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Torreele E. Why are our medicines so expensive? Spoiler: Not for the reasons you are being told…. Eur J Gen Pract 2024; 30:2308006. [PMID: 38299574 PMCID: PMC10836477 DOI: 10.1080/13814788.2024.2308006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024] Open
Abstract
Often described as a natural economic trend, the prices that pharmaceutical companies charge for new medicines have skyrocketed in recent years. Companies claim these prices are justified because of the 'value' new treatments represent or that they reflect the high costs and risks associated with the research and development process. They also claim that the revenues generated through these high prices are required to pay for continued innovation.This paper argues that high prices are not inevitable but the result of a societal and political choice to rely on a for-profit business model for medical innovation, selling medicines at the highest price possible. Instead of focusing on therapeutic advances, it prioritises profit maximisation to benefit shareholders and investors over improving people's health outcomes or equitable access.As a result, people and health systems worldwide struggle to pay for the increasingly expensive health products, with growing inequities in access to even life-saving medicines while the biopharmaceutical industry and its financiers are the most lucrative business sectors.As the extreme COVID-19 vaccine inequities once again highlighted, we urgently need to reform the social contract between governments, the biopharmaceutical industry, and the public and restore its original health purpose. Policymakers must redesign policies and financing of the pharmaceutical research and development ecosystem such that public and private sectors work together towards the shared objective of responding to public health and patients' needs, rather than maximising financial return because medicines should not be a luxury.
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Affiliation(s)
- Els Torreele
- Institute for Innovation and Public Purpose, University College London, London, UK
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2
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Hassan MZ, Shirin T, Satter SM, Rahman MZ, Bourner J, Cheyne A, Torreele E, Horby P, Olliaro P. Nipah virus disease: what can we do to improve patient care? THE LANCET. INFECTIOUS DISEASES 2024; 24:e463-e471. [PMID: 38185127 DOI: 10.1016/s1473-3099(23)00707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 01/09/2024]
Abstract
The year 2023 marked the 25th anniversary of the first detected outbreak of Nipah virus disease. Despite Nipah virus being a priority pathogen in the WHO Research and Development blueprint, the disease it causes still carries high mortality, unchanged since the first reported outbreaks. Although candidate vaccines for Nipah virus disease exist, developing new therapeutics has been underinvested. Nipah virus disease illustrates the typical market failure of medicine development for a high-consequence pathogen. The unpredictability of outbreaks and low number of infections affecting populations in low-income countries does not make an attractive business case for developing treatments for Nipah virus disease-a situation compounded by methodological challenges in clinical trial design. Nipah virus therapeutics development is not motivated by commercial interest. Therefore, we propose a regionally led, patient-centred, and public health-centred, end-to-end framework that articulates a public health vision and a roadmap for research, development, manufacturing, and access towards the goal of improving patient outcomes. This framework includes co-creating a regulatory-compliant, clinically meaningful, and context-specific clinical development plan and establishing quality standards in clinical care and research capabilities at sites where the disease occurs. The success of this approach will be measured by the availability and accessibility of improved Nipah virus treatments in affected communities and reduced mortality.
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Affiliation(s)
- Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK.
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - Syed M Satter
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Mohammed Z Rahman
- Programme for Emerging Infections, Infectious Diseases Division, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Josephine Bourner
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Ashleigh Cheyne
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Els Torreele
- Institute for Innovation and Public Purpose, University College London, London, UK; Independent Researcher and Advisor, Geneva, Switzerland
| | - Peter Horby
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
| | - Piero Olliaro
- Pandemic Sciences Institute, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, University of Oxford, Oxford, UK
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3
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Dutt D, Mazzucato M, Torreele E. An mRNA technology transfer programme and economic sustainability in health care. Bull World Health Organ 2024; 102:344-351. [PMID: 38680466 PMCID: PMC11046156 DOI: 10.2471/blt.24.291388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 05/01/2024] Open
Abstract
The World Health Organization (WHO) set up the messenger ribonucleic acid (mRNA) technology transfer programme in June 2021 with a development hub in South Africa and 15 partner vaccine producers in middle-income countries. The goal was to support the sustainable development of and access to life-saving vaccines for people in these countries as a means to enhance epidemic preparedness and global public health. This initiative aims to build resilience and strengthen local vaccine research, and development and manufacturing capacity in different regions of the world, especially those areas that could not access coronavirus disease 2019 (COVID-19) vaccines in a timely way. This paper outlines the current global vaccine market and summarizes the findings of a case study on the mRNA technology transfer programme conducted from November 2022 to May 2023. The study was guided by the vision of the WHO Council on the Economics of Health for All to build an economy for health using its four work streams of value, finance, innovation and capacity. Based on the findings of the study, we offer a mission-oriented policy framework to support the mRNA technology transfer programme as a pilot for transformative change towards an ecosystem for health innovation for the common good. Parts of this vision have already been incorporated into the governance of the mRNA technology transfer programme, while other aspects, especially the common good approach, still need to be applied to achieve the goals of the programme.
