Vaccine or Medication to Against COVID-19?

Vaccine or Medication to Against COVID-19? Author Mario Arturo RUIZ ESTRADA, University of Malaya, Kuala Lumpur 50603, [H/P] (+60) 126850293 [E-mail] [email protected] Abstract In this research, we debate two possible choices against global COVID-19. The first choice, a vaccine, is available in the market until now. The second choice is medication under the use of hydroxychloroquine and ivermectin together. Therefore, this research aims to find a practical and suitable choice to promptly reduce and stop COVID-19 damage. Using the Pandemic Control Choices Box (PCC-Box), the PCC-Box tries to find the best choice. Hence, we try to find the benefit/cost of both choices and select which one is more cheap and effective to generate global welfare. Keywords: COVID-19 vaccine, economic modeling, policy modeling, vaccination, medication, pandemics. JEL: A1 1. Introduction While the COVID-19 crisis is sharing common problems and uncertainty globally, COVID-19 has had over twelve months, creating a mess economically and socially. Moreover, the genesis of COVID-19 has its origins in Wuhan, China, in December 2019. Subsequently, China began to spread faster worldwide until this malignant virus arrives in each corner of the world. With 85 million infected cases, 1.8 Million death cases, 60 Million recovered instances, and 15 Million active cases until January 2021 (WHO, 2020). This paper is interested in finding choices to stop the COVID-19 propagation under the election between two possible choices. The first choice (ex-ante) is a vaccine that is available on the market to prevent COVID-19. The second choice (ex-post) is to make a medicine under hydroxychloroquine and ivermectin together. Since the COVID-19 started to spread globally, governments, civil society, and the private sector. They feel powerless to how to manage the present global pandemic. There is a genuine fear about the COVID-19 threat posed by high speculation and uncertainty globally about the COVID-19 vaccine effectiveness until now. Moreover, to propose using a medicine under hydroxychloroquine and ivermectin, it is possible to open a new option against the COVID-19 effects shortly. It is against this backdrop that few studies have delved into vaccination or medication for COVID-19. Some studies look at the few possible parallels choices to reduce COVID-19 damages. The answer to stopping COVID-19 is understandable in light of the gaping difference between vaccine or medication to bear the brunt of the cost of COVID-19 just as SARS or MERS, respectively. However, this paper examines COVID-19 from a more general perspective encompassing other relevant issues such as possible alternative medications and new sanitary measures, rather than a narrow vaccine outlook. To do so, we use the Pandemic Control Choices Box (PCC-Box) to perform a comparative analysis to evaluate the best solution to wait for vaccination or medication in the short and long run. The defining characteristic of the PCC-Box, which we discuss in the next section, examines these two solutions simultaneously from a holistic perspective. 2. The Vaccine vs. Medication for COVID-19 The damages of COVID-19 globally carry catastrophic effects. Therefore, the present global COVID-19 crisis encourages finding possible choices against it under a worldwide vaccination (ex-ante) or medication (post-ante) as a feasible solution. Firstly, the COVID-19 vaccine is trigging to be the best choice against this virus globally with divergences opinions and possible results in the short and long run. Therefore, until now, many pharmaceutical firms with a large supply of vaccines are promoted worldwide, such as Sorrento Therapeutics, ImmunoPrecise Antibodies, Roche, AstraZeneca, GlaxoSmithKline, Novartis, Tonix Pharmaceuticals, CSL, Sanofi, and Merck (Statista, 2020). According to this research, four experimental vaccines call attention to its possible success against COVID-19 worldwide, such as ChAdOx1 nCoV-19, CoronaVac, Pfizer, and Sputnik-V. All these vaccines present similar objectives and mechanisms in common, followed by: • The number of doses (2 doses). • Logistic (efficient interconnectivity between air and land transportation with a modern and sophisticated refrigeration systems to preserve longer the vaccines). • The high production cost includes considerable R&D funding support for observation, data collection, experimentation, publication, and implementation). On the other hand, the measure in the levels of risk and effectiveness of the COVID-19 vaccine implies massive production, large storage, and the implementation of practical vaccination campaigns to cover many people everywhere and anytime. The main objective is to eradicate and stop the propagation of COVID-19 and avoid a full uncontrolled pandemic situation in the medium and long