Equitable Vaccination: Strengthening Global Open Science Initiatives and Biopharmaceutical Manufacturing Capacities
By Molly Borritt
This post is part of a series in diverse mediums focusing on the theme “How do we envision equity in global health?”. These submissions are by McGill students who were part of the course, Fundamentals of Global Health, in Fall 2023.
The COVID-19 pandemic has strained healthcare systems, caused economic disruption, and led to widespread disease and loss of life over the past four years. While just under 7 million deaths from COVID-19 have been confirmed, experts estimate that the true number is much closer to 27 million, and continuing to rise (Mathieu et al., 2020). Vaccines hit the market less than nine months after the World Health Organization (WHO) declared a pandemic in March 2020 (Hawthorn, 2021).
Although the WHO declared the end of COVID-19 as a global health emergency in May 2023 (Duff, 2023), Chief Dr. Tedros Adhanom Ghebreyesus has cautioned about the “threat of another pathogen emerging with even deadlier potential” in the future (Chasan, 2023). Thus, reflecting upon the challenges and inequities that arose from COVID-19 is critical in helping to ensure that the world is prepared for another pandemic. One of the most significant failures was inequitable vaccine distribution: to date, 79.86% of those in High-Income Countries (HIC) have received at least one dose of COVID-19 vaccine, compared to 32.82% of people in Low-Income Countries (LIC) (“Global Dashboard for Vaccine Equity”, 2021). These severe disparities are driven by profit-driven pharmaceutical companies and the over-reliance on vaccine-sharing initiatives from HICs to adequately vaccinate LIC populations.
Currently, negotiations are underway between countries at the WHO to introduce a global accord on pandemic prevention, preparedness, and response (WHO Media Team, 2023). This will seek to address advances in research and development (R&D), technology transfer, and benefit-sharing (Kavanagh et al., 2023). Moving forward, the world must transition away from reliance on pharmaceutical companies and vaccine-sharing initiatives, and instead prioritise the financing of open science initiatives and vaccine manufacturing capacity in LMICs, ultimately striving to achieve vaccine sovereignty Borritt 2 and equity. Equitable access to vaccines not only saves lives and curbs the spread of diseases worldwide, but the development of herd immunity also mitigates the risk of further mutations that can lead to global disease variants; hence, vaccine equity must be a global priority.
In negotiating the new global accord, the world should seek to elevate open science initiatives which foster the “collective management and sharing of technology” (Torreele et al., 2023); doing so will transfer the power of creating lifesaving medications from the hands of a select number of pharmaceutical companies into the hands of public researchers, in pursuit of collective health benefit. Currently, the pharmaceutical industry is entirely profit-driven, and will not seek to develop or manufacture vaccinations or therapeutics for diseases which do not present an attractive business landscape (Torreele et al., 2023). The current R&D model threatens Lower and Middle-Income Countries (LMICs), due to the localised nature of most global epidemics in these regions. These diseases, often called "neglected diseases," do not demand a substantial volume of biopharmaceuticals as they are predominantly confined within these areas (Torreele et al., 2023).
COVID-19 was an exception, presenting a strong global business case which allowed the world’s 20 biggest pharmaceutical companies combined to “[hand] shareholders and executives more than $1 million every 5 minutes between 2020 and 2022” – almost the same amount of money that they spent on developing vaccines and medications (“Big Pharma”, 2023). The United States’ National Institute of Health funded the majority of Moderna’s vaccine development, through their contribution of USD 18 billion (Gonzalez, 2023). Moderna proceeded to make a profit of USD 36 million a day in 2021, with a profit margin of Borritt 3 around 70% (Gonzalez, 2023). This is equivalent to the profit margins at which many luxury goods are sold; however, lifesaving vaccinations should not be considered as a luxury.
Despite an unsuccessful year-long effort to convince “pharmaceutical companies to share knowledge and vaccine technologies in the middle of a devastating global pandemic” undertaken by the WHO and several governments (Gonzalez, 2023), these companies have refused, even though Moderna’s vaccine was funded by taxpayer dollars. To avoid this challenge in the future, governments should place conditionalities on their vaccine funding, forcing pharmaceutical companies to share intellectual property to advance collective ownership, affordability, and accessibility of vaccines (Torreele et al., 2023). While this may offer a temporary solution, pharmaceutical companies would still retain control of intellectual property in this scenario, enabling them to prioritise selling biopharmaceuticals to the world’s wealthiest countries.