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Affiliation(s)
- Devika Dutt
- King’s College London, Bush House NE 4.08, 30 Aldwych, WC2B 4BG, London, England
| | - Mariana Mazzucato
- Institute for Innovation and Public Purpose, University College London, London, England
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Duran-Fernandez R, Bernal-Serrano D, Garcia-Huitron JA, Hutubessy R. Financing for pandemic preparedness and response measures: a systematic scoping review. Bull World Health Organ 2024; 102:314-322F. [PMID: 38680465 PMCID: PMC11046164 DOI: 10.2471/blt.23.290207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/07/2023] [Accepted: 01/25/2024] [Indexed: 05/01/2024] Open
Abstract
Objective To obtain insights into reducing the shortfall in financing for pandemic preparedness and response measures, and reducing the risk of another pandemic with social and economic costs comparable to those of the coronavirus disease. Methods We conducted a systematic scoping review using the databases ScienceDirect, Scopus, JSTOR, PubMed® and EconLit. We included articles published in any language until 1 August 2023, and excluded grey literature and publications on epidemics. We categorized eligible studies according to the elements of a framework proposed by the World Health Organization Council on the Economy of Health for All: (i) root/structural causes; (ii) social position/foundations; (iii) infrastructure and systems; and (iv) communities, households and individuals. Findings Of the 188 initially identified articles, we included 60 in our review. Most (53/60) were published after 2020, when academic interest had shifted towards global financing mechanisms. Most (37/60) addressed two or more of the council framework elements. The most frequently addressed element was infrastructure and systems (54/60), discussing topics such as health systems, financial markets and innovation ecosystems. The roots/structural causes were discussed in 25 articles; communities, households and individuals in 22 articles; and social positions/foundations in 11. Conclusion Our review identified three important gaps: a formal definition of pandemic preparedness and response, impeding the accurate quantification of the financing shortfall; research on the extent to which financing for pandemic preparedness and response has been targeted at the most vulnerable households; and an analysis of specific financial instruments and an evaluation of the feasibility of their implementation.
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Affiliation(s)
- Roberto Duran-Fernandez
- Tecnológico de Monterrey, Escuela de Gobierno y Transformación Pública, Eugenio Garza Lagüera y, Av. Rufino Tamayo, Valle Oriente, San Pedro Garza García 66269, Mexico
| | - Daniel Bernal-Serrano
- Tecnológico de Monterrey, Escuela de Gobierno y Transformación Pública, Eugenio Garza Lagüera y, Av. Rufino Tamayo, Valle Oriente, San Pedro Garza García 66269, Mexico
| | | | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Martin R, Maleche A, Gay J, Fatima H. Lessons learnt from COVID-19 to reduce mortality and morbidity in the Global South: addressing global vaccine equity for future pandemics. BMJ Glob Health 2024; 9:e013680. [PMID: 38167259 PMCID: PMC10773420 DOI: 10.1136/bmjgh-2023-013680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
COVID-19, which killed more than 6 million people, will not be the last pandemic. Vaccines are key to preventing and ending pandemics. Therefore, it is critical to move now, before the next pandemic, towards global vaccine equity with shared goals, intermediate steps and long-term advocacy goals. Scientific integrity, ethical development, transparency, accountability and communication are critical. Countries can draw on lessons learnt from their response to the HIV pandemics, which has been at the vanguard of ensuring equitable access to rights-based services, to create shared goals and engage communities to increase access to and delivery of safe, quality vaccines. Access can be increased by: fostering the spread of mRNA intellectual property (IP) rights, with mRNA vaccine manufacturing on more continents; creating price transparency for vaccines; creating easily understandable, accessible and transparent data on vaccines; creating demand for a new international legal framework that allows IP rights to be waived quickly once a global pandemic is identified; and drawing on scientific expertise from around the world. Delivery can be improved by: creating strong public health systems that can deliver vaccines through the lifespan; creating or strengthening national regulatory agencies and independent national scientific advisory committees for vaccines; disseminating information from reliable, transparent national and subnational surveillance systems; improving global understanding that as more scientific data become available, this may result in changes to public health guidance; prioritising access to vaccines based on scientific criteria during an epidemic; and developing strategies to vaccinate those at highest risk with available vaccines.
