Over the last few days a number of things related to the lockdown in Malaysia happened. First, on Sunday (January 24), a letter was leaked out that was mentioning the possibility of a total lockdown (like the one from March-May 2020) after February 4 (source). On Monday (January 25), Noor Hisham made a surprising comment, which was interpreted by some media outlets as meaning that the current MCO will end on February 4, and it will be replaced by a 3-month CMCO (source). This made me realize how misunderstood the situation was (and continues to be) - not just by the average Malaysian, but by some in the Malaysian media space as well. Additionally, on a regular basis I hear and read comments about how the vaccines are coming and they will save us. Here's how the situation actually looks like - I am warning you in advance, it's not pretty, so if you are feeling particularly optimistic about the future and do not want to have your elevated hopes crushed, please stop reading.

In the past I have written twice about the vaccination campaign and the potential end of the COVID pandemic - first in the beginning of December 2020 here, and then in the beginning of January 2021 here. In my earlier article, I explained why vaccines will not be enough for the population of the world in 2021, even if everything goes according to plan - and many things have not been going according to plan as I will explain below. The Economist Intelligence Unit (EIU) just released a research which shows that the vaccination campaign in India and China may stretch until the end of 2022 (source) while most of the poorer nations won't achieve anything close to herd immunity before 2024 (source). In my latter article, I explained that there are a few major challenges and risks that the campaign for the end of the COVID crisis will face. The risks are:

1) Significant disparity between roll-outs in different regions (even more significant than the current projections are);

2. Faster mutation rates towards a more transmissible variant.

First, it is important to understand why easily transmissible variant is more dangerous, and in fact more deadly in terms of absolute numbers, than a more virulent variant for instance.
This video explains that very well - go to 2 min 30 sec in the video.

By now there are at least a handful of variants of the COVID-19 virus which are considered more transmissible. Of these, the most widespread as of now is the so-called UK variant, named B.1.1.7, which is by now the dominant variant in large parts of the UK, and it is expected to become the dominant variant in big parts of Europe and in the US relatively soon (source, source). There are varying reports, showing this variant to be anywhere between 10% and 70% more transmissible than the current worldwide dominant variants, and recently the UK issued reports that it might also be more deadly - by as much as 30% (source).

The transmissibility of a virus can be determined in two ways. The first sign is based on genomic sequencing of a significant number of the samples that have returned positive. By sequencing the virus variants in these samples, scientists can determine which the dominant variant in an area is. Due to natural selection, the virus variant that is more transmissible becomes the dominant variant over time. The second sign is by estimating the viral load in a sample. The viral load shows the amount of viruses within an area on the swab. The higher the viral load, the more transmissible the virus is. Both of these methods of estimation show that the UK variant is significantly more transmissible. Based on the first sign method, there are currently multiple other variants of concern being carefully analyzed, including a few in the United States (source, source).

3. Virus strain to which the current vaccine versions do not provide effective immunity.

However, while the economic damage the UK variant can bring (and is currently bringing to the UK) can be devastating, it is not the one that is of the most major concern to the scientists around the world. The South Africa variant - B.1.351, and the Brazil variant (in fact a few slightly different variants from the lineage B.1.1.28), are more worrisome. These two variants of the virus appear to be able to escape at least partially the immunity created towards older variant of the virus on which all the currently available vaccines have been developed (source). That is the reason why vaccine makers started reworking their vaccines urgently (source).

The vaccines produced by Moderna and Pfizer are based on a technology that could potentially be adjusted more easily towards new mutations of the virus. For instance, BioNTech has said that it can change its vaccine within 6 weeks (source). Unfortunately, that is not the case with the technology utilized by the rest of the vaccine manufacturers, and Pfizer + Moderna have currently existing contracts for delivery of a little more than 1.2 billion doses sufficient for 600 million people, based on Bloomberg data referenced above.

4. Fear from vaccines' side effects.

In my article from Devember, I shared some researches that showed unwillingness of people to get vaccinated, especially in Europe. The researches were conducted in June (source), July-August (source), and September (source) 2020. According to some more recent studies, things haven't changed much. In fact, the willingness to vaccinate has dropped in all the surveyed country except for the United States between October and December 2020:

(Source)

Even more worrisome, only in Brazil more than 50% of the people have responded with "Strongly Agree":

(Source)

5. Vaccine production problems and setbacks.

Pfizer and AstraZeneca announced delays in their deliveries to the EU and Canada, prompting a number of European countries to threaten legal action (source, source, source, source, source, source).

We should be reminded that these are the early stages of the vaccination campaign, and such problems are expected. However, as the campaign rolls out globally and delivery logistics become even more complicated, things may turn even more worrisome if quick measures are not taken.

Of more concern may be another problem which has resulted in Sweden pausing payments to Pfizer (source). Without going into unnecessary details, the problem stems from the fact that initially each vial of Pfizer's vaccine was expected to contain 5 doses of the vaccine. However, later on it was discovered that 6 doses could be extracted from each vial with the usage of a special syringe called "low dead volume syringe". Pfizer has managed to persuade regulators in the US and in the EU that 6 doses are available per vial, and the company delivers vials based on the 6-dose presumption. In other words - less vials are expected to be delivered than initially planned (source). Unfortunately, the low dead volume syringes are in short supply, and even their biggest producer - the United States, cannot source enough (source).

6. Vaccine tests problems.

In my article from December I mentioned the failed Sanofi/GSK vaccine trials (source). Unfortunately, just 2 days ago Merck also discontinued its vaccine program due to insufficiently strong immune response post-vaccination (source).

At the same time, many questions remain regarding the Russian Gamaleya vaccine, as insufficient trial test data has been provided (source). The Sinovac vaccine showed different efficacy rates in different trials, varying from 50.4% in the Brazil trial (source) to 91.25% in the Turkey trial (source), raising questions.

Conclusion

I consider myself a realist. I like to refer to data and information before making decisions. Unfortunately the existing data is darker than what I have expected. 2021 appears to be going to be economically more damaging than initially predicted due to the more contagious variants of the virus, requiring stricter lockdowns for longer periods of time (or alternatively - a complete halt of international travel). The vaccination campaign is so far not going according to plan, and especially the EU is lagging significantly behind its plans, while the US only sped up with the coming to power of Joe Biden last week. Developing, populous countries are not expected to have their vaccination campaign done before 2022-2023, while third-world countries are looking for a timeline sometimes beyond 2025, while at the background the virus mutates to variants that escape the previously acquired immune response. It will be best if we all prepare ourselves for the long haul.

Important disclaimer: Any views expressed are for informational and discussion purposes only. None of this information is intended as, and must not be understood as, a source of advice. It is imperative that you always do your own research and that you make any decisions based on your personal situation and your own personal understanding.