AstraZeneca and the University of Oxford acknowledged a manufacturing error on Wednesday that is raising questions about the preliminary results of its experimental vaccine against COVID-19, which is the one to be packaged in Mexico.

The statement describing the error came days after the company and the university described the injections as “highly effective” and failed to mention why some study participants did not receive the full vaccine dose in the first of the two injections that were applied to them.

Surprisingly, the group of volunteers who received one lower dose appeared to be much better protected than the volunteers who received two full doses.

In the low-dose group, AstraZeneca said, the vaccine appeared to be 90 percent effective . In the group that received two full doses, the vaccine appeared to be 62 percent effective . Combined, the drug manufacturers said the vaccine appeared to be 70 percent effective . But the way in which the company and the university arrived at the results and reported them has led to specific questions from the experts.

The partial results announced Monday come from large ongoing studies in the UK and Brazil designed to determine the optimal vaccine dose, as well as examine safety and efficacy. Multiple combinations and doses were tested in the volunteers. They were compared to others who received a meningitis vaccine or a saline injection.

Do the researchers want to give half a dose?

Before beginning an investigation, scientists detail all the steps they are taking and how they will analyze the results. Any deviation from that protocol can cast doubt on the results.

In a statement issued Wednesday, the University of Oxford said that some of the vials used in the trial did not have the appropriate concentration of vaccine, so some volunteers received half doses. The university said it discussed the problem with regulators and agreed to complete the last stage of the trial with two groups. The manufacturing issue has been corrected, according to the statement.

Experts say the relatively small number of people in the low-dose group makes it difficult to know whether the observed efficacy in the group is real or a statistical quirk. About 2,741 people received a half dose of the vaccine followed by a full dose, AstraZeneca said. A total of 8,895 people received two full doses.

Another factor: none of the people in the low-dose group were over 55 years old. Younger people tend to elicit a stronger immune response than older people, so it could be that the youth of the participants in the low-dose group was the reason it looked more effective, not the size of the dose.

Another point of confusion comes from the decision to pool the results of two groups of participants who received different dosage levels to achieve an average effectiveness of 70 percent, said David Salisbury, associate member of the global health program in the expert group of Chatham House.

“He has taken two studies that used different doses and created a compound that does not represent either dose,” he said of the figure. “I think a lot of people are having a problem with that.”

Why would a smaller first dose be more effective?

The Oxford researchers say they are not sure and are working to find out why.

Sarah Gilbert, one of the Oxford scientists leading the research, said the answer is likely related to providing exactly the right amount of vaccine to trigger the best immune response.

I think it’s the amount of Goldilocks you want, not too little, not too much. Too much could also give you a poor quality response, ”he said. “So you want just the right amount and it’s a bit hit and miss when you’re trying to go fast to get the perfect first time.”

Details of the trial results will be published in medical journals and provided to UK regulators so they can decide whether to authorize distribution of the vaccine.

Those reports will include a detailed breakdown that includes demographic and other information about who got sick in each group, and will provide a more complete picture of how effective the vaccine is.

Moncef Slaoui, who leads America’s coronavirus vaccination program, Operation Warp Speed , said Tuesday in a call with reporters that U.S. officials are trying to determine which immune response the vaccine produced and may decide to modify the AstraZeneca study in the United States to include half doses.

“But we want it to be based on data and science,” he said.

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As COVID-19 has spread around the world, it has challenged preconceptions about which places would best address the worst public health crisis in a generation.

Advanced economies like the United States and the United Kingdom , ranked by various pre-2020 measures as the most prepared for a pandemic, have repeatedly been overwhelmed by cases and face a return to costly shutdowns.

Meanwhile, other countries, including developing nations, have defied expectations, some having nearly eliminated the pathogen within their borders.

Bloomberg analyzed the numbers to determine the best places to be in the coronavirus era – where has the virus been most effectively managed with the least amount of disruption to business and society?