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Affiliation(s)
- Rebecca Martin
- Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Jill Gay
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- J Gay Associates, Takoma Park, Maryland, USA
| | - Haram Fatima
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- Georgia State University, Atlanta, Georgia, USA
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Torreele E, Wolfe D, Kazatchkine M, Sall A, Ruxrungtham K, Fitchett JRA, Liu J, Kobinger G, Vaca-González C, Gómez C, Terblanche P, Swaminathan S, Olliaro P, Clark H. From private incentives to public health need: rethinking research and development for pandemic preparedness. Lancet Glob Health 2023; 11:e1658-e1666. [PMID: 37652070 DOI: 10.1016/s2214-109x(23)00328-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 09/02/2023]
Abstract
Pandemic preparedness and response have relied primarily on market dynamics to drive development and availability of new health products. Building on calls for transformation, we propose a new value proposition that instead prioritises equity from the research and development (R&D) stage and that strengthens capacity to control outbreaks when and where they occur. Key elements include regional R&D hubs free to adapt well established technology platforms, and independent clinical trials networks working with researchers, regulators, and health authorities to better study questions of comparative benefit and real-world efficacy. Realising these changes requires a shift in emphasis: from pandemic response to outbreak control, from one-size-fits-all economies of scale to R&D and manufacture for local need, from de novo product development to last-mile innovation through adaptation of existing technologies, and from proprietary, competitive R&D to open science and financing for the common good that supports collective management and sharing of technology and know-how.
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Affiliation(s)
- Els Torreele
- Institute for Innovation and Public Purpose, University College London, London, UK.
| | - Daniel Wolfe
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michel Kazatchkine
- Global Health Centre, The Graduate Institute for International Affairs and Development, Geneva, Switzerland
| | | | - Kiat Ruxrungtham
- School of Global Health and Chula Vaccine Research Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Joanne Liu
- School of Population and Global Health, McGill University, Montréal, QC, Canada
| | - Gary Kobinger
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Claudia Vaca-González
- Think Tank Medicines, Information and Power, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Carolina Gómez
- School of Pharmacy, National University of Colombia, Bogotá, Colombia
| | - Petro Terblanche
- Afrigen Biologics, Cape Town, South Africa; Faculty of Sciences, North-West University, Potchefstroom, South Africa
| | | | - Piero Olliaro
- ISARIC Global Support Centre, Pandemic Sciences Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand
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Roche R, Odeh NH, Andar AU, Tulapurkar ME, Roche JA. Protection against Severe Illness versus Immunity-Redefining Vaccine Effectiveness in the Aftermath of COVID-19. Microorganisms 2023; 11:1963. [PMID: 37630523 PMCID: PMC10459411 DOI: 10.3390/microorganisms11081963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Anti-SARS-CoV-2 vaccines have played a pivotal role in reducing the risk of developing severe illness from COVID-19, thus helping end the COVID-19 global public health emergency after more than three years. Intriguingly, as SARS-CoV-2 variants emerged, individuals who were fully vaccinated did get infected in high numbers, and viral loads in vaccinated individuals were as high as those in the unvaccinated. However, even with high viral loads, vaccinated individuals were significantly less likely to develop severe illness; this begs the question as to whether the main effect of anti-SARS-CoV-2 vaccines is to confer protection against severe illness or immunity against infection. The answer to this question is consequential, not only to the understanding of how anti-SARS-CoV-2 vaccines work, but also to public health efforts against existing and novel pathogens. In this review, we argue that immune system sensitization-desensitization rather than sterilizing immunity may explain vaccine-mediated protection against severe COVID-19 illness even when the SARS-CoV-2 viral load is high. Through the lessons learned from COVID-19, we make the case that in the disease's aftermath, public health agencies must revisit healthcare policies, including redefining the term "vaccine effectiveness."
