Geneva–Seattle collaboration in support of developing country vaccine manufacturing

Sustainable vaccine manufacturing in low- and middle-Income countries

The sustainable manufacturing of vaccines in developing countries is critical to increasing equitable access to vaccines and pandemic preparedness globally. Sustainable manufacturing requires that organizations engaged in the development, production and supply of vaccines have viable business models and incentives to manufacture vaccine products. The expanding manufacturing capabilities and capacities of developing countries vaccine manufacturers (DCVMs) are increasingly positioning these organizations to meet the national and regional public health needs in developing countries; however, key industry challenges such as regulatory barriers, low prices and demand uncertainty for vaccine products, and limited R&D funding threaten the long-term viability of vaccine manufacturers. This study assesses the technical capabilities, manufacturing capacities, and aspirational plans of DCVMs, exemplifying the business models and strategies undertaken to sustainably manufacture vaccines in developing countries. The public health importance of a healthy vaccine industry which enables manufacturers is discussed throughout. Vaccine manufacturers reported diverse product portfolios and R&D pipelines and utilized an array of vaccine technology platforms. Large manufacturing capacities were reported, a critical factor in manufacturers achieving economies of scale and supplying large volumes of vaccine doses to the world's most populous regions. Partnerships and collaboration within the industry and with international organizations along the vaccine value-chain were cited with high frequency. Manufacturers also reported aspirational plans to enter new markets, acquire new technologies and invest in the development of novel and improved vaccines. As DCVMs aim to have an increasing impact on the global vaccine ecosystem, a coordinated multi-stakeholder approach is required alleviate critical industry barriers to ensure that all efforts produce vaccines are sustainable and enable developing countries to realize the public health benefit of vaccines.

China and the global search for health security: history, vaccines, and governance

China is a key player, not just an actor, in the global search for health security. Reiteration of this point is useful for International Relations studies, which often portray China as a factor to contend with, especially given the background of the country as the first to report the outbreak of the COVID-19 pandemic. This paper adopts an analytical framework developed through a summary of routines in Chinese engagement in global health from a practitioner’s perspective: aid, interdependence, governance and knowledge. These are the core elements in a country’s pursuit of engagement with the rest of the world. After the introduction, the second section of the paper reviews contributions from China in the history of global plague control over the past century. The third section discusses structural issues affecting access to vaccines, which are essential for bringing COVID-19 under effective control. The fourth section identifies a number of challenges China is facing in global health governance. The final section offers a few concluding thoughts, reiterating the nature of interdependence in the global search for enhancement of health security.

Public-private partnering as a modus operandi: Explaining the Gates Foundation's approach to global health governance

In its first decade, The Bill and Melinda Gates Foundation (BMGF) focused much of its efforts on enabling the establishment of transnational public-private partnerships (PPPs) oriented towards increasing low-income country (LIC) access to essential health technologies. Critics have argued these efforts further enriched already profitable firms which long ignored the needs of populations with limited purchasing power, while lessening political will to invest in urgently needed public sector capacity to produce essential health technologies independently of market pressures. Missing from these critical analyses were the perspectives of those shaping BMGF's global health programming. Drawing on interviews with senior BMGF staff and external affiliates undertaken between 2010 and 2012, this article seeks to address this gap. We argue that BMGF's embrace of PPPs was adopted out of the belief that neither public agencies nor industry were capable of providing LICs with essential health technologies autonomously, and that their conflicting mandates required an honest broker to initiate and sustain collaboration between the two sectors. The Foundation's comparative advantage in global health governance was thus seen by those informing its work, as its capacity to negotiate such partnerships, which we argue has also been the basis of its agenda-setting influence in this domain.

Roadmap for strengthening the vaccine supply chain in emerging countries: Manufacturers' perspectives

Manufacturers have a significant stake in the vaccine supply chain as their reputations rest on the effectiveness of their vaccines at the point of vaccination. The risks of low performing supply chains are detrimental for the safety and effectiveness of vaccines, with potential consequences to future supply in the case of adverse events. For this reason, a study was set up to explore the involvement of developing country manufacturers in the vaccine supply chain over the next decade to determine the areas where innovations could have a positive impact on the supply chain, focusing on the secondary stages of production where formulation, filling and packaging take place. An expert desk review identified eight areas of interest for the vaccine supply chain and informed the development of a survey to assess the relevance of the areas identified. The review also conjectured whether the overall effect of the identified areas is cost-neutral or resulting in net savings to countries. Overall, respondents identified five areas as of highest interest and subsequently an expert working group of representative manufacturers prioritized three of them. Specifically, traceability in the context of global digital health initiatives, stockpiling in the context of addressing vaccine shortages, stock-outs, outbreaks and epidemic prevention, and new packaging technologies are discussed in this report. It is important that vaccine manufacturers be actively engaged in global stakeholders' forums, as equal partners in determining the best ways for improving the vaccine supply chain.

A situation analysis of the state of supply of in vitro diagnostics in Low-Income Countries

In vitro diagnostics (IVDs) are medical devices and accessories used to test bodily samples for causative agents of disease. IVDs play a central role in the diagnosis of individuals, in the rationale use of medicines, in burden of disease estimates, as well as in public health surveillance; especially for detection of emerging epidemics, the identification and monitoring of antimicrobial resistance, and the documentation of infection rates in populations. This article examines how the state of (a) product quality, (b) pricing, and (c) development country manufacturing capacity, are affecting the supply of IVDs in Low-Income Countries (LICs). Data informing this work is derived from interviews with representatives of leading stakeholder organisations working in this space, and analysis of secondary literature. The findings of this analysis are that the supply of IVDs in LICs is undermined by (i) significant variation in product quality; (ii) inconsistent market demand from governments; (iii) limited opportunities for pooled procurement; (iv) a lack of transparency and consistency in product pricing; and (v) insufficient competition among producers capable of innovating for populations with limited purchasing power and low-resource settings. The article then examines four strategies for how these challenges can be overcome.