Virus variants point to need to scale up vaccine manufacture

AS governments around the world struggle to roll out vaccines, we can already see that systemic change is urgently required. New realities are imposing themselves, demanding different approaches to disease surveillance and vaccine development, production and distribution. COVID-19 provides an opportunity for nations and the multilateral system to reimagine how they collaborate for pandemic preparedness and response — now and in the future.

Scientists and researchers achieved a near-miracle by developing effective vaccines within mere months.

But so far, that blessing has been largely limited to the world’s most affluent.

As World Health Organisation (WHO) director-general Tedros Adhanom Ghebreyesus has warned, the world is on the brink of a “catastrophic moral failure”.

Compounding this problem is the emergence of new variants of COVID-19.

Viruses naturally evolve, more virus mutations are inevitable and vaccine booster shots tailored to the variants may be required.

COVID-19, or some shape-shifting version thereof, is going to be with us for the foreseeable future. And once COVID-19 is successfully addressed, the threat of future pandemics will continue to loom over us.

Covax has delivered at least 31 million vaccine doses to more than 50 countries. However, the new vaccines also give us a peek into a possible new future, based on genomic information and vaccine platform technologies. In principle, within days of detecting and sequencing variants, or future viruses with pandemic potential, vaccines could be effectively reprogrammed and repeatedly given.

Think of it as the literal equivalent of anti-virus upgrades — only instead of protecting your computer’s operating systems, they’ll be protecting people’s lives from the threat of pandemics.

As variants emerge and are analysed, scientists will be able to respond with upgraded vaccines, capable of being downloaded to the public through new channels of worldwide production and distribution.

None of this changes current public health advice to take whatever authorised vaccine is offered and to follow stringent public health measures to reduce the risk of variants arising.

However, it is a reassuring vision of how we might respond to what is a perpetual threat to public health — and not just a once-in-a-century pandemic. But significant adjustments will be required.

First, we will require enhanced public health surveillance, building upon and strengthening existing surveillance systems. Without rigorous systems of data and detection, and genomic sequencing capacity, the world will be slow to identify emerging risks.

Such delays could mean that new variants might flourish undetected, costing lives and forcing future lockdowns. The response is to bridge those gaps and strengthen existing surveillance systems.

We are going to have to invest far more aggressively in public health surveillance, in data collection and data sharing.

Second, our systems of vaccine manufacture and production will also need to be scaled up to accommodate new realities. These vaccine platforms will be asked to react in ways never before imagined. Like the anti-virus software, we are going to have to build systems of manufacture that are capable of facilitating downloads rapidly. Centres of production may need to change output on a dime and rewire to produce new vaccine updates.

Just as importantly, increased and distributed domestic manufacturing capacity and production — often at the regional level — will be required to ensure genuine security of supply for all. The prospect of a world responding to multiple variants or girding against the threat of future pandemics will require careful consideration of existing supply chains and manufacturing location. Many regions or countries may decide that domestic capability is about to shift from a nice-to-have to must-have status.

All of this will require some new approaches to the way we conceptualise and organise vaccine manufacturing platforms. While sharing dollars and doses have proven vital in addressing immediate needs, only domestic production — resting on technology transfer and sharing of intellectual property — will lead to national or regional self-reliance. Between 2006 and 2016, the WHO implemented a programme of technology transfer for influenza vaccines, which offers an important model to apply to COVID-19 vaccines.

We are also reminded that surveillance and vaccination require strong systems of primary healthcare, which also delivers testing and treatment to care for COVID-19 cases alongside broader public health measures. Primary healthcare is what makes all of this possible: without it, emerging threats will not be identified and new vaccines will not get distributed.

Even more fundamentally, a global antiviral system of public health surveillance and adaptive, distributed vaccine platforms using novel technologies will only succeed with the governance of all countries, firmly rooted in the multilateral system.

This antiviral system is the classic global public good and the WHO, which is governed by 194 member states and already has a Pandemic Influenza Preparedness Framework, provides the appropriate governance arrangement. If we hope to forestall the spread of new variants — or, for that matter, the emergence of future pandemics — we must mount a collective, global response.