Stacey L. Knobler, MSc
Vice President, Vaccine Innovation & Global Immunization, Sabin Vaccine Institute
Inequitable vaccine distribution has exacerbated the COVID-19 crisis for the world’s poorest populations and prolonged the pandemic. Regional vaccine self-sufficiency will boost global health and economic security.
Astonishingly effective vaccines against COVID-19 were created, tested and manufactured in an all-out push to stop the pandemic. That effort has fallen short in part because wealthy countries locked up access to an outsized share of those vaccines and not for the first time: a similar scenario occurred during the 2009 H1N1 influenza pandemic. To meet future pandemic threats that inevitably will arise—as well as pressing local needs—every global region must gain the ability to discover, develop, manufacture and distribute vaccines.
Recognising the value of vaccines
A growing body of evidence shows that vaccines offer far more than disease protection. Vaccinated populations enjoy increased educational economic productivity and financial security, along with reduced healthcare expenditures and pressure on health systems. Vaccines therefore not only improve the lives of the individuals who receive them, but also their households, their communities and the whole of society. Gaining these benefits requires investment in vaccine R&D infrastructure to serve the entire world, not just wealthy countries. It is time to build capacity in every global region—and especially in the Global South—to deliver vaccines tailored to local needs that are safe, effective and affordable.
Expanding vaccine access
Today, vaccine R&D largely happens in the high-income countries from which vaccine makers reap most of their profits. There has been little private-sector interest in pursuing vaccines against diseases such as malaria and tuberculosis that mainly threaten low- and middle-income countries. Similarly, there is little profit incentive in designing vaccines for places that lack refrigeration, or where needle injections are culturally unacceptable or difficult to administer safely.
These constraints limit the benefits of vaccination in much of the world and, in the COVID-19 pandemic, have contributed to the loss of lives and livelihoods, as well as to the rise of variant viruses. We are learning the hard way that infectious diseases can spread anywhere unless they are stopped everywhere.
We are learning the hard way that infectious diseases can spread anywhere unless they are stopped everywhere.
Creating regional vaccine ecosystems
To increase vaccine access, effectiveness and uptake worldwide, we must abandon the “one size fits all” approach to vaccine R&D and make it more regionally responsive. That means building the entire vaccine ecosystem—spanning discovery through development, clinical trials, manufacturing, distribution and administration—to meet the specific needs of each region, along with the necessary infrastructure and workforce.
Establishing vaccine ecosystems in each global region will make the whole world healthier, safer and more prosperous. Estimates of the investment necessary to accomplish this comprise a tiny fraction of what COVID-19 has already cost the global economy. Now is the time for national governments, donors, and development banks to recognise the value of regionally responsive vaccine ecosystems and to provide the ongoing investment necessary to create and sustain them.
Building back better
While COVID-19 exposed gaps in global pandemic preparedness, it also proved the value of several novel vaccine technologies, most notably the potentially adaptable mRNA platforms.
The “plug-and-play” design of mRNA vaccines, and their relative simplicity of manufacture, puts them within reach of countries that now lack vaccine infrastructure. It also makes possible the production of vaccines to stop viral threats whenever and wherever they emerge, forestalling future pandemics.
mRNA vaccines and other advances spurred by the COVID-19 experience offer the technical means to better prepare the world for pandemics to come. When regionally responsive vaccine ecosystems exploit such breakthroughs to protect local populations from a myriad of viral threats, we truly will have “built back better.”
