A transformation response to future pandemics envisions developing new vaccines against almost any conceivable viral threat within as little as three months from threat recognition – ensuring equitable vaccine access and a world prepared for almost any viral outbreak
The Covid-19 pandemic has reshaped our world in unimaginable ways, emphasising the critical importance of global collaboration and equitable vaccine access. The goals of initiatives such as COVAX were commendable, and the result was, in fact, historic, even in the face of considerable obstacles. It is now a moment to reflect on the issues relating to research and development in vaccines against emerging infectious diseases and access to those vaccines, to discuss the role of the Coalition for Epidemic Preparedness Innovations, and to highlight the urgency of adapting our strategies to combat evolving pandemic threats. Ultimately, the 100 Days Mission is vital for the world to be able to address two critical needs: speed and access.
The accelerated development of Covid-19 vaccines stands as a remarkable scientific achievement. However, their deployment lays bare the stark disparities in vaccine access across the globe. To this day, low- and middle-income countries face significantly lower vaccination rates than high-income countries, due to a host of challenges. As of October 2022, vaccination coverage in low-income countries stood at just 25%; only a quarter of the population had received at least one vaccine dose. In stark contrast, in high-income countries that rate stood at 72%.
Addressing vaccine access inequity requires a deep understanding of its root causes. Manufacturing inequity was an initial stumbling block. Although COVAX reduced the gap of first access between high-income countries and low- and middle-income countries to a historic 66 days, the concentration of vaccine production in India and a few high-income countries, combined with vaccine nationalism, led to supply shortages, and delayed access for low- and middle-income countries at the expense of global health security. Competition for vaccine supplies, as well as competition between countries and initiatives such as COVAX, clearly hindered equitable distribution and exacerbated disparities. Distribution and absorption capacity challenges compounded these problems, with logistical hurdles such as cold chain requirements and remote transportation impeding timely vaccine delivery.
The absence of a pre-existing and well-established global collaborative mechanism for equitable vaccine manufacturing and access meant that initiatives like COVAX had to be constructed hastily during the pandemic’s most acute phase. This fragmented approach clearly exposed the need for a more cohesive, proactive and coordinated strategy for pandemic preparedness.
Throughout the pandemic, CEPI was pivotal in advancing accelerated vaccine R&D and equitable access. CEPI’s funding and facilitation of Covid-19 vaccine development expedited the creation of multiple vaccine candidates. CEPI remains committed to investing in broadly acting vaccines against betacoronaviruses and other pathogens, ensuring preparedness for potential future outbreaks. However, challenges hindering equitable access to Covid-19 vaccines persist. CEPI’s potential to succeed in its mission to enable speed and access is threatened by the complex landscape of vaccine manufacturing and distribution.
Emerging infectious diseases are sending us multiple warnings that another Disease X is out there. From the outbreak of severe acute respiratory syndrome in 2002 to the H5N1 ‘bird flu’ in 2004, the H1N1 ‘swine flu’ in 2009, the Middle East respiratory syndrome in 2012, the Ebola crisis of 2014, the Zika outbreak in 2015 and, most recently, the global impact of Covid-19 – these events are occurring with increasing frequency. They are a constant reminder of the threats of pandemics and epidemics. Covid-19 is our most recent wake-up call and highlights the need to adapt our strategies for future threats. Vaccine research, development, manufacturing and distribution must remain at the forefront of our preparedness efforts.
CEPI’s 100 Days Mission, endorsed by the leaders of all G7 and G20 members, offers a transformative response to future pandemics. This mission envisions developing new vaccines against almost any conceivable viral threat within as little as three months from threat recognition. The mission, integrated into the G7’s similar 100-day ambitions, emphasises the urgent need for innovation in developing safe, effective and affordable diagnostics, therapeutics and vaccines in future health crises, including by addressing issues relating to manufacturing and delivery.
The urgency of such a mission cannot be overstated. A 100-day timeline for Covid-19 vaccine development would have saved countless lives and trillions of dollars. Achieving this goal would offer the world a real chance of containing outbreaks before they escalate into global pandemics. The mission is a critical springboard for enhancing global preparedness against ongoing and future threats.
CEPI’s 100 Days Mission places equity at its core. However, rapid and equitable vaccine access can only succeed within a system reconfigured to deliver such equity effectively. One building block for achieving this could be stronger regional leadership and coordination of R&D and manufacturing for relevant diseases, facilitating efficient and localised responses to emerging threats. Furthermore, innovations such as a global vaccine library, prepositioning information, tools and products can also be transformative and expedite vaccine development.
There is urgency in forging partnerships at global, regional and national levels for pandemic preparedness. Partnerships have already contributed – and have the potential to contribute more – to creating a more interconnected and collaborative global health ecosystem. The establishment of an animal model, a centralised laboratory and manufacturing networks could facilitate resource sharing, expedite research progress and enhance access. CEPI’s commitment to equitable vaccine distribution aligns with the moral imperative of ensuring that new medical countermeasures, including vaccines, are accessible to all, particularly vulnerable people in low- and middle-income countries.
The world remains at risk of a Disease X of far greater severity than Covid-19. International cooperation must transition from high-level political commitments to concrete actions. The political declaration of the United Nations General Assembly High-Level Meeting on Pandemic Prevention, Preparedness and Response has been disappointing in this regard. The ongoing negotiations for the pandemic accord present a unique opportunity to address the issue. Concrete steps forward by the International Negotiating Body could involve enhancing and solidifying equitable access commitments for public funding in R&D as well as developing the normative framework for a truly collaborative global vaccine library.
Covid-19 has forcefully reminded us of the critical importance of global collaboration and equitable vaccine access. Scientific innovations and strengthened partnerships are integral to the 100 Days Mission. By addressing the root causes of inequity and placing global preparedness at the forefront, we have a historic opportunity to create a more resilient and fairer world capable of confronting the ever-present threats of epidemics and pandemics.
Acknowledgements: The authors thank Kate Kelland for providing editorial support.