How Do You Solve a Problem Like World Vaccination?

IRA FLATOW: This is Science Friday. I’m Ira Flatow. It seems like here in the US we’ve turned a corner in the COVID-19 pandemic. Most of the population can be vaccinated. And restrictions for masks and distancing are loosening. But we won’t be able to get a handle on this pandemic until the rest of the world has access to a vaccine. And if you thought distributing shots to rural areas here in the US was hard, imagine distributing them to every corner of the globe.

President Biden this week pledged to send 20 million more vaccine doses abroad. That would total 80 million doses. So where does the world vaccination effort stand? One international effort to vaccinate the world is called COVAX, COVID-19 Vaccines Global Access. A member of the implementation team is joining us now. Dr. Bruce Aylward, Senior Advisor to the Director General at the World Health Organization joins me from Geneva, Switzerland. Welcome to Science Friday.

BRUCE AYLWARD: Thank you very much, Ira.

IRA FLATOW: Nice to have you. So how many vaccinations do you know have been distributed so far through COVAX? Where have they gone? Can you give us a thumbnail sketch?

BRUCE AYLWARD: Sure. So as of today, COVAX has distributed just over 67 million doses of vaccines, which is a relatively modest number. The important thing, Ira, is how far those doses have gone. We’ve distributed vaccine now to over 124 countries around the world. And this includes almost all of the lowest income countries around the world, the low, middle income countries.

So we’ve distributed doses in almost all countries of sub-Saharan Africa, of the Middle East, of Latin America, Central Asia, many, many Pacific, Caribbean and other island nations, as well– so across a broad swath of the world.

IRA FLATOW: You’ve also distributed doses to Canada, have you not? Why Canada?

BRUCE AYLWARD: Well, when we set up the ACT accelerator a year ago, the goal was to establish a truly global mechanism that would allow every country of the world to collaborate and work together to reduce the risk, number one, of developing new vaccines, to pool the procurement to get the best possible prices and volumes, and then to equitably collaborate in the rollout of these around the world. And so Canada is one of the 190 countries that joined the COVAX Facility. And there have been other high-income countries that have also received doses, such as South Korea, for example, through the COVAX Facility– pretty modest doses, actually, Ira, in terms of the overall doses, because the emphasis has been to get doses to the countries that truly have no other access.

IRA FLATOW: Now, I know that COVAX had a goal of distributing at least 100 million doses worldwide by the end of March. That did not happen. Can you tell us what kind of roadblocks prevented that goal?

BRUCE AYLWARD: Yeah, there has been a couple of challenges to scaling up COVAX as rapidly as possible in terms of the volumes that we want to be pushing through this mechanism to get vaccines out to as many vulnerable people around the world as possible. The first one was it took producers a long time to get their vaccines validated by WHO, meeting the necessary international standards for safety, efficacy, programmatic quality, and also just quality of the product. So there were delays in getting that done. Manufacturers took a lot longer than they expected.

And then once the vaccines started to flow, many of our suppliers found that they had over, let’s say, promised what they could actually deliver and get through their own system. So that was slow. And then we, of course, had the big outbreak in India and the huge escalation there, which meant that a big proportion of the doses that should have come through COVAX ended up getting redirected, because there are coming from India, and they actually stayed in India to try and address the vulnerability and risk to the population there.

So all of that has slowed down the doses through COVAX. And that is the reason that, as we’ve gone to look for other sources, Ira, much of that is locked up in contracts with the rich countries of the world. So that’s why we have turned to them now to look at how can you work with us to try and fill that gap as rapidly as possible.

IRA FLATOW: You know, I’m having a feeling of deja vu all over again, because just a few weeks ago we had Saad Omer from Yale urging on developed nations to donate vaccines. Here we are again, you saying basically the same thing. Have we known this was going to happen all along?

BRUCE AYLWARD: Absolutely. That’s the reason we established the COVAX Facility. We knew one year ago from our experience in pandemic flu and in other crises like this, that as you develop these new tools that you need, the new countermeasures, new vaccines, new tests, new treatments, they’re going to be in very scarce supply. So right from the very beginning, you have to develop mechanisms to ensure more fair sharing, let’s say, of those products as they become available. And that’s why we established this global mechanism.

IRA FLATOW: Is there any way to incentivize rich countries to donate the vaccines to COVAX?