The COVID Resilience Ranking scores savings of more than $ 200 billion on ten key metrics: from virus case growth to overall death rate, testing capabilities, and vaccine supply agreements places have wrought.

The capacity of the local health system, the impact of restrictions related to the coronavirus, such as economic blockades, and the freedom of movement of citizens are also taken into account.

The result is an overall score that is a kind of snapshot of how the pandemic is developing in these 53 places right now.

By rating your access to a coronavirus vaccine, we also provide a window into how the fortunes of these economies may change in the future.

It’s not a final verdict, nor could it be with flaws in the virus data and the accelerating pace of this crisis, which has seen subsequent waves confuse places that handled things right the first time.

Circumstance and sheer luck also play a role, but they are difficult to quantify.

The Ranking will change as countries change their strategies, the climate changes and the race intensifies for a viable vaccine.

Still, the gap that has opened up between economies above and below will likely endure, with potentially long-lasting consequences in the post-COVID world.

Ranking of the countries with the best management of COVID-19:
Country Bloomberg COVID Resilience Score

1. New Zealand 85.4
2. Japan 85
3. Taiwan 82.9
4. South Korea 82.3
5. Finland 82
6. Norway 81.3
7. Australia 81.2
8. China 80.6
9. Denmark 77
10. Vietnam 74.3
11. Singapore 74.2
12. Hong Kong 73.6

13 Canada 73.2

1. Germany 71.2
2. Thailand 70.2
3. Sweden 68.7
4. United Arab Emirates 67.5
5. United States 66.5
6. Indonesia 66.1
7. Ireland 65.1
8. Israel 65
9. Russia 65
10. Netherlands 64.4
11. Bangladesh 64.2
12. Egypt 63.2

26.Switzerland 62.3

1. Pakistan 61.7
2. UK 61.5
3. Malaysia 61.4
4. Turkey 60.6
5. Greece 59.9
6. Saudi Arabia 59.6
7. Portugal 59.2
8. India 58.1
9. South Africa 57.8
10. Austria 56.3
11. Brazil 56.2
12. Chile 55.9
13. Iraq 54.9
14. Italy 54.2
15. Spain 54.2
16. Nigeria 53.9
17. Romania 53.6
18. Poland 52.2
19. France 51.6
20. ​​Philippines 48.9
21. Iran 48.7
22. Colombia 48.1
23. Czech Republic 46.8
24. Belgium 45.6
25. Peru 41.6
26. Argentina 41.1
27. Mexico 37.6

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Better performance
New Zealand tops the rankings as of November 23 thanks to swift and decisive action.

The small island nation began taking action on March 26 before a single COVID-19-related death occurred, closing its borders despite the economy’s heavy reliance on tourism.

At first, Prime Minister Jacinda Ardern’s government said it would aim for the “elimination” of the virus, investing resources in testing, contact tracing and a quarantine, all as a strategy to ‘turn off’ local transmission.

Having largely succeeded, New Zealanders basically live in a world without the disease caused by SARS-COV-2. The nation has seen only a handful of infections in the community in recent months, and live music and large-scale social events are back.

Although its tourism industries are suffering, New Zealand is also well positioned for a vaccine with two supply agreements, including one for the injection developed by Pfizer and BioNTech of Germany.

Second is Japan , which charted a different path. Legal means were lacking to enforce a blockade, but other strengths emerged quickly.

Due to tuberculosis outbreaks in the past , the country has maintained a public health center system with contact markers that were quickly reassigned to treat COVID-19.

High levels of social trust and compliance meant that citizens proactively wore masks and avoided crowded places.

Although you are now seeing a record increase in infections as winter approaches, the nation of more than 120 million people has only 331 severe cases of COVID-19 today; France, with a population half the size, has nearly 5,000 virus patients in intensive care.

Japan’s ability to avoid fatalities despite having the oldest population in the world pushed it higher, as did its foresight by closing four vaccine deals, including the top two candidates that use revolutionary mRNA technology.