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Affiliation(s)
- Renuka Roche
- Occupational Therapy Program, School of Health Sciences, College of Health and Human Services, Eastern Michigan University, Ypsilanti, MI 48197, USA;
| | - Nouha H. Odeh
- Ph.D. Program in Immunology and Microbiology, Department of Biochemistry, Microbiology & Immunology, School of Medicine, Wayne State University, Detroit, MI 48201, USA;
| | - Abhay U. Andar
- Baltimore County, Translational Life Science Technology, University of Maryland, Rockville, MD 20850, USA;
| | - Mohan E. Tulapurkar
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Joseph A. Roche
- Physical Therapy Program, Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
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8
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Evaborhene NA, Oga JO, Nneli OV, Mburu S. The WHO pandemic treaty: where are we on our scepticism? BMJ Glob Health 2023; 8:e012636. [PMID: 37316254 DOI: 10.1136/bmjgh-2023-012636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
| | - Jessica Oreoluwa Oga
- School of Law and Security Studies, Babcock University, Ilishan-Remo, Ogun, Nigeria
| | - Onyeka Vivian Nneli
- Associate Service Delivery Officer, Palladium International Development, Abuja, Nigeria
| | - Sheila Mburu
- Health Advisor, Tony Blair Institute for Global Change, London, UK
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9
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Cueni T. Lessons learned from COVID-19 to stop future pandemics. Lancet 2023; 401:1340. [PMID: 37087171 PMCID: PMC10119557 DOI: 10.1016/s0140-6736(23)00507-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/02/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Thomas Cueni
- International Federation of Pharmaceutical Manufacturers and Associations, 1202 Geneva, Switzerland.
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10
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Barnes-Weise J, Hoemeke L, Telford B. Public investment in the development of vaccines: providing equitable access around the world. BMJ 2023; 381:743. [PMID: 37024131 DOI: 10.1136/bmj.p743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Julia Barnes-Weise
- Global Healthcare Innovation Alliance Accelerator (GHIAA), PO Box 14713, Research Triangle Park, NC 27709, USA
| | - Laura Hoemeke
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Bridie Telford
- Global Healthcare Innovation Alliance Accelerator (GHIAA), PO Box 14713, Research Triangle Park, NC 27709, USA
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11
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Dinatolo MF, Rahman L. Let's outlive, not just live with, the COVID-19 virus using a 'glocal' health equity lens. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:229-230. [PMID: 36853586 PMCID: PMC9973230 DOI: 10.17269/s41997-023-00753-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/06/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Michael Francesco Dinatolo
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Laila Rahman
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
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Torreele E, McNab C, Adeyi O, Bonnell R, Dhaliwal M, Hassan F, Kazatchkine M, Kim H, Kim J, Legido-Quigley H, Liu J, Nishtar S, Ruxrungtham K, Terblanche P, Todd E, da Silva Freire M, Velásquez G, Sirleaf EJ, Clark H. It is time for ambitious, transformational change to the epidemic countermeasures ecosystem. Lancet 2023; 401:978-982. [PMID: 36924776 DOI: 10.1016/s0140-6736(23)00526-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Els Torreele
- Institute for Innovation and Public Purpose, University College London, London, UK; Independent Consultant, Geneva, Switzerland
| | | | | | | | | | - Fatima Hassan
- Health Justice Initiative, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michel Kazatchkine
- Global Health Centre, The Graduate Institute for International Affairs and Development, Geneva, Switzerland
| | - Hani Kim
- RIGHT Foundation, Seoul, South Korea
| | - Jerome Kim
- International Vaccine Institute, Seoul, South Korea; College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Joanne Liu
- School of Population and Global Health and Pandemics and Health Emergencies Readiness Lab, McGill University, Montréal, QC, Canada
| | | | - Kiat Ruxrungtham
- Chula School of Global Health and Chula Vaccine Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Petro Terblanche
- Afrigen Biologics, Cape Town, South Africa; North West University, Cape Town, South Africa
| | | | - Marcos da Silva Freire
- Departamento de Desenvolvimento Tecnológico (Bio-Manguinhos), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | - Ellen Johnson Sirleaf
- Ellen Johnson Sirleaf Presidential Centre for Women and Development, Montserrado, Monrovia, Liberia
| | - Helen Clark
- The Helen Clark Foundation, Auckland, New Zealand
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13
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Alakija A. Past time for a PACTT for humanity. Lancet 2023; 401:884-886. [PMID: 36907193 DOI: 10.1016/s0140-6736(23)00500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
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14
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Farlow A, Torreele E, Gray G, Ruxrungtham K, Rees H, Prasad S, Gomez C, Sall A, Magalhães J, Olliaro P, Terblanche P. The Future of Epidemic and Pandemic Vaccines to Serve Global Public Health Needs. Vaccines (Basel) 2023; 11:vaccines11030690. [PMID: 36992275 DOI: 10.3390/vaccines11030690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
This Review initiates a wide-ranging discussion over 2023 by selecting and exploring core themes to be investigated more deeply in papers submitted to the Vaccines Special Issue on the "Future of Epidemic and Pandemic Vaccines to Serve Global Public Health Needs". To tackle the SARS-CoV-2 pandemic, an acceleration of vaccine development across different technology platforms resulted in the emergency use authorization of multiple vaccines in less than a year. Despite this record speed, many limitations surfaced including unequal access to products and technologies, regulatory hurdles, restrictions on the flow of intellectual property needed to develop and manufacture vaccines, clinical trials challenges, development of vaccines that did not curtail or prevent transmission, unsustainable strategies for dealing with variants, and the distorted allocation of funding to favour dominant companies in affluent countries. Key to future epidemic and pandemic responses will be sustainable, global-public-health-driven vaccine development and manufacturing based on equitable access to platform technologies, decentralised and localised innovation, and multiple developers and manufacturers, especially in low- and middle-income countries (LMICs). There is talk of flexible, modular pandemic preparedness, of technology access pools based on non-exclusive global licensing agreements in exchange for fair compensation, of WHO-supported vaccine technology transfer hubs and spokes, and of the creation of vaccine prototypes ready for phase I/II trials, etc. However, all these concepts face extraordinary challenges shaped by current commercial incentives, the unwillingness of pharmaceutical companies and governments to share intellectual property and know-how, the precariousness of building capacity based solely on COVID-19 vaccines, the focus on large-scale manufacturing capacity rather than small-scale rapid-response innovation to stop outbreaks when and where they occur, and the inability of many resource-limited countries to afford next-generation vaccines for their national vaccine programmes. Once the current high subsidies are gone and interest has waned, sustaining vaccine innovation and manufacturing capability in interpandemic periods will require equitable access to vaccine innovation and manufacturing capabilities in all regions of the world based on many vaccines, not just "pandemic vaccines". Public and philanthropic investments will need to leverage enforceable commitments to share vaccines and critical technology so that countries everywhere can establish and scale up vaccine development and manufacturing capability. This will only happen if we question all prior assumptions and learn the lessons offered by the current pandemic. We invite submissions to the special issue, which we hope will help guide the world towards a global vaccine research, development, and manufacturing ecosystem that better balances and integrates scientific, clinical trial, regulatory, and commercial interests and puts global public health needs first.
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Affiliation(s)
- Andrew Farlow
- Nuffield Department of Medicine, University of Oxford, Broad St., Oxford OX1 3BD, UK
- Oxford Martin School, University of Oxford, Broad St., Oxford OX1 3BD, UK
| | - Els Torreele
- Independent Consultant and Institute for Innovation & Public Purpose (IIPP), University College London, London WC1E 6BT, UK
| | - Glenda Gray
- Office of the President, South African Medical Research Council (SAMRC), Tygerberg 7050, South Africa
| | - Kiat Ruxrungtham
- Center of Excellence in Vaccine Research and Development (Chula Vaccine Research Center, Chula VRC), Bangkok 10330, Thailand
- School of Global Health (SGH), Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Helen Rees
- Wits RHI, University of Witwatersrand, Johannesburg 2050, South Africa
| | - Sai Prasad
- Bharat Biotech International Limited, Genome Valley, Shameerpet, Hyderabad 500 078, India
| | - Carolina Gomez
- Facultad de Derecho, Universidad Nacional de Colombia, Cra 45, Bogotá 111321, Colombia
| | - Amadou Sall
- Virology Department, Institut Pasteur de Dakar, 36, Avenue Pasteur, Dakar 10200, Senegal
| | - Jorge Magalhães
- Centre for Technological Innovation, Institute of Drugs Technology-Farmanguinhos, Oswaldo Cruz Foundation, Rio de Janeiro 21041-210, Brazil
| | - Piero Olliaro
- ISARIC Global Support Centre International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford OX1 3BD, UK
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15
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Roy V. Financing covid-19 mRNA vaccines. BMJ 2023; 380:413. [PMID: 36858438 DOI: 10.1136/bmj.p413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Victor Roy
- Yale National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA
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