Estimating & comparing greenhouse gas emissions for existing intramuscular COVID-19 vaccines and a novel thermostable oral vaccine

BACKGROUND: Climate impacts are rarely considered in health impact and economic assessments of public health programs. This study estimates the greenhouse gas (GHG) emissions averted by a novel oral SARS-CoV-2 (COVID-19) vaccine compared with four existing intramuscular vaccines: AstraZeneca's COVISHIELD®, Pfizer/BioNTech's COMIRNATY®, Moderna's mRNA-1273, and Johnson & Johnson's Ad26.COV2.S COVID-19 vaccine. METHODS: We estimated GHG emissions averted for five vaccine modalities across nine countries. GHG emissions averted were derived from differences in cold chain logistics, production of vaccine supplies, and medical waste disposal. Countryspecific data including population coverage and electricity production mix were included in GHG emissions calculations. Results are presented in averted GHG per vaccine course and country level based on modeled vaccination demand. FINDINGS: Per course, an oral vaccine is estimated to avert between 0.007 and 0.024 kgCO(2)e compared with Johnson & Johnson, 0.013 to 0.048 kgCO(2)e compared with AstraZeneca, 0.23 to 0.108 kgCO(2)e compared with Moderna, and 0.134 to 0.466 kgCO(2)e compared with Pfizer/BioNTech. The total GHG averted varied across countries based upon predicted demand, mix of electrical production, and vaccination strategy with the largest emissions reductions projected for India and the United States. INTERPRETATION: Our results demonstrate large potential GHG emissions reductions from the use of oral vs. intramuscular vaccines for mass COVID-19 vaccination programs. Up to 82.25 million kgCO(2)e could be averted from utilization of an oral vaccine in the United States alone, which is equivalent to eliminating 17,700 automobiles from the road for one year. FUNDING: Funding was provided by Vaxart, Inc. Vaxart, Inc. is currently developing an oral COVID-19 vaccine, the characteristics of which were utilized to define the thermostable oral vaccine discussed in this study. Apart from providing data on the characteristics of the oral vaccine under development, the funders had no influence over the study design, methods, statistical analyses, results, framing of results, decision to submit the manuscript for publication, or choice of journal.