The success of Taiwan , which ranks third, is even more remarkable when considering its ties to mainland China, where the virus first appeared last December.

Networks broadcasting troubling news from Wuhan allowed Taiwan to act early to restrict entry into its borders. The island then pioneered a technology-centric approach to rallying its 23 million people to protect itself: launching apps that detail where masks are in stock or list the locations where infected people have been .

More than 200 days have passed without a case of the locally transmitted virus and, as in New Zealand, life has largely returned to normal, although the borders remain closed.

However, Taiwan so far has not signed any bilateral agreements for the most advanced vaccines.

Fast reaction
Many in the ‘top 10’ pioneered and modeled what have emerged as the most effective strategies to fight COVID-19. Border control has been a key element, beginning with China’s original sanitary cordon around Hubei province, which largely protected the rest of the country from infection.

The economy where this crisis began is the largest of the best performing ones , with massive tests implemented at the first sign of new cases and a mandatory 14-day quarantine for travelers.

China’s propensity to impose aggressive lockdowns in regions where medical or tracking resources are scarce is a handicap.

The three Nordic nations in the top ten seats reflect how border control has been used effectively in Europe.

Finland and Norway have blocked entry to most foreigners since mid-March, although they are part of the Schengen area without a passport from Europe.

The top-ranked European nations managed to avoid the resurgence that now engulfs countries like France, Britain and Italy caused in part by summer vacation travel.

Effective testing and tracing is a hallmark of almost all of the top 10, built into the South Korean approach.

The country approved self-made diagnostic kits within weeks of the virus’ outbreak, pioneered test stations, and has an army of ultra-fast contact trackers who review credit card records and camera footage. surveillance to track groups.

Like Japan, Pakistan and other parts of Asia, Korea has built on the recent epidemic experience after suffering an outbreak of the Middle East respiratory syndrome, or MERS, in 2015.

The experience of the 2003 SARS outbreak, which involved a similar coronavirus, helped East and Southeast Asia this time, noted Helen Clark, who was New Zealand’s prime minister at the time.

“They had plans and they knew about contact tracing and isolation and so on,” he said in an interview. “That experience was etched in his memories.”

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The magic formula?
COVID-19 has permeated nations in different ways.
COVID-19 has permeated nations in different ways. Bloomberg
The poor performance of some of the world’s most prominent democracies, including the United States, the United Kingdom, and India , in contrast to the success of authoritarian countries such as China and Vietnam , has raised questions about whether democratic societies are prepared to deal with the challenges. pandemics.

The Bloomberg COVID Resilience Ranking tells a different story: Eight of the top 10 are democracies . Success in containing the SARS-COV-2 virus with the least disruption appears to depend less on being able to order people to submit, but on governments generating a high degree of trust and social compliance.

When citizens have faith in the authorities and their guidance, closures may not be necessary at all, as evidenced by Japan, Korea and, to some extent, Sweden . New Zealand emphasized communication from the start, with a four-tier alert system that gave people a clear picture of how and why the government would act as the outbreak evolved.

Investment in public health infrastructure is also important.

Underestimated in many places before 2020, contact tracing systems, effective testing, and health education bolstered the best, helping to socialize handwashing and wearing face masks.

This has been key to avoiding financially crippling lockdowns, said Anthony Fauci , America’s top infectious disease official.

Social cohesion has been an important differentiating factor in this pandemic, noted Alan López, award-winning professor and director of the global burden of disease group at the University of Melbourne.

“If we look at Japanese society, Scandinavian societies, there is very little inequality and a lot of discipline in them,” said López. “That would translate into a more cohesive response from the country and that’s why they are at the top.”

Advantage of the vaccine
The lack of an effective response to the virus by the United States has been one of the most startling developments in the pandemic.

