- Vaccine announcements get the globe closer to eradicating the virus, but questions still remain.
- Business leaders will need to consider a range of potential scenarios for access and distribution to adjust to the changes still ahead.
- For business planning only, Salesforce Future Lab developed a selection of hypothetical scenarios in discussions with leading experts to help leaders understand the range of scenarios for which they might need to plan.
Recently, Pfizer and Moderna reported preliminary results from their phase 3 COVID-19 vaccine trials to be at least 95% effective in preventing coronavirus illness. A third vaccine, from AstraZeneca, is reportedly also highly effective. With this news, the range of uncertainties has narrowed for business leaders and a potential end to the crisis has come more clearly into view.
Still, many questions remain and in my nearly 50 years of scenario planning, I’ve never seen uncertainty like that which has arisen from the COVID-19 pandemic. Leaders are in need of guidance as to how to plan for the months ahead. Salesforce has been tracking the many uncertainties surrounding COVID-19 since March and developed a range of scenarios that clarify a selection of key possible outcomes and help show the range of possibilities leaders must keep in mind. Considering potential uncertainties and outcomes can help any company make clear-eyed choices during a time of great change.
What is the World Economic Forum doing about the coronavirus outbreak?
Responding to the COVID-19 pandemic requires global cooperation among governments, international organizations and the business community, which is at the centre of the World Economic Forum’s mission as the International Organization for Public-Private Cooperation.
Since its launch on 11 March, the Forum’s COVID Action Platform has brought together 1,667 stakeholders from 1,106 businesses and organizations to mitigate the risk and impact of the unprecedented global health emergency that is COVID-19.
The platform is created with the support of the World Health Organization and is open to all businesses and industry groups, as well as other stakeholders, aiming to integrate and inform joint action.
As an organization, the Forum has a track record of supporting efforts to contain epidemics. In 2017, at our Annual Meeting, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched – bringing together experts from government, business, health, academia and civil society to accelerate the development of vaccines. CEPI is currently supporting the race to develop a vaccine against this strand of the coronavirus.
Pillars of uncertainty
1. Vaccine availability
Questions on availability are closer to being resolved, as several early candidates could be well-poised to receive emergency authorization. Still, authorization is a key next step. In addition, there are at least a half dozen other vaccines in development that have entered final (phase 3) trials. Like the candidates from Pfizer, Moderna and AstraZeneca, many of these other candidates focus on a spike protein, the clubbed part of the virus' surface that penetrates human cells, potentially boding well for others in that cohort.
2. Vaccine effectiveness
With a novel pathogen, epidemiologists can’t predict how long immunity will last in individuals. A vaccine that lasts just a few months is barely useful, while one that lasts a year is much more so.
Two-year immunity is on the high end of expectations, since coronaviruses are “notoriously famous for not granting durable immunity,” in the words of Michael T. Osterholm, the head of the Center for Disease Research and Policy (CIDRAP) at the University of Minnesota.
Also important to containing the pandemic is whether a vaccine prevents infection or only illness. A vaccine that prevents only against illness will not stop the virus’ spread. “We have to be very, very careful in making assumptions,” said Osterholm.
3. Vaccine hesitancy
Vaccine hesitancy was a widespread problem even before COVID-19 – and was named of the World Health Organization’s (WHO) top global health threats in 2019. In fact, around 45% of Americans in one recent poll said they wouldn’t seek out the coronavirus vaccine if it were available. Herd immunity could require 60-80% of the global population to receive an effective vaccine, and some leaders, such as Pfizer CEO Alberta Bourla, warn that people who don’t take the vaccine could be the “weak link” that allows the virus to continue to spread.
Side effects could create other challenges. Dr. Larry Brilliant, an epidemiologist and CNN medical analyst noted that rare but dangerous side effects will not be discovered with only 30-40,000 people trials. With typical rates of vaccine injury at roughly one per million, phase 3 trials could miss a problem that crops up at a rate of one per hundred thousand, further contributing to vaccine hesitancy and anti-vaccination sentiment.
4. Vaccine distribution
The challenge of vaccine development is matched only by the incredible complexities of production and distribution. Since COVID-19 emerged last December, groups from the WHO to the National Governors Association in U.S. have focused on key questions, such as: how will it be quickly and efficiently delivered and dispensed? Who gets it first? Will countries limit access to it?
Complicating matters, the majority of vaccines under development will require two doses given 21- or 28-days apart, and two of the leading candidate vaccines have different handling requirements and must be stored at different temperatures. These types of cold chain requirements will likely slow rollout in the developing world as well. “Ensuring over a billion people globally have access… is as critical as developing the vaccine itself,” Bourla told the paper in October.