run, respectively (RAPS, 2020). Moreover, recent studies support the efficacy of Ivermectin against SARS-CoV-2 invitro. COVID-19 patients receiving high doses of Ivermectin in randomized trials can quickly go against SARS-CoV-2 (Camprubí et al. 2020). Another pioneer that suggests using Ivermectin as a potential candidate for the treatment of COVID-19 is Gupta, Sahoo, Kumar, and Alok (2020). which strongly recommend its uses worldwide (Chaccour et al. 2020). They suggest that Ivermectin is a potential candidate for the treatment of Covid 19. According to preliminary results in the research work by Hashim et al. (2020) got impressive preliminary experimental results followed by: “The Ivermectin with doxycycline reduced the time to recovery and the percentage of patients who progress to a more advanced stage of disease; besides, Ivermectin with doxycycline reduced mortality rate in severe patients from 22.72% to 0%; however, only 18.2% of critically ill patients died with Ivermectin and doxycycline therapy. Taken together, the earlier administered Ivermectin with doxycycline shows a higher rate of successful therapy.” Another document that supports the use of ivermectin is by Angela Patri and Gabriella Fabbrocini (2020). They mention that the SARS-CoV-2 supports effective drugs to treat or, even better, prevent COVID-19. Two drugs classically used by dermatologists help to fight against COVID-19, such as hydroxychloroquine and ivermectin. Both authors strongly recommend that the use of hydroxychloroquine and ivermectin together. These can help quickly against COVID19 shortly. The use of ivermectin in the dose of 12 mg BD alone or in combination with other therapy for five and seven days may be considered as a safe therapeutic option for mild-moderate or severe cases of Covid-19 infection. It is cost-effective, especially when the other drugs are very costly & not readily available, according to Vora et al. (2020) and Jermaine al. (2020). Another interesting issue about ivermectin is commercialized because it showed excellent safety and effectiveness in human health. The current status of ivermectin was continuing to surprise and excite scientists until our days. Hence, the ivermectin is an antiparasitic agent to treat onchocerciasis, strongyloidiasis, lymphatic filariasis, and scabies for veterinary and human medicine, respectively (Zhao and Zhan, 2020). Simultaneously, the ivermectin is an antiparasitic agent with demonstrated antiviral activity against SARS-CoV-2 (Formiga et al., 2020) and (Gupta et al., 2020). Finally, this paper proposes an alternative mechanism of action for this drug that makes it possible to have antiviral activity against the COVID-19 and the processes already reported in the literature. 3. Background Research in the Study of Vaccine and Medication to Against COVID-19 The study about control COVID-19 expansion needs to use two approaches. This paper applies two approaches as a vaccine for COVID-19 viz. medication for COVID-19. In the first part of this research, an effort is to identify the relevant research issues against COVID-19. A total of 250 papers on the COVID-19 eradication from 25 scientific journals were published in 2020 for this purpose (Springer Nature and Elsevier, 2020). Next, the percentage of participation by research approach between vaccination and medication for COVID-19 calculations are following the next results: • 85% of the total research works about COVID-19 focus on vaccination • 15% of total research works about COVID-19 focus on medication The research about vaccines for COVID-19 was more researched and discussed (85%) than medication research against COVID-19 with only 15%. As the medications against COVID-19, attention is focused on one specific area, viz. vaccination studies, respectively. In a nutshell, this paper maintains that the medications research against COVID-19 poses many limitations in studying to control COVID-19. It is merely one part of the complicated puzzle of COVID-19 research. On this account, this study further maintains that the investigation against the COVID19 requires to increase the research in the medication side soon as possible join forces from scientists and medical researchers around the world before it is very late. 4. An Introduction to the Pandemic Control Choices Box (PCC-Box) The main objective of any pandemic crisis evaluation request minimum two choices (C1 and C2). Solving any urgent pandemic crisis depends on the most cheap and efficient to against any pandemic until we find the best choice in the balance point for a suitable choice to solve the acute situation. Initially, we assume that each player has a choice over personal benefit and subsequently for the benefit of the group (society). Nevertheless, the initial division between two choices as vaccine or medicine. The two choices remain tightly sealed, with