The superpower leads the world in cases and deaths, and its reaction to the crisis has been delayed from the start, from a shortage of medical equipment and supplies, to a lack of coordination in testing and tracing efforts and the politicization of the use of More expensive.

Instead, the administration of outgoing President Donald Trump has focused primarily on treatments and vaccines. Some $ 18 billion was allocated to dose developers to accelerate their work on an initiative known as Operation Warp Speed , even as states asked for financial help to tackle the crisis.

This singular approach propelled the United States up the Bloomberg rankings: The growing burden of cases and the increase in deaths means that it would otherwise be 11 notches lower. The extraordinary efficacy of the experimental mRNA vaccines, which could be licensed for emergency use in the United States starting next month, may mark a turning point there.

While some other places also have agreements with the same number of vaccines, the US has ordered the most doses in the world, more than 2.6 billion , according to potential and finalized supply agreements followed by researchers at Duke Global Health. Innovation Center. Still, monumental challenges remain in vaccine distribution across the country.

“In the case of the US, the only thing they have done well is that they have financed more R&D, not only for companies based in the country, but for companies around the world,” explained Bill Gates at the New Economy Forum. from Bloomberg this month. “That was a good thing. That was a boon to the world. America is at the back of the pack.”

Canada is also bolstered by its focus on vaccines , signing supply agreements with five different injections in the final stages and ensuring sufficient doses for many times its population.

The European Union , which is forging agreements on vaccines as a bloc, has three agreements finalized.

China also scores high on access to vaccines, although its deals are largely with its own local developers, who have provided comparatively less information on the effectiveness of its injections than some Western companies.

In the battle of the superpowers, China has practically eliminated the virus within its borders, but scores lower than the United States on the pre-pandemic universal health coverage indicator , which measures the effectiveness of a health system.

Overall, the COVID Vaccine Access indicator reflects the enduring power of the rich and great nations, even if some have failed to contain the virus.

Smaller developing economies that have struck deals have done so largely by offering to host clinical trials and vaccine manufacturing.

“The big countries have made sure to be first in line, sometimes with extremely comprehensive measures,” Singapore Prime Minister Lee Hsien Loong said this month. “I can understand that political urgency. I think it is a reality that they will get away with it. “

Outliers and surprises
Countries have taken different measures regarding the pandemic.
Countries have taken different measures regarding the pandemic. Bloomberg
Bloomberg’s COVID Resilience Ranking exposes some uncomfortable truths for nations that were once considered the most advanced in the world. As of November 23, major European countries such as the UK and France are in the lower half of the list.

Connectivity has emerged as a curse in the era of the pandemic, with global travel hubs and world cities like London, New York, and Paris becoming epicenters where infections were first seeded by travelers from elsewhere.

Places like Thailand and Singapore that have travel and tourism have seen bigger blows to their economies.

By contrast, developing countries such as Pakistan and Bangladesh have benefited from their relative remoteness. Their populations are also much younger on average, which has helped keep their overall death rates low. Limited evidence and poor quality data obscure the picture in these places, although case and death reporting is happening everywhere.

Western Europe is now in the midst of a fierce wave that has forced governments to impose new blockades. Containment achieved in the spring was undone as restrictions were eased, allowing vacationers to re-seeding the virus.

Belgium has the worst overall death rate of the 53 economies after the virus swept through nursing homes. This position stems from the decision to record all nursing home deaths at the height of the first outbreak as related to COVID-19, even without an official diagnosis through testing.

The UK, Italy and France have seen cases and deaths skyrocket in recent months, and France’s tighter lockdown has pushed it down the Ranking.

France’s positive test rate increased to more than 20 percent in early November from around 1 percent in July. After imposing a new lockdown on October 30, the rate fell below 12 percent as of November 23.

Sweden, which was originally singled out for avoiding lockdowns , now scores relatively high on almost all Bloomberg metrics, ranking 16th overall.

After an initial wave of deaths among older people, that country’s performance on the indicators reflects fewer cases, deaths and fewer disruptions than in other parts of Europe.