BRUCE AYLWARD: Absolutely. And in approaching that, Ira, we look at two things. First of all, why share doses? We like to say share. It’s the right thing to do, people know. The second thing is it makes great economic sense. if we look at high-income countries, they are going to lose an estimated $9 trillion this year in economic losses. Well, globally, half of that will be lost if they only vaccinate the high-income countries. So there’s a huge economic incentive, in the trillions, to vaccinate globally to get the global economy moving.

And then, of course, we have the virus itself telling us, look, it makes sense from a health security perspective, because otherwise, I’m going to mutate and variants are going to arise. And they could make your tools, your vaccines that you’re already using ineffective. So you need to approach this on a global scale. So there’s lots of incentives from that side. But then when it comes to COVAX itself, why do it that way instead of bilaterally.

And most countries, like the US, they want to have the biggest impact they can. They want to get to as many countries as possible as fast as possible and make sure the people who really need these doses get them. And that’s what the COVAX Facility offers, because we can get to every country in the world. We’re already getting to them. We can get there very, very fast.

The first donation that we had, Ira, was only about 10 days ago, or two weeks ago, from France. And within 24 hours of that deal being signed, the vaccine was in the air on the way to Mauritania. So we can move fast, and we make sure it gets to places and to the people that really need it.

IRA FLATOW: I would imagine, then, you might feel like you’re racing against the clock here, considering what you said about the aggressiveness of the virus and the mutation of the virus.

BRUCE AYLWARD: And even without the virus mutating, Ira, if you look today at the graph, we’re still at one of the peaks of this pandemic. People are dying every single day that should not be dying. Health care workers are getting sick who should not be getting sick. Now, most of those, increasingly, are in low-income, lower, middle-income countries.

And we have enough vaccine in the world. We don’t even have to be very generous. We have enough vaccine in the world to make it a much safer place for the people who are trying to save lives and to keep alive our older, cherished populations.

IRA FLATOW: So if we have all of that vaccine in total what is the main reason we’re not getting those out to the people who need them.

BRUCE AYLWARD: Well, every leader in every country is there to take care of their people first, right? And so what they’ve been trying to do is ensure that they get their health care workers vaccinated, their older populations vaccinated. And then, in the face of an evolving virus, they thought, well, maybe we’d better get even more people vaccinated more robustly to give us more protection against that.

So they’ve been struggling to try and find that balance and find that tipping point where they feel like, OK, we’re confident that we’ve got this under control, or at least we’re going in the right direction. And now we can be sharing.

And we’re seeing more and more of that, Ira. If we go back three months ago, we had no donations. And if you look today, you’ve got the UAE, you’ve got Sweden, you’ve got Spain, you’ve got Norway, you’ve got France all saying that they want to donate doses and do it very quickly. The key is, Ira, we need people to donate and move doses fast, because every day that we don’t get a vaccine into somebody somewhere, a health care worker gets sick. An older person dies. And that’s avoidable.

IRA FLATOW: And that’s where we’re going to have to leave it, because our time has run out. I want to thank you very much for taking the time to talk with us.

BRUCE AYLWARD: It’s been my pleasure, Ira. Thank you.

IRA FLATOW: Dr. Bruce Aylward, Senior Advisor to the Director General at the World Health Organization in Geneva, Switzerland. So the vaccine supply chain has hit some roadblocks. How much of this could have been foreseen? Joining me now is an expert on medical supply chains. Prashant Yadav is a Senior Fellow at the Center for Global Development and a Professor at INSEAD Business School based in Washington, DC. Welcome to Science Friday.

PRASHANT YADAV: Thank you for having me on the show.

IRA FLATOW: We were talking just now about how distributing vaccines to the world has proven to be a difficult task, to say the least. How does what we’re seeing now with the COVID vaccine supply chain compare to how medicine distribution has gone historically?

PRASHANT YADAV: So medicine distribution is concentrated in certain geographies, in India, and China, in parts of Italy, and Puerto Rico, and Ireland. Vaccine manufacturing has some similarities. But at the same time, it has many aspects which are different. And there is concentration of vaccine manufacturing in the US and in India and China and Brazil. But the total amount of vaccine manufactured globally still is only a fraction of what we are seeing as the demand for COVID vaccines.

IRA FLATOW: It’s not just a question of distribution? It’s also a question of supply, making enough vaccines?

