Seth Berkley on how to improve global access to vaccines
ONE OF THE few positive legacies of the covid-19 pandemic is the pace and scale of scientific innovation that it triggered. The world received vaccines at record-breaking speed, the result of work based on revolutions in biotechnology, artificial intelligence, gene-editing and computing. We already have two vaccines that can prevent certain forms of cancer. More may emerge by the end of the decade, along with new ones capable of targeting heart disease, acne and a range of tropical diseases. These could save countless millions more lives. So if ever there was a time to level the global-health playing field, it is now. This has been my mission for more than four decades, and for the past 12 years as chief executive of Gavi, the public-private global-health partnership that I am about to leave. As Gavis first board chair, Nelson Mandela, put it, life or death for a child should not be dependent on where they are born. But although science can help close many of the gaps in global-health equity, some of the biggest remaining barriers are economic and geopolitical. Take the pandemic. Science may have developed and manufactured covid vaccines in less than 11 monthsand not just one, but over time dozens of thembut most of the early doses went to rich countries. If distribution is left to market dynamics alone, poorer countries will almost always get less. People in such places will either be priced out of the market or not even considered viable customers by profit-focused manufacturers, as was historically the case for a wide range of vaccines. In the case of covid-19, vaccine nationalism and trade barriers also played a part in restricting the global delivery of jabs. Despite these travails, more than 56% of people in lower-income countries eligible for free doses via COVAX, a multilateral vaccines-access initiative, have received at least two covid-vaccine dosesnot far behind the global average of 65%. More than 80% of children worldwide now receive all three doses of the DPT vaccine against diphtheria, pertussis (whooping cough) and tetanus. All this is because their fate has not been left entirely to markets. Organisations such as Gavi exist for this reason: to address vaccine-market failures. Poorer countries often used to have to wait for more than a decade to access new vaccines. Gavi changed that, not through science but economics. By pooling demand from lower-income countries, thus providing manufacturers with long-term guarantees, we were in effect able to create new markets in these countries. At the same time we encouraged other manufacturers to enter these markets, or to develop new vaccines, stimulating innovation and competition, helping to bring prices down and cutting the time it took for poorer countries to get access to vaccines to within just a year or two of the wait for rich countries. As a result, the number of Gavis vaccine suppliers has increased from five in 2000 (mostly from Europe or North America) to 24 today (more than half of which are based in emerging markets). When the pandemic struck, COVAX showed that it was possible to deliver the first jab in a developing country just over a month after the first mass vaccination in a high-income country (Britain)although large volumes were delayed for many countries for up to nine months. The worry now is that with covid-19 no longer seen as a global health emergency, the world will slip back into the neglectful habits of the past. To avoid this, we need to anticipate potential failures or bottlenecks in future pandemic markets. That means building on the mechanisms developed during this pandemic and ensuring that contingent finance is in place, enabling donors to speed up funding to Gavi in response to future health threats. It also means investing in long-term market solutions to prevent protectionist export controls from impeding global supply chains. For example, investing in vaccine-manufacturing in poorer regionsparticularly Africa, which currently produces less than 0.1% of global supplycould help to make access more equitable during future health crises, even in the face of national vaccine-hoarding. Building vaccine-producing capacity in such regions will take time. It requires the creation of a sustainable vaccine ecosystem that includes manufacturing facilities, subsidies to defray some of the high initial costs of building them, specialised workforces, rigorous and independent regulatory systems, and sustained demand for routine vaccines. Gavi is currently working with Africa CDC, a public-health agency of the African Union, and its Partnership for African Vaccine Manufacturing to develop a financial instrument that could help new manufacturers to compete. We are now in a better position than ever to level the global-health playing field. In June 2021 leaders from the G7 called on scientific, governmental and industry experts to ensure that in the future vaccines, diagnostics and therapeutics are available at affordable prices within 100 days of a pandemic threat being identified. This 100 Days Mission is a welcome aspiration, but accelerating the science must not be the sole focus. Mechanisms are needed to overcome economic and political barriers to equal access. With a wave of exciting new jabs coming our way, from malaria vaccines to inoculations against respiratory syncytial virus and perhaps tuberculosis and Group B Streptococcus (and, hopefully, some day HIV), there is no excuse to continue to deny or delay access for poorer countries. After decades of working in this field, I have great faith that when science delivers, so, with the right kind of intervention, can markets. Seth Berkley is the chief executive of Gavi, the Vaccine Alliance. He will step down on August 3rd.