interests strongly guarded and difficult to take the best choice in against a pandemic. The Pandemic Control Choices Box (PCC-Box) primarily introduces an alternative graphical modeling to evaluate the possibility of any critical pandemic between or among two choices and players. Moreover, the PCC-Box serves as an appropriate mechanism to solve pandemic crisis that could be put to effective use by health policymakers and researchers to evaluate how to against a pandemic between two choices simultaneously. To illustrate, we have two players and choices (Pi and Cj), we assume that Player-1 (P1 = High income) select Choice-1 (C1 = Vaccine) and Player-2 (P2 = Low income) takes choice-2 (C2 = Medicine). We assume the existence of a big concern (Co) about both choices (C1 = vaccine) and (C2 = medication) according to the income. The Gap (Co = big concern) between both player is equal to Player-1 (C1) minus Player-2 (C2) advantages on the one hand (see Expression 1). Co = P1 (C1) – P2 (C2) (1) On the other hand, each individual advantage depends on the final result from its multiinput-output table. The multi-input-output database table design is an alternative style of database analysis framework that permits the storage of a large amount of data to measure a single variable. This single variable can show the advantages of each player according to its income. Every single independent variable is formed by the "n" number of sub-variables. The number of sub-variables in each primary independent variable is non-limited. For this reason, the multi-input-output database table concept does not have any specific ranking but a primary classification of sub-variables. To give it the same weight to all sub-variables, it is deemed necessary to use a binary system. The binary system helps to maintain a balance among all variables in each multi-input-output database table. Once the number of sub-variables is determined, the next step is to collect the statistical and historical data that constitute sub-variables (“n” number) in every single primary variable for each player and its choice (P1 (C1) and P2 (C2)). All sub-variables in every single primary variable such as P1 (C1) and P2 (C2) may not have any direct relationship between them -- they may be independent variables or endogenous variables. However, all the sub-variables in each multi-input-output database table are meant to measure a single variable or primary independent variable, that is, each of the players advantages according to its choice (Pi (Cj)). Each of the two players and choices slected (P1 (C1) and P2 (C2)) to be measured is viewed as a primary independent variable (i.e., endogenous variable). However, there is no connection and interdependency among two players and its choice (P1 (C1) and P2 (C2)) when joined in the box. The two players' advantage Pi is used to draw the PCC-Box representing the evolution and stages of solving a critical pandemic crisis. There are two players of benefits (Pi) to be obtained. The two players of Pi are Player-1 (C1) and Player-2 (C2). The first step is to define all variables and parameters. Once all the variables and parameters are defined, the data based on the variables and parameters are listed in each multi-input database table. The next step is to add the values of all variables' in the column of the present situation (PS) in each multiinput database table. The total possible advantages (TPA) obtained are then located in the TPA column next to PS column (See Table 1). With TPA in place, the next step is to compute each players's advantages (Pi). The computation is done by applying the expression (2) to the multiinput database tables' values. Pi = ΣTPAPi(Cj) x 100 / ΣPSPi(Cj) where i = (1,2) and j = (1,2) (2) After we compute each player's advantages for P1 (C1) and P2 (C2) (see Expressions 1 and 2), we can then plot on the frontier line (see Figure 1). Hence, the balance point of solving the acute pandemic crisis is the center point between both players' and choices advantages (Pi(Cj)), where all players need to arrive for possible viable and sustainable solutions. The target to meet both players: Player-1 (C1) and Player-2 (C2), in the balance point to find a suitable choice to the critical pandemic crisis solution (PCS). Generating a successful essential pandemic crisis solution between two players depends on how much the Player-1 (C1) can pay and how much the Player-2 (P2) is avaible to pay to arrive at the balance point of solving the acute pandemic crisis that both players will meet (see Expression 3). We want to state that the balance point and player's and choices advantage always maintain a real-time (☼) movement. PCS = (+C1) > ☼BCPCP < ☼ (-C2) (3) The essential condition for the balance critical pandemic crisis point (BCPCP) is that both groups need to arrive at a possible viable solution. We