SOUTH KOREA had been praised for “successfully containing” the virus during the early stages of the pandemic. More recently, however, critics have painted a less rosy picture. While the United States had made plans to develop and purchase vaccines since April of last year, South Korea only began talks with vaccine-makers in July[1]. When the government announced in November last year that it had secured 44 million doses of the COVID-19 vaccine[2], many expressed disappointment at how the country that had contained the virus comparatively well had failed to purchase enough doses for its entire population.

The confusion

   In an interview with the Wall Street Journal, Lee Cheol-woo, a senior researcher at the International Vaccine Institute, claimed that South Korea could afford to wait for the COVID-19 vaccine. At the time, the number of daily cases in Korea was down to the hundreds, in contrast with the thousands of new cases in most other countries[3]. However, in less than a month, a “third wave” of COVID-19 hit Korea, during which daily cases skyrocketed to over 1,000 for the first time—the most the country had seen to date. The government came under even more pressure following the discovery of new, more infectious variants of the virus from the United Kingdom and South Africa on December 14 and 18 [4]. By the end of the month, the government had purchased an additional 12 million doses, bringing total procurements up to 56 million.

   However, the damage to public confidence had already been done. The rapidly changing situation, coupled with mixed messages from the government, fueled confusion. Critics point out that the government often used the terms “treatments” and “vaccines” almost interchangeably. “The words vaccine and treatment appear in the same position in the same sentence, but their weight is not the same. […] If people believe treatment can be a great hope, it can be a problem,” said Dr. Jung Jae-hoon (Prof., Dept. of Preventive Medicine, Gachon Univ.) to The Korean Doctors’ Weekly. As a result, the state of South Korea’s vaccine procurement program remained unclear to the public for many months.

Initial approaches

   Why has South Korea’s vaccine procurement program been so lackluster? One major reason may have been the initial domestic concern around vaccine development abroad. The Korean government did not expect a foreign vaccine to be ready by 2021. Hence, the purchase of foreign vaccines was not initially included in the government budget for the 2021 fiscal year. According to Dr. Ma Sang-hyuk, the Vice President of the Korea Vaccine Society, this “miscalculation” led the government to focus on “developing treatment medicine or domestic vaccines[5]” instead. Ma’s claims echo those made during the Korean Federation of Science and Technology Societies (KOFST) forum in April 2020. Given the resources and the organizational structure of Korea’s health and research sectors, many at the event proposed that the government focus on treatment research and advised against prioritizing the development of a domestic vaccine[6].

   Indeed, South Korean contributions in the field of treatment development have been promising; researchers at Yonsei University’s Severance Hospital were among the first in the world to demonstrate the effectiveness of treatment that utilizes plasma from recovered COVID-19 patients[7]. Moreover, the Korean Ministry of Food and Drug Safety has approved Celltrion’s Regkirona antibody treatment for patients aged 60 or older and those at higher risk. According to test results, Regkirona decreases the risk of “COVID-19-related hospitalization” and “progression […] to severe COVID-19” in patients with moderate symptoms. Full approval will be granted once Celltrion submits results from phase three trials[8].

Competing interests

   Despite success with treatments, mass vaccination is still paramount if the pandemic is to end. However, instead of acquiring vaccines from abroad, the government bet on domestic pharmaceutical companies, pushing back foreign vaccine procurements even further.

   Since the beginning of the pandemic, President Moon Jae-in has actively supported domestic vaccine research and development. During a meeting at the Institut Pasteur Korea in April 2020, President Moon promised to support domestic vaccine development “until the end” and announced a \210 billion investment in the sector[9].

   One candidate stands out in the Korean vaccine race; the GBP510 vaccine from SK Bioscience is nearing phase three clinical trials. Regardless of the progress, however, many experts have voiced their concerns about the feasibility of phase three trials. Dr. Kwon Jun-wook, head of the National Health Institute, stated that Korea lags behind other countries due to “the absence of a clinical trial system for vaccines” and the “lack of experience, personnel, investment, networks, and governance” in the vaccine industry[10]. Thus, by focusing on domestic suppliers, the government was relying on an incomplete, if not flawed, system that could not meet the nation’s needs.

   As a result, SK Bioscience has had to seek government support for phase three testing. “The biggest challenges in vaccine development are the time and money spent on [phase three] clinical trials,” said Lee Sang-mook, SK Bioscience’s Strategy and Planning Director[11]. Other Korean pharmaceutical companies in earlier stages of vaccine development have also expressed the need for more government involvement. Kang Chang-yul, CEO of the Korean pharmaceutical company Cellid, requested that the Korea Disease Control and Prevention Agency (KDCA) help implement a “better review system” and facilitate comparative research between domestic and foreign suppliers to increase the efficiency of the drug approval process[12].

   Although SK Bioscience expects to release its GBP510 vaccine by the end of 2021, critics believe that Korea missed the “critical interval” for foreign vaccine purchases back in 2020 by speculating on the uncertainties of domestic vaccine development[13]. During his appearance on the KBS TV program, “Sunday Diagnosis,” Prime Minister Chung Sye-kyun even admitted that the emphasis on domestic vaccine development and the focus on Korea’s testing and treatment approach contributed to delays in foreign vaccine procurements[14].

   So why did the government push for domestic development? Proponents stress the benefits that such an endeavor would bring. President Moon claimed that the pandemic is an opportunity to “advance the field of bio-medicine in Korea.” Moon also believed that a domestic vaccine would help establish Korean “vaccine sovereignty[15].” This enthusiasm, coupled with the fact that the number of daily new cases remained relatively low during the middle of 2020, led the government to favor domestic vaccine development.

Pushing forward

   Despite the initial reluctance, the government has realized the importance of foreign suppliers. Earlier this year, it secured 23 million additional doses, which brought total vaccine purchases up to 79 million[16]. Moreover, it seems likely that some foreign vaccines will be domestically produced. The government is pursuing talks with Moderna regarding a potential $200 million investment from the latter to build a vaccine production factory in Korea[17]. Similarly, SK Bioscience has struck deals with Novavax and AstraZeneca to manufacture their vaccines[18]. Besides boosting supply, the technology transfers that will be made as a part of the agreement are likely to expedite the development of the company’s own vaccines, such as the aforementioned GBP510 vaccine and a second vaccine called the NBP2001, which is at an earlier stage of development.

   The government has also aimed for more clarity. In contrast to the vague statements made during the early stages of vaccine procurements, President Moon has begun to emphasize greater transparency. He expects the KDCA to “maintain trust by explaining the vaccination procedure to the people in detail [19].”

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   Although a speedy recovery from the pandemic seems unlikely at this point, there is reason to be cautiously optimistic: vaccinations have begun. There is no doubt that progress is being made. However, vaccines are not a silver bullet. Victory in the veritable war against COVID-19 ultimately depends on individual sacrifice. Even as vaccinations are being carried out, it is important to remember that individual efforts to combat the spread of COVID-19 are indispensable.

[1] Yonhap News

[2] KBS

[3] John Hopkins University

[4] WHO

[5] ABC News

[6] Chosun Biz

[7] Dong-a Ilbo

[8] BioWorld

[9] Korea TV

[10] Hello DD

[11] Medigate News

[12] Medigate News

[13] Joongang Daily

[14] KBS

[15] Hankook Ilbo

[16] KBS

[17] Al Jazeera

[18] Business Korea

[19] Yonhap News