A less disruptive approach is more sustainable in the long term, said Hitoshi Oshitani, professor of infectious diseases at Tohoku University and a key architect of such a strategy in Japan.

“I don’t think this virus will disappear in the next few months, and probably in the next few years, so we have to find the best way to live with it,” Oshitani said in an interview.

The poverty trap
While they may have been wrong about the insidious nature of the virus, advanced economies such as the US and Germany have seen their testing ability and that of doctors to prevent COVID-19 deaths improve over time.

These advantages do not exist in Latin America, the region most devastated by the pandemic. It occupies the bottom half of the Ranking, with Mexico in the worst of 53.

The latest positive test rate available in the country is a whopping 62 percent, suggesting that undetected infection is widespread.

Mexican officials have acknowledged that the death toll in the country is likely significantly higher than official data, due to limited evidence.

Brazil, site with the third largest outbreak in the world after India, ranks 37th.

Like Trump, the threat of coronavirus has been repeatedly downplayed in several Latin American nations.

This “arrogant” leadership approach, coupled with the lack of social safety nets and strong public health systems, has worsened the crisis, said Cynthia Arnson, director of the Latin American Program at the Wilson Center for Studies in Washington DC.

Latin America is the most urbanized region in the world and a large part of the population lives in crowded conditions where social distancing is difficult. The high proportion of people who depend on informal work and daily wages means that few are willing to stay at home.

“Large disparities between public and private healthcare have reached the region, as have other forms of inequality, including education,” Arnson stated.

Most Latin American countries will not be able to return to pre-pandemic growth levels until 2023 and per capita income will not recover until 2025, later than anywhere else, noted the International Monetary Fund (IMF).

Although attention has focused on the shock in developed countries, the impact of the pandemic in emerging economies is likely to be longer and more sustained.

In India, decades of social and economic progress have disappeared as children are taken out of school to work, and the discriminatory caste system looms again as jobs become scarce in cities.

The pandemic will widen the gap between rich and poor nations, with up to 150 million people pushed into extreme poverty by the end of next year. This will delay progress in reducing poverty by three years, according to the World Bank.

In places like sub-Saharan Africa, the crisis has a long trail.

“We are seeing that in Africa there are many more deaths from the interruption of primary health care, including vaccination. That has created a greater number of victims than what the coronavirus has actually caused, ”said Bill Gates, who also pointed to the disruption in education as a major setback.

“We need to rebuild in those countries and we need to kick-start innovation. It is, I would say, a setback of at least three or four years for Africa ”.

Whats Next?
Winter, vaccines, virus mutation: the outlook for the pandemic remains uncertain in 2021 and beyond.

Still, after enduring a year of fighting COVID-19, governments and populations now have a better understanding of the pathogen, the best way to slow its spread and mitigate the damage it inflicts.

As the data changes in the coming months, the Bloomberg COVID Resilience Ranking will also change; we will update the image as it evolves.

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How was the Bloomberg COVID Resilience Ranking designed?

Everyone is fighting the same coronavirus, but almost a year after the pandemic started, the quality of life and control of the spread of the pathogen look vastly different around the world. The COVID Resilience Ranking ranks the 53 largest economies based on their success in containing the virus with the least possible social and economic disruption.

We consider many data sets, indicators and indices produced by organizations around the world and apply three fundamental criteria to narrow the list to the 10 components of our Ranking:

How complete is the data?

Many relevant indexes and databases, for example measures of trust in government, cover only a small number of places. We focus on indicators that cover the vast majority of the 53 economies in the Ranking, filling in the gaps with substitutions where reasonable.

How up to date is the data?

All data sets are lagging, some up to a few years. Due to the pace and transformational impact of the pandemic, we chose to use the most up-to-date data sets where possible, with a maximum delay of one year. Seven of our indicators are updated daily, one is updated quarterly and two are annual figures.

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