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Three possible outcomes
These uncertainties can be combined to create a range of plausible scenarios that highlight the many possibilities to consider. My team at the Salesforce Futures Lab developed a selection of hypothetical scenarios in discussions with leading experts in epidemiology, geopolitics, economics, and social movements, to help business leaders grapple with the months to come. They are presented for business planning purposes only, from the most hopeful to the most challenging. These scenarios illustrate the range of variation that leaders must plan for and help drive home the importance of keeping tabs on what possibilities are currently on the table.
Hypothetical Scenario 1: “Zero Hurdles”
In this most-optimistic scenario, both the Pfizer and Moderna vaccines receive emergency approval in the coming weeks, and the two companies release comprehensive data that fully substantiates their earlier claims of 95% efficacy. Meanwhile, additional vaccines successfully clear their phase 3 trials, increasing the total range vaccine options.
COVAX, the multilateral arrangement designed to ensure orderly and equitable global distribution, brokers deals for vaccine creators to license production around the world, allowing a rapid ramp up of global manufacturing early in 2021, anchored by the large capacity of India’s Pune Serum Institute. Distribution, in this scenario, runs smoothly and even low-income countries would have easy and timely access, achieving at least selective vaccination where mass vaccination is not achievable. Innovations like smart labels on vaccine vials reduce spoilage due to heat exposure in doses that must be stored at ultracold temperatures.
Thanks to unified leadership, messaging, and investment from a wide range of international organizations, public trust in the vaccine is high and herd immunity reduces transmission by early 2022.
Impact to business leaders: In this scenario, business leaders could look forward to the crisis ending as quickly and evenly as possible around the world. In-person work and consumer confidence could come back close to pre-crisis levels over the summer and fall of 2021, though masking, distancing, and ventilation would still be necessary for many more months.
Hypothetical Scenario 2: “Sprint and Stumble”
This scenario sees a range of vaccines developed by a range of different countries around the world, buoyed by tests on militaries or pushed forward by emergency authorization. Production would scale up quickly, creating a climate of heady optimism that the pandemic is all but finished. However, since each vaccine would likely vary in effectiveness and come with some side effects, those factors could fuel vaccine hesitancy and or even misinformation. As a result, adoption of the vaccines in this scenario is uneven; while a large minority of people do take it, by 2025 the numbers have still not broken the threshold of herd immunity.
Impact to business leaders: In this scenario, many business leaders might initially make investments betting on a rapid re-emergence from crisis conditions, only to be surprised as optimism evaporates. As the crisis stretched on, those who recognized the continuing risk would likely be in the best position, but even they would still face stiff economic headwinds.
Hypothetical Scenario 3: “Long March”
In this potential course of events, repeated disappointments exhaust the public, as one vaccine candidate after another fails to provide the needed combination of efficacy and durability. Government leaders resort to repeated lockdowns during 2021, but many countries’ stimulus is insufficient, resulting in a wave of business and personal bankruptcies.
Finally, a usable vaccine is approved early in the summer of 2022. This vaccine would be rolled out globally much like any other vaccine, with COVAX working with countries around the world to ramp up local production. Several countries nearly eradicate the virus within 18 months, and a larger group is successful within two years. The virus is never fully eradicated, as it continues to persist in the most unstable parts of the world, but many countries are able to move on
Impact to business leaders: In this scenario, business leaders could be increasingly challenged to maintain the safety of their staff and customers before the vaccine arrives, as the public becomes less willing to adhere to public health guidance. But after its arrival, the impact is similar to “Zero Hurdles” above, with a relatively rapid return to workplace safety and consumer confidence.
There is no way to know now which vaccine(s) will work which is why, as the Guardian recently noted, “wealthy countries are paying upfront for something that has not yet been proven to work [and are] willing to spend whatever it takes to get their economies running again. And yet, they could back the wrong horse. It’s a lottery on an unprecedented scale.” As we all play that lottery, we hope these stories give organizations a framework within which to stress-test their own expectations, plan for several realities at once, and navigate today’s unprecedented uncertainty with confidence.
To help businesses and organizations around the world make their workplaces safe in this context, Salesforce launched Work.com for Vaccines this September. The tool, built on the Salesforce Customer 360 platform, helps governments and healthcare organizations around the world more safely and efficiently manage vaccine programs at scale. Work.com includes technology for inventory management, clinical scheduling and administration. It also provides a range of features to help organizations shift with the changes that the virus could bring, helping leaders handle shift management, tackle contact tracing and even respond to emergency and employee wellness issues.
Such a technology drives home the need for tools that offer organizations flexibility to adjust to changing circumstances. More critically, it drives home the need to put a range of preparation measures in place, forging much-needed trust with workers navigating the pandemic in the long term. That trust will be critical for taking care of staff and customers – and for building resilience organizations will need in the months and years ahead.
Mick Costigan and Noah Flower contributed reporting to this article.