Does the Vaccine Rollout Ensure Equitable Access?

We wanted to know more about the disparities that have arisen as vaccine rollout campaigns continue, so we spoke with two experts from the Access to Medicine Foundation – Claudia Martinez, Research Programme Manager for the Access to Medicine Index, and Fatema Rafiqi, Research Programme Manager for the Antimicrobial Resistance Benchmark.

What challenges are affecting vaccine rollout?

Fatema Rafiqi: There are several challenges for us to resolve. For example, there are well-documented logistical issues surrounding delivery, transport, and storage, as well as how to organize and staff the drive to administer vaccines to ensure timely, safe and efficient distribution without wastage. Each country, with its own health system and infrastructure, faces a unique set of hurdles. The priority should be to ensure equitable access to COVID-19 vaccines worldwide. Currently, the total demand for vaccines exceeds supply; however, in some high-income countries, the reverse is true, while low- and middle-income countries are reliant on donations and the COVAX program coordinated by the WHO.  

Are initiatives like COVAX enough?

Rafiqi: There are between 2 billion and 5 billion people in low- and middle-income countries who are still awaiting COVID-19 vaccines. So far, COVAX expects to deliver 2 billion doses this year to 190 countries. To be able to close the gap with demand, more manufacturers and more sources of vaccines must be secured, which will require support and action from governments and the industry. There is still untapped manufacturing capacity and opportunities to use licenses, share data and expertise, and partner with manufacturers to increase supply. Achieving global access to COVID-19 vaccines is critical for saving lives, jobs, global economic security, and minimizing the time for mutations to set in and enable the virus to evolve and evade the vaccines.

What can pharma do now?

Claudia Martinez: A core issue highlighted by the pandemic has been the need for expanded capacity for vaccine manufacturing and distribution networks locally, as well as the importance of having robust supply chains to ensure uninterrupted supply. There is huge untapped manufacturing potential in low-and-middle-income countries. Pharmaceutical companies can and should support initiatives aimed at strengthening and building local capacity for the manufacturing of vaccines, and support the deployment of vaccination programs. The 2021 Access to Medicine Index highlights how companies can enter into technology transfer agreements with local manufacturers to expand medicines supply locally, as well as engage in voluntary licensing to enable generic versions of their products to be manufactured (1).  

What role can local manufacturing hubs play in improving access?

Rafiqi: Local manufacturing hubs mean shorter distribution chains for the finished product. They are also able to tap into local knowledge about specific needs and conditions on the ground for transport and storage. And that reduces transport obstacles by making the best use of cold-chain capacity and preventing failures.

How can we best prepare for future pandemics?

Martinez: Action is needed on multiple fronts. The 2021 Access to Medicine Index found that R&D targeting coronaviruses surged in 2020, from zero projects in 2018 to 63 projects, reflecting a clear and vigorous response by pharma to the COVID-19 pandemic. However, a further 15 emerging infectious diseases (EIDs) that pose a risk of a pandemic receive very little R&D attention. But the industry cannot be caught out again with empty pipelines. More R&D needs to go into EIDs. Pharmaceutical companies can also share compound libraries and similar assets for other EIDs so that they can be put to full use preparing for the next pandemic.

When it comes to patents, companies should either proactively engage in voluntary licensing to enable generic manufacturers to boost supply or publicly waive patent rights. We also saw a limited number of companies demonstrate the ability to react to and anticipate supply disruptions. Specialist teams dedicated to ensuring continuous supply in low- and middle-income countries should become standard in pharmaceutical companies’ toolkits against pandemics, and we also need action to improve local availability through capacity building initiatives with local manufacturers.

What other challenges have been highlighted by the pandemic?

Martinez: The pandemic laid bare the global fault lines in our system for developing and delivering vaccines and medicines to our communities. For example, despite significant advances in driving down child mortality rates in recent decades, almost 5.2 million children under five – most of whom are in low- and middle-income countries – still die every year from preventable and treatable diseases. Far too often, the youngest members of society are at the back of the queue when it comes to receiving treatment because of a shortage of appropriate medicines. We just published an analysis of pharma’s efforts to tackle this issue and found that just 7 percent of the pipeline specifically targets children under 12 (2). 

The pandemic must be grasped as a wake-up call for the pharmaceutical industry; though there are medicines for children moving through pipelines, the selection of drugs is limited. We also have to ask ourselves whether they will be accessible to those living in low- and middle-income countries. Pharma must now use its learnings from the pandemic and apply them to ensure consistent medicines access for us all.