen Shih-chung stated that the likelihood of reaching projected delivery of 10 million doses (including one million via domestic production) by the end of August is increasingly high. Moreover, if the 5.88 million previous doses are factored in (including donations from the U.S., Japan, and Lithuania), nearly 70 percent of Taiwanese adults will be able to receive one vaccine dose during the second half.

American vaccines are expected to become Taiwan’s mainstream.

In addition to the 2.5 million doses donated by the U.S. government, Taiwan also purchased Moderna vaccines, two shipments of which were received in late May and June, for a total of 390,000 doses.

(Source: Pei-Ying Hsieh)

Also, while Taiwan has not yet imported Pfizer–BioNTech vaccines, Hon Hai, TSMC, and the Tzu Chi Foundation have ordered a combined 15 million doses of that variant. If all goes well, it will become Taiwan’s mainstream vaccine in the future.

Why did these three choose Pfizer-BioNTech? Yen Po-wen explains that because it offers relatively good protection, “it is more likely to be purchased,” and Tzu Chi is “happier with its delivery schedule and production volume.”

Tzu Chi hopes that middle school students can receive a vaccine before school starts in order to avert community spread. In other words, delivery of the vaccines must be taken by the end of August at the latest.

And perhaps it will become clear soon when Taiwan can achieve herd immunity.

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Translated by David Toman
Edited by TC Lin
Uploaded by Penny Chiang