A more permanent solution is the implementation of an open-science model, whereby R&D and manufacturing are funded by governments, multilateral mechanisms, and development banks, but operate “independent[ly] of governments” (Torreele et al., 2023). This model fosters innovation, grants open access to generated data, and enables widespread biopharmaceutical manufacturing. During the COVID-19 pandemic, the WHO introduced an open-science initiative called the mRNA Technology Transfer Hub, “regarded as a radical plan to reduce dependency by the South on the North” (Gonzalez, 2023). Its hub was established in South Africa, with 15 manufacturers located in Global South countries committed to “pursuing improved mRNA vaccines and therapeutics, optimising manufacturing, and adapting mRNA to address unmet health needs” (Gonzalez, 2023). The hub focuses on addressing neglected diseases that disproportionately affect Global South countries. All innovations, data, and manufacturing know-how will be shared with involved Borritt 4 countries and the global markets. The only condition is that, in the event of an international public health emergency, these countries must supply 10% of their total vaccine output to the WHO or public agencies at the cost of manufacture plus 20% (Gonzalez, 2023). The creation and scaling of open science initiatives such as the mRNA Technology Transfer Hub offer hope of a future where we can “diversify and democratise biopharmaceutical manufacturing in all regions of the world” (Gonzalez, 2023), contributing towards vaccine equity.
To avoid the devastating consequences of vaccine nationalism and hoarding, as seen during the COVID-19 pandemic, manufacturing capacities must be strengthened and distributed among LMICs to reduce reliance on HICs. During the COVID-19 pandemic, HICs acted out of self-interest, hoarding vaccines from a limited global supply and violating multilateral purchasing commitments to the COVAX vaccine sharing mechanism, instead striking up bilateral deals with vaccine manufacturers. Canada was no exception; in fact, Canada “secur[ed] the most doses per capita of any country”, with approximately 11 doses per person by the end of 2020 (Houston et al., 2023). Instead of focusing on equitably distributing constrained resources during public health emergencies, we should seek to prioritise the development and licensing of manufacturing capacities in LMICs, so they can achieve vaccine sovereignty without reliance on donations or excess production capacity in HICs.
Currently, only 0.1% of the world’s vaccine supply is produced in Africa, but expanding this could “make its health systems more resilient and better prepared for public health emergencies, promote social cohesion and economic progress, and insulate countries from external actions” (Alakija, 2023). The Africa Centres for Disease Control and Prevention has called for 60% of vaccines necessary for African populations to be Borritt 5 manufactured in the African continent by 2040 (Alakija, 2023). To do so, suitable financing mechanisms must be established, including mobilising funding and securing advanced market commitments from governments to ensure that manufacturing facilities can be sustained during periods without a public health emergency (Dzau et al., 2022). More coherent strategic financing, partnerships, and open science initiatives can help to unite current efforts and achieve vaccine equity in the future.
It would be oversimplistic to suggest that a lack of vaccine supply is the only barrier to vaccinating the world’s population. Last-mile access challenges, vaccine hesitancy, and rising anti-science sentiments all threaten the goal of achieving herd immunity. Therefore, vaccine equity advocacy efforts and the global accord must consider how to address these challenges, in addition to focusing on manufacturing capacity.
In conclusion, developing open science initiatives and strengthening manufacturing capacities in LMICs are priorities to achieve vaccine sovereignty and equity in the new global accord. Teamwork and collective action, organised through initiatives like the World Health Organization’s mRNA Technology Transfer Hub, are necessary to respond effectively to the threat of future pandemics, which require sustainable financing and partnerships. Prioritising open science initiatives and manufacturing capacities in the new accord, while addressing other barriers to access, can curb disease spread, save lives, and promote global equity
Works Cited
Alakija, A. (2023). Vaccine manufacturing in Africa. BMJ, 381, 908. https://doi.org/http://dx.doi.org/10.1136/bmj.p908
Big Pharma spent almost as much enriching shareholders as on R&D during pandemic. The People’s Vaccine. (2023, October 15). https://peoplesvaccine.org/resources/media-releases/big-pharma-spent-almost-as-much-e nriching-shareholders-as-on-research-and-development-during-pandemic/
Chasan, A. (2023, May 23). Prepare for next pandemic, future pathogens with “even deadlier potential” than COVID, WHO chief warns. CBS News. https://www.cbsnews.com/news/next-pandemic-threat-pathogen-deadlier-than-covid-worl d-health-organization/
Duff, M. (Ed.). (2023, May 5). WHO chief declares end to COVID-19 as a global health emergency. UN News. https://news.un.org/en/story/2023/05/1136367
Dzau, V. J., Balatbat, C. A., & Offodile II, A. C. (2022). Closing the global vaccine equity gap: equitably distributed manufacturing. The Lancet, 399(10339), 1924–1926. https://doi.org/https://doi.org/10.1016/S0140-6736(22)00793-0
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