Editor’s Note (12/21/21): This article is being showcased in a special collection about equity in health care that was made possible by the support of Takeda Pharmaceuticals. The article was published independently and without sponsorship.
How do we prevent a pandemic like this from happening again? As we start to tackle that question, inevitably part of it will involve looking back at the mistakes that were made with COVID-19, and rightly so. But it’s also important to learn from the things we got right, because this pandemic could have been worse, much worse. So, if we want to ensure that this is the last pandemic to cause devastation on this scale, then not only do we need to build on these successes, but the time to do that is now.
Without question, one of the biggest of those successes has been the unprecedented speed at which vaccines were developed, approved and rolled out, and not just to those who can afford to pay. This has already saved countless lives and made the end of this global crisis a tangible reality. Even so, to avoid a repeat of this disaster we still need to figure out how to avoid supply bottlenecks so we can get there faster; by some people’s reckoning, that means being ready to delivery vaccines within just 100 days after a pandemic has been declared. Solving that doesn’t have to involve reinventing the wheel. What’s more, we already have a model for how to do it in the way we tackle flu.
To understand how, first consider what we need: the ability to rapidly develop and approve vaccines that protect against an as-yet unknown threat and at breakneck speed; to increase and globalize vaccine manufacturing, by devolving it from the Global North and building capacity in the Global South, and through increased use of technology transfers, so that we have the ability to rapidly produce extremely large volumes—more than are normally produced globally in a given year—so people everywhere are protected; and we need a global distribution network and supply chains to actually get those vaccines out to people.
With COVID-19, the scientific and vaccine manufacturing community, and new organizations like the Coalition for Epidemic Preparedness Innovations (CEPI), rallied and got us not just one but more than a dozen approved vaccines so far, and in record speed—just 327 days for the first one. Even so, we didn’t get enough doses, or at least won’t get them fast enough. With a pandemic, speed is critical; it’s not enough to protect people in just some parts of the world and let the rest of the world wait. To stop transmission, high-risk people need to be prioritized everywhere.
This is all the more frustrating given that, with COVID, we now have a way to provide equitable access, so that people in countries that can’t afford these vaccines can still get them. Compared to the last pandemic, in 2009, we’ve been able to get vaccines to people in lower-income countries two times faster, to four times the number of countries and with seven times the volume of doses over a comparable period. Of course, this is still not good enough. But what is so remarkable is that, unlike with the flu, we did this without any approved coronavirus vaccines to work from and, without a dedicated global pandemic network already in place.
This was made possible because 193 economies came together in support of the COVAX Facility, an initiative created to provide rapid, fair and equitable access to COVID-19 vaccines. Set up as one of three pillars of the Access to COVID-19 Tools Accelerator, COVAX draws on the preexisting strengths of the three organizations leading it, the World Health Organization, the Coalition of Epidemic Preparedness Innovations (CEPI) and Gavi. The latter, which I run, is itself a vaccine alliance made up of a range of global health partners that also include UNICEF, the World Bank and a global network of civil society organizations—all engaged in the effort.
Despite having no surge capacity or funding to start with, we were able to build on these preexisting strengths to pull all the pieces together needed to not only accelerate the development and availability of COVID-19 vaccines, but also ensure that compensation, liability and indemnification safety nets were in place, and quickly secure more than 1.3 billion doses, so far, for people in 92 lower-income countries, those that may not be able to afford them and therefore might be left behind. All this enabled us to start rolling them out to these countries, ensuring that all the logistics, personnel, monitoring and data systems were in place, just 39 days after people in high-income countries got their first jab.
The single biggest missing piece by far is how we get doses faster. There have already been more than 1.5 billion produced, but we’re still seeing the same kinds of vaccine nationalism and export restrictions that plagued us during the 2009 swine flu pandemic, where almost the entire global supply of doses ended up in the possession of just a handful of wealthy countries, leaving few for the rest of the world.
With COVID, we are trying to accelerate equitable access so people get them even quicker, by encouraging governments to donate their surplus doses to COVAX until further supplies come online, but in the long term, for future pandemics, we can’t assume that governments won’t continue to put national interests first. Technology transfers have also helped significantly and are one reason why we were able to get vaccines in the volumes we have so quickly. This is where vaccine developers share both their intellectual property and the vital know-how needed to make vaccines, with other manufacturers, particularly those in emerging economies. But there aren’t enough of these transfers; we need more including more geographical diversity in the production sites.
So, the only watertight solution is to increase global supply and globalize it. One way to do that is to increase manufacturing capacity across the globe; to gain the ability to suddenly produce large volumes at speed during a crisis, but without leaving factories idle the rest of the time, is to take inspiration from how we prepare for flu pandemics.
Until now, influenza has been the main focus of pandemic preparedness, and with good reason. Over the past century, there have been four flu pandemics. So, for decades we have had a global network of suppliers standing ready to produce pandemic flu vaccines when the need arises, but the rest of the time these facilities stay busy churning out seasonal flu vaccines to protect the people most at risk from nonpandemic flu strains. When a flu pandemic strikes, these facilities can rapidly shift production to produce vaccines targeting the pandemic strain. It’s a system that largely works, but we now need to replicate that model for a broader range of pandemic threats.
The way to do that is to build on our existing global supply chains, such as the routine immunization programs that are currently used to vaccinate 90 percent of the world’s children from vaccine-preventable diseases. Here we already have a global supply and distribution network, and over the last 20 years organizations like Gavi have helped expand and grow that, from five manufacturers to 17 just for developing countries. If we expand that further and, in particular, build capacity in emerging economies, and make sure that the supply chains for equipment and materials are robust, so the Global South has the ability to produce its own vaccines, not only can we increase supply of these vaccines, but with technology transfers the same facilities can be used to increase global supply of and access to pandemic vaccines when the need arises.
Most of what we need to avoid a repeat of this crisis already exists, particularly now that we have a networked solution like COVAX. We just need to ensure that partners have the surge capacity to scale up quickly and there is contingency funding so that the effort is properly resourced to deal with the sudden needs caused by a pandemic. But we also urgently need to invest in additional manufacturing capacity in the Global South. That won’t happen overnight. But if we start now then we can be sure we’ll be prepared for the next one, because it is an evolutionary certainty there will be a next one.
This is an opinion and analysis article; the views expressed by the author or authors are not necessarily those of Scientific American.