have two types of crucial solutions in the balance of pandemic crisis, followed by the higher balance critical pandemic crisis point (HBCPCP), follow by Expressions (4.1) and (4.2). Finally, we have the lower balance critical pandemic crisis point (LBCPCP) that follows two necessary steps: The first step is to find the average (PA) between P1 (C1) and P2 (C2) (see Expression 4.3), and the second step is to find the lower balance point of P1 (C1) and P2 (C2) under the application of Expressions (4.4 and 4.5). We assume that HBCPCP, LBCPCP, and player advantage (P1 (C1) and P2 (C2)) are always running in real-time (☼) under the application of the Omnia Mobilis Assumption (Ruiz Estrada, 2011). ☼HBCPCP-P1 = 50% - ☼P1(C1) (4.1) ☼HBCPCP-P2 = 50% - ☼P2(C2) (4.2) ☼PA = ☼P1 (C1) + ☼P2 (C2) / 2 (4.3) ☼LBCPCP-G1 = ☼PA - ☼P1(C1) (4.4) ☼LBCPCP-G2 = ☼PA - ☼P2(C2) (4.5) The analysis of the higher and lower balance point of critical pandemic crisis solution (HBCPCP and LBCPCP) is followed by If the product is negative (-). It means how much P2 (C2) needs to pay less to arrive at the (higher and lower) balance point of critical pandemic crisis solution to generate a possible strategy with P1 (C1). Whereas, if the result is positive (+), it means how much Player-1 (C1) needs to pay high price improve its advantages to arrive at the balance point of critical pandemic crisis solution to against the pandemic together with P2 (C2). Table 1: The Multi-Input-Output Database Table VARIABLES/EVENTS P1(C1) P2(C2) PS HBCPCP P1(C1) HBCPCP P2 (C2) LBCPCP LBCPCP P1(C1) P2(C2) Advantage A-1 A-2 A-3 . . . A-n Fig. 1: The Pandemic Control Choices Box (PCC-Box) Source: Ruiz Estrada, 2017 5. The Application of the Pandemic Control Choices Box (PCC-Box): Simulation According to the PCC-Box, we found exciting results against the COVID-19 pandemic anywhere and anytime using two choices such as Choice-1 (C1= vaccine) and Choice-2 (C2 = medicine). The first choice (C1) is the vaccine that is the ex-ante measure against COVID-19. We did two simulations underselling or donate free the vaccine. The first simulation shows that Player-1 (P1) with sufficient income is available to buy the vaccine easily anytime under Choice-1 (C1 = Vaccine) has an effectiveness of 8.5/50 with poor results. Hence, If P1(C1) the vaccine is selling to the public, only a small minority will have access to get its benefits immediately. The final mission of the vaccine is useless. Only a limited number of people can have access to it. On the other hand, we can confirm that if the vaccine is free, then P1(C1) has an effectiveness of 45/50 with good results to against COVID-19. We suggest that only a national free vaccination campaign can help succeed against COVID-19 under the Choice-1 (Vaccine). Hence, the P1(C1) is extremely expensive for many people to pay (see Figure 2). In the case of Player-2 (P2) with low income with the possibility to access Choice2 (C2 = Medicine) with effectiveness of 44/50 shows good results. But if the medicine is free in public hospitals, P2(C2) shows 45.5/50 effectiveness with good results also. We can observe that the P2(C2) is the best choice than P1(C1). The main reason for the disparity between P1(C1) and P2(C2) has its origins in the income and levels of poverty. Hence, the (C2 = medicine) is more effective than (C1 = vaccine) in both simulations. We can say that C2 is more inclusive and respond much better than C1 against COVID-19 in the short and long run (see Figure 2). Fig. 2: The Application of PCC-Box to Evaluate Vaccine or Medicine Implementtion to Against COVID-19 Effectively Source: Author Calculations 6. Conclusion We concluded that the best choice between vaccine and medicine against COVID-19. The uses of medicine (ex-post measure) are more effective than the vaccination (ex-ante measure). In terms of measures implications, our simulations suggest the following. The vaccine only can work efficiently if the government supports a full national vaccination free to the public. On the other hand, if the vaccine is selling to the public, then the effectiveness against COVID-19 will be lower, according to our preliminary results. The significant observation is that in a global pandemic, vaccination, or medication needs to be considered public goods to generate global welfare. At the same time, global welfare can cause favorable conditions for economic growth faster worldwide. 7. References Camprubí,D., Almuedo-Riera, A., Martí-Soler, H., Soriano, A., Hurtado, J.C., Subirà, C., GrauPujol, B., Krolewiecki, A., Muñoz, J. (2020). Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients. PLOS ONE. https://doi.org/10.1371/journal.pone.0242184 Chaccour, C., Hammann, F., Ramón-García, S., & Rabinovich, N. R. (2020). Ivermectin and COVID-19: Keeping Rigor in Times of Urgency. 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