PRASHANT YADAV: Yeah, so [INAUDIBLE] manufacturing capacity– the estimates vary, but let’s say it’s somewhere between 8 to 10 billion for 2021. And that is, in some ways, sufficient. But the timing of when that manufacturing capacity comes online is where the challenges are. If most of it only becomes available in the fourth quarter of 2021 or in the first part of 2022, then we will have a long wedge and a delay between having achieved over 50% to 60% vaccination coverage in a large number of developed countries. At the same time, many developing countries would not even have covered their essential health care professionals and high-risk populations.

IRA FLATOW: You talked about vaccines being manufactured outside of the United States, there has been a lot of talk about COVID-19 vaccine patents recently. Some people have called on manufacturers to forego intellectual property rights in an effort to get as many people vaccinated as possible. Is it that simple?

PRASHANT YADAV: So in the long term, having better access to intellectual property may help us. Medium-term, what we need is more manufacturing capacity that can come online rapidly. That requires manufacturing sites with the right kind of equipment which can do cell cultures. Second, and most importantly, in my opinion, it requires having chemistry manufacturing and control specialists, lab people who can make sure that the process parameters remain stable, there is process consistency, and quality of manufacturing is not compromised.

And the third thing, which is a new constraint we’ve seen in the last few months, is a lot of the equipment that goes into manufacturing, especially because we are starting to use more and more of single-use bioreactors and single-use filters for growing cells and other biological processes– and these have now become in short supply. There are only four or five manufacturers globally which makes such equipment. So in a way, patent waivers will not help us enhance manufacturing capacity unless we can solve for more people who know chemistry manufacturing and controls, and somehow we can add more output for single-use bioreactors and other single-use equipment, and also some other critical materials that are needed.

So all of these things together perhaps can help. But then it raises the question– the fastest way to get on the learning curve of stabilizing a manufacturing process, achieving the process consistency, may be to have the team which has, in the first place, developed the process transfer this know-how. And that could be achieved, in my opinion, through voluntary licensing, the kinds of arrangements that we have seen between AstraZeneca and the Serum Institute of India, or Johnson & Johnson, Biological E. And a number of such voluntary licensing arrangements have been done.

The benefit is that the team which has worked on developing a manufacturing process from scratch and has worked hard and gotten up high on the learning curve transfer that very quickly, instead of the receiving company’s team having to iterate multiple times, trying various combination of the process parameters, till the time they can get to perfected.

IRA FLATOW: In case you just joined us, I’m Ira Flatow. And this is Science Friday from WNYC Studios. So how do you pass this knowledge on from those people who know how to do it, who have developed it, and getting it to the places where they can use it?

PRASHANT YADAV: Our traditional modality has been a group of people who are part of the original team travel to the new site. And they work closely with the team at the new site in helping them establish the process.

IRA FLATOW: Well, wouldn’t this small group of people take a long time to get to all those sites?

PRASHANT YADAV: That is our binding constraint at the moment. And I think, in the medium term, as we think about preparedness, and as we think about future pandemics and how would we have sufficient manufacturing capacity, one key area we have to invest in is to have a larger pool of people who know biologics manufacturing who are spread out globally or are at least available to carry out such technology transfer with short time notice. And that’s the key preparedness investments that we will have to make.

IRA FLATOW: And so what is the takeaway from this pandemic, as we look forward, and we know there are going to be other viruses that emerge? What is the preparedness takeaway and lesson to be learned from this?

PRASHANT YADAV: Three things, in my opinion– the first is vaccine manufacturing capacity is a huge global public good. Having some surplus vaccine manufacturing capacity is an investment that societies should be willing to make. We have to figure out how to keep it running live and sustainable, which means that capacity may have to be flexible so that, in routine times, it can be at least kept alive by making a modest amount of other vaccines.

Vaccine supplies have to be managed in a way that we respect the global nature of the vaccine supply chain. We have to acknowledge both in the political process in the way our global trade treaties are organized and also population-level awareness of the fact that, by closing borders we are not helping anyone, not ourselves and not the world, just because the vaccine supply chain is intrinsically very global.

And a third thing that probably is equally important is to have some decentralized manufacturing capacity and decentralize in places where it is easy to export product out. And it’s easy and has good trade and transport links instead of a concentration in US, EU, and India. If it was somewhat more geographically distributed, I think we may be better.

IRA FLATOW: Very interesting lessons– it’s nice to get your opinion on this. Thank you very much for taking the time to be with us today.

PRASHANT YADAV: Thank you for having me on the show.

IRA FLATOW: Prashant Yadav, Senior Fellow at the Center for Global Development and a professor at the INSEAD Business School